Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge

Abstract Background The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear. OBJECTIVES To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF. Methods We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression. Results HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P<0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p<0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF. Conclusions HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype. Funding Acknowledgement Type of funding source: None

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Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽

10.1136/heartjnl-2017-311857 ◽

2017 ◽

Vol 104 (6) ◽

pp. 487-493 ◽

Cited By ~ 14

Author(s):

Ekrem Yasa ◽

Fabrizio Ricci ◽

Martin Magnusson ◽

Richard Sutton ◽

Sabina Gallina ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Orthostatic Hypotension ◽

Cardiovascular Events ◽

Hospital Admissions ◽

Cox Regression ◽

All Cause Mortality ◽

Unexplained Syncope ◽

The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

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P1885Cha2ds-2vasc score lacks of ability to predict mortality in patients attending the emergency department with atrial fibrillation in the presence of troponin i

European Heart Journal ◽

10.1093/eurheartj/ehz748.0633 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M I Gonzalez Del Hoyo ◽

G Cediel ◽

A Carrasquer ◽

G Bonet ◽

K Vasquez-Nunez ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Emergency Department ◽

Regression Analysis ◽

Troponin I ◽

Cox Regression ◽

Cox Regression Analysis ◽

All Cause Mortality

Abstract Background CHA2DS2-VASc score has been used as a surrogate marker for predicting outcomes beyond thromboembolic risk in patients with atrial fibrillation (AF). Likewise, cardiac troponin I (cTnI) is a predictor of mortality in AF. Purpose This study aimed to investigate the association of cTnI and CHA2DS2-VASc score with long-term prognosis in patients admitted to the emergency department with AF. Methods A retrospective cohort study conducted between January 2012 and December 2013, enrolling patients admitted to the emergency department with AF and having documented cTnI measurements. CHA2DS2-VASc score was estimated. Primary endpoint was 5-year all-cause mortality, readmission for heart failure (HF), readmission for myocardial infarction (MI) and the composite end point of major adverse cardiac events defined as death, readmission for HF or readmission for MI (MACE). Results A total of 578 patients with AF were studied, of whom 252 patients had elevated levels of cTnI (43.6%) and 334 patients had CHA2DS2-VASc score >3 (57.8%). Patients with elevated cTnI tended to be oldercompared with those who did not have cTnI elevation and were more frequently comorbid and of higher ischemic risk, including hypertension, prior MI, prior HF, chronic renal failure and peripheral artery disease. The overall median CHA2DS2-VASc score was higher in those with cTnI elevation compared to those patients elevated cTnI levels (4.2 vs 3.3 points, p<0.001). Main diagnoses at hospital discharge were tachyarrhythmia 30.3%, followed by heart failure 17.7%, respiratory infections 9.5% and acute coronary syndrome 7.3%. At 5-year follow-up, all-cause death was significantly higher for patients with cTnI elevation compared with those who did not have cTnI elevation (56.4% vs. 27%; logrank test p<0.001). Specifically, for readmissions for HF and readmissions for MI there were no differences in between patients with or without cTnI elevation. In addition, MACE was reached in 165 patients (65.5%) with cTnI elevation, compare to 126 patients (38.7%) without cTnI elevation (p<0.001). On multivariable Cox regression analysis, cTnI elevation was an independent predictor of all-cause death (hazard ratio, 1.67, 95% confidence interval [CI]: 1.24–2.26, p=0.001) and of MACE (hazard ratio 1.47, 95% confidence interval 1.15–1.88; P=0.002), but it did not reach statistical significance for readmissions for MI and readmissions for HF. CHA2DS2-VASc score was a predictor on univariate Cox regression analysis for each endpoint, but it did not reach significance on multivariable Cox regression analysis for any endpoint. Conclusions cTnI is independently associated with long-term all-cause mortality in patients attending the emergency department with AF. cTnI compared to CHA2DS2-VASc score is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of patients with atrial fibrillation.

