Effect of atrial fibrillation on long-term survival in patients hospitalised for heart failure with preserved ejection fraction☆

Background: Long-term survival data on patients with heart failure (HF) in community-based populations are limited. Preserved ejection fraction (PEF) is present in 50-60% of HF patients. We examined whether trends in long-term survival differed between HF patients with preserved (ejection fraction >/= 45) and reduced ejection fraction (REF) in the context of modern treatment. Methods: The Minnesota Heart Survey, a community-based population study conducted in the Minneapolis-St. Paul metropolitan area, abstracted a random sample of hospital records for patients aged 35-84 with a discharge diagnosis of HF in 1995 and 2000. In the absence of a gold standard diagnosis of HF, hospitalization records that met at least four of six published classification algorithm definitions were considered HF related. Mortality was ascertained from medical records and by linkage to death certificates from the Department of Health. Kaplan-Meier was used for unadjusted survival and Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR). Results: In 1995 1269 HF patients (PEF, n = 423; REF, n = 846) and in 2000 1103 HF patients (PEF, n = 413; REF, n = 690) were identified. The prevalence of hypertension, diabetes mellitus and hyperlipidemia were significantly higher in 2000; the utilization of ACE-Inhibitors, beta-blockers and revascularization were also significantly greater in 2000. In 1995, the unadjusted 9-year survival was 21% in REF and 28% in PEF; in 2000 these numbers were 28% in REF and 29% in PEF (Figure). After adjustment for sex and age the HR for 9-year mortality in 1995 was 0.77 (95% CI: 0.68 - 0.89) for HF patients with PEF compared to REF, p = 0.0003; in 2000 the adjusted HR for 9-year mortality in patients with PEF compared to REF was 0.95 (95%CI: 0.82 - 1.10), p = 0.48. Conclusion: Survival after a HF related hospitalization is low with less than 30% of patients surviving nine years. The increased utilization of ACE-Inhibitors and beta-blockers may partially explain the improved survival among HF patients with REF.

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Renal function and long-term survival after hospital discharge in heart failure with preserved ejection fraction

International Journal of Cardiology ◽

10.1016/j.ijcard.2009.09.529 ◽

2011 ◽

Vol 147 (2) ◽

pp. 278-282 ◽

Cited By ~ 35

Author(s):

Dan Rusinaru ◽

Otilia Buiciuc ◽

David Houpe ◽

Christophe Tribouilloy

Keyword(s):

Heart Failure ◽

Renal Function ◽

Ejection Fraction ◽

Hospital Discharge ◽

Preserved Ejection Fraction ◽

Term Survival ◽

Long Term Survival

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Higher cardiorespiratory fitness predicts long-term survival in patients with heart failure and preserved ejection fraction: the Henry Ford Exercise Testing (FIT) Project

Archives of Medical Science ◽

10.5114/aoms.2019.83290 ◽

2019 ◽

Vol 15 (2) ◽

pp. 350-358 ◽

Cited By ~ 2

Author(s):

Olusola A. Orimoloye ◽

Swetha Kambhampati ◽

Albert J. Hicks III ◽

Mahmoud Al Rifai ◽

Michael G. Silverman ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiorespiratory Fitness ◽

Exercise Testing ◽

Preserved Ejection Fraction ◽

Term Survival ◽

Long Term Survival ◽

Patients With Heart Failure ◽

Henry Ford

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Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.119.006798 ◽

2020 ◽

Vol 13 (10) ◽

Cited By ~ 1

Author(s):

Kentaro Kamiya ◽

Yukihito Sato ◽

Tetsuya Takahashi ◽

Miyuki Tsuchihashi-Makaya ◽

Norihiko Kotooka ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Rehabilitation ◽

Preserved Ejection Fraction ◽

Composite Outcome ◽

Term Survival ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Related Quality

Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

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Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

Vascular Medicine ◽

10.1177/1358863x17714153 ◽

2017 ◽

Vol 22 (4) ◽

pp. 307-315 ◽

Cited By ~ 6

Author(s):

Kavita B Khaira ◽

Ellen Brinza ◽

Gagan D Singh ◽

Ezra A Amsterdam ◽

Stephen W Waldo ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Left Ventricular ◽

Term Survival ◽

Long Term Survival ◽

Reduced Ejection Fraction ◽

History Of

The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.