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Readmissions, Death and Its Associated Predictors in Heart Failure With Preserved Versus Reduced Ejection Fraction

Journal of the American Heart Association ◽

10.1161/jaha.121.021414 ◽

2021 ◽

Author(s):

Wan Ting Tay ◽

Tiew‐Hwa Katherine Teng ◽

Oliver Simon ◽

Wouter Ouwerkerk ◽

Jasper Tromp ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Recurrent Events ◽

Cox Regression ◽

Beta Blockers ◽

Unique Identifier ◽

Reduced Ejection Fraction ◽

Asian Patients ◽

All Cause Mortality

Background Data on rehospitalizations for heart failure (HF) in Asia are scarce. We sought to determine the burden and predictors of HF (first and recurrent) rehospitalizations and all‐cause mortality in patients with HF and preserved versus reduced ejection fraction (preserved EF, ≥50%; reduced EF, <40%), in the multinational ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry. Methods and Results Patients with symptomatic (stage C) chronic HF were followed up for death and recurrent HF hospitalizations for 1 year. Predictors of HF hospitalizations or all‐cause mortality were examined with Cox regression for time to first event and other methods for recurrent events analyses. Among 1666 patients with HF with preserved EF (mean age, 68±12 years; 50% women), and 4479 with HF with reduced EF (mean age, 61±13 years; 22% women), there were 642 and 2302 readmissions, with 28% and 45% attributed to HF, respectively. The 1‐year composite event rate for first HF hospitalization or all‐cause death was 11% and 21%, and for total HF hospitalization and all‐cause death was 17.7 and 38.7 per 100 patient‐years in HF with preserved EF and HF with reduced EF, respectively. In HF with preserved EF, consistent independent predictors of these clinical end points included enrollment as an inpatient, Southeast Asian location, and comorbid chronic kidney disease or atrial fibrillation. The same variables were predictive of outcomes in HF with reduced EF except atrial fibrillation, and also included Northeast Asian location, older age, elevated heart rate, decreased systolic blood pressure, diabetes, smoking, and non‐usage of beta blockers. Conclusions One‐year HF rehospitalization and mortality rates were high among Asian patients with HF. Predictors of outcomes identified in this study could aid in risk stratification and timely interventions. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01633398.

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Abstract P088: Perceptions of Alcohol as Heart Healthy: The Health eHeart Study

Circulation ◽

10.1161/circ.131.suppl_1.p088 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Isaac R Whitman ◽

Mark J Pletcher ◽

Eric Vittinghoff ◽

Kourtney E Imburgia ◽

Carol Maguire ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Blood Pressure ◽

Red Wine ◽

Controlled Trials ◽

Cross Sectional ◽

History Of ◽

Sectional Analysis ◽

Influence Behavior

Background: Moderate consumption of alcohol may provide protection against myocardial infarction and mortality, but also likely increases blood pressure and incidence of atrial fibrillation. Despite the absence of rigorous controlled trials on the actual cardiovascular benefits of alcohol, the lay press frequently portrays alcohol as “heart healthy” (HH). No study to date has described individuals’ perceptions regarding the health effects of alcohol, how they gained this perception, nor how that perception may influence behavior. Methods: We performed a cross-sectional analysis of data obtained between March 8, 2013 to September 29, 2014 from consecutive participants enrolled in the Health eHeart Study, a prospective, internet-based cohort study. The characteristics of participants that reported alcohol as HH were determined. Results: A total of 5,417 participants answered questions regarding their perception of alcohol. Thirty percent (n=1,707) viewed alcohol as HH, 39% (n=2,157) viewed it as bad for the heart, and 31% (n=1,718) were unsure. Of those reporting alcohol as HH, 78% cited lay press as a source of their knowledge, 14% cited their doctor, and 92% reported that red wine exclusively was HH. In adjusted analyses, older age, higher education, higher income, and United States residence were associated with a perception of alcohol as HH (Figure). Those with a history of heart failure (HF) were significantly less likely to cite alcohol as HH. Compared to those who did not report alcohol as HH, those who perceived alcohol as HH consumed more alcohol (median 5 drinks per week, IQR 2-8 vs. median 3 drinks, IQR 1-7, p=0.001; adjusted: 10% more alcohol per week, 95% CI 1-20% more, p=0.02). Conclusions: Among more than 5,000 consecutive Health eHeart participants, approximately one third believe alcohol is HH and one third believes it is not. Those who believe alcohol is HH were of higher socioeconomic status, more likely to be American, less likely to have HF, and reported drinking more alcohol.