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Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry

European Heart Journal ◽

10.1093/eurheartj/ehy626 ◽

2018 ◽

Vol 39 (48) ◽

pp. 4277-4284 ◽

Cited By ~ 61

Author(s):

Barak Zafrir ◽

Lars H Lund ◽

Cecile Laroche ◽

Frank Ruschitzka ◽

Maria G Crespo-Leiro ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

European Society ◽

Preserved Ejection Fraction ◽

Prognostic Implications ◽

European Society Of Cardiology

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Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm11020288 ◽

2022 ◽

Vol 11 (2) ◽

pp. 288

Author(s):

Emmanuel Androulakis ◽

Catrin Sohrabi ◽

Alexandros Briasoulis ◽

Constantinos Bakogiannis ◽

Bunny Saberwal ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Systematic Review ◽

Ejection Fraction ◽

Control Strategy ◽

Meta Analysis ◽

Rhythm Control ◽

Preserved Ejection Fraction ◽

Patients With Heart Failure

Background: Catheter ablation (CA) for atrial fibrillation (AF) has been proposed as a means of improving outcomes among patients with heart failure and reduced ejection fraction (HFrEF) who are otherwise receiving appropriate treatment. Unlike HFrEF, treatment options are more limited in patients with preserved ejection fraction (HFpEF) and the data pertaining to the management of AF in these patients are controversial. The aim of this systematic review and meta-analysis was to investigate the effects of CA on outcomes of patients with AF and HFpEF, such as functional status, post-procedural complications, hospitalization, morbidity and mortality, based on data from observational studies. Methods: We systematically searched the electronic databases MEDLINE, PUBMED, EMBASE and the Cochrane Library for Central Register of Clinical Trials until May 2020. Results: Overall, the pooling of our data showed that sinus rhythm was achieved long-term in 58.0% (95% CI 0.44–0.71). Long-term AF recurrence was noticed in 22.3% of patients. Admission for HF occurred in 6.2% (95% CI 0.04–0.09) whilst all-cause mortality was identified in 6.3% (95% CI 0.02–0.13). Conclusion: This meta-analysis is the first to focus on determining the benefits of a rhythm control strategy for patients with AF and HFpEF using CA, suggesting it may be worthwhile to investigate the effects of a CA rhythm control strategy as the default treatment of AF in HFpEF patients in randomized trials.

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5951The impact of regulatory T lymphocytes on long-term survival in patients with ischemic heart failure with reduced ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz746.0101 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Sulzgruber ◽

L Koller ◽

S Blum ◽

A Hammer ◽

N Kazem ◽

...

Keyword(s):

Heart Failure ◽

T Lymphocytes ◽

Ejection Fraction ◽

Cellular Immunity ◽

Cardiovascular Mortality ◽

Left Ventricular Ejection ◽

Term Survival ◽

Long Term Survival ◽

Regulatory T Lymphocytes

Abstract Background Heart failure with reduce ejection fraction (HFrEF) constitutes a global health issue representing a prevalent clinical syndrome. While pro-inflammatory cytokines proved to have a pivotal role in the development and progression of HFrEF, less attention has been paid to the cellular immunity. Regulatory T lymphocytes (Tregs) seem to have an important role in the induction and maintenance of immune homeostasis especially in patients after acute coronary syndrome and coronary vessel disease. Therefore, we aimed to investigate the impact of Tregs on the outcome of patients presenting with ischemic HFrEF. Methods We prospectively enrolled 112 patients with HFrEF defined by New York Heart Association (NYHA) functional class >II and left ventricular ejection fraction (LVEF) <40%. Patients were stratified in ischemic (iHFrEF, n=57) and dilated etiology (dHFrEF, n=55). Cells from fresh heparinized blood were stained and analyzed using BD FACS Canto II flow cytometry. Cox regression hazard analysis was used to assess the influence of Tregs on survival. The multivariate model was adjusted forage and gender. Results Comparing patients with iHFrEF to dHFrEF we found a significantly lower fraction of Tregs within lymphocytes in the ischemic subgroup (0.42% vs. 0.56%; p=0.009). After a mean follow-up time of 4.5 years 32 (28.6%) patients died due to cardiovascular causes. We found that Tregs were significantly associated with cardiovascular survival in the entire study cohort with an adjusted HR per one standard deviation (1-SD) of 0.60 (95% CI 0.39–0.92; p=0.017). Interestingly while there was no association with cardiovascular survival independently in the dHFrEFsubgroup (adj. HR per 1-SD of 0.62 (95% CI 0.17–2.31); p=0.486), we found a significant inverse association of Tregs and cardiovascular survival in patients with iHFrEFwith an adj. HR per 1-SD of 0.59 (95% CI 0.36–0.96; p=0.034). Figure 1. Survival Curves of Cardiovascular Mortality. Kaplan-Meier plots showing survival free of cardiovascular mortality in the total study collective (A) and patients stratified in ischemic CMP (B) as well dilative CMP (C) according to tertiles of frequencies of regulatory T cells. Tertile 1 = high; Tertile 2 = mid; Tertile 3 = low. Conclusion Our results indicate a potential influence of Tregs in the pathogenesis and progression of iHFrEF, fostering the implication of cellular immunity in iHFrEF pathophysiology and proving Tregs as a predictor for long-term survival among iHFrEF -patients.

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