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Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: insights from the iCOR randomised controlled trial

European Heart Journal ◽

10.1093/eurheartj/ehab724.3099 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Yun Viladomat ◽

C Enjuanes Grau ◽

E Calero Molina ◽

E Hidalgo Quiros ◽

N Jose Bazan ◽

...

Keyword(s):

Heart Failure ◽

Primary Endpoint ◽

Cox Regression ◽

Controlled Trial ◽

Cox Proportional Hazards ◽

P Value ◽

Post Discharge ◽

Secondary Endpoints ◽

Positive Effect

Abstract Background/Introduction The potential impact of telemedicine (TM) in the monitoring of heart failure (HF) patients is still uncertain, largely due to the heterogeneity of the studies published to date. A subgroup of patients in which its key role is particularly uncertain is that of the frailest patients mainly due to TM-based strategies have been often discouraged on the basis of a foreseeable limited benefit in them. Purpose The aim of this study was to define the efficacy of a TM-based managed care solution across different HF patient frailty phenotypes in a cohort of HF patients recruited in a randomized clinical trial (The Insuficiència Cardíaca Optimitzaciό Remota [iCOR] study) evaluating the efficacy of a TM-based management compared to usual care (UC) in the early post-discharge period. Methods Five previously described frailty clusters were analysed. Cox proportional-hazards regression models were used to evaluate the effect of each cluster and group of treatment (and its interaction) on a series of endpoints (the incidence of non-fatal HF events as primary endpoint and all-cause hospitalization, all-cause death and the composite endpoint combining of all-cause death or non-fatal HF events as secondary endpoints). The incidence proportion of the first occurrence of each of the study endpoints was calculated for each study arm and for cluster, and these compared using χ2 tests. Additionally, a survival analysis was conducted using Cox regression to describe the event-free survival experience of the combination of the clusters with each of the 2 treatment groups for the study endpoints evaluated, and p-value was used to compare the different curves. Results The positive effect of TM compared to UC strategy was consistent across all frailty phenotypes (p-value for interaction 0.711). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value=0.016). As shown for the primary endpoint, the positive effect of TM compared to UC strategy was consistent across all frailty phenotypes also for the secondary endpoints (all p-value for interaction >0.05). Likewise, the risk of all-cause hospitalization or the composite end-point of all-cause death or non-fatal HF event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value=0.030 and 0.016 respectively). However, the risk of all-cause death did not differ across subgroup strata (p-value>0.05). Conclusion(s) This study showed that non-invasive TM-based follow-up tools are effective compared to UC in preventing fatal and non-fatal adverse events in the early post-discharge period, regardless of the 5 different frailty phenotypes. Importantly, when comparing TM-based follow-up with UC management in patients belonging to equal frailty cluster, those who were followed-up by eHealth had a considerably lower risk of non-fatal HF events, hospitalization or death. FUNDunding Acknowledgement Type of funding sources: None. Cox regression non-fatal HF events Cox regression all-cause hospitalization

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Renin–angiotensin system inhibitors and clinical outcomes in patients with atrial fibrillation and heart failure: a propensity score-matched study from the Chinese Atrial Fibrillation Registry

Journal of International Medical Research ◽

10.1177/03000605211041439 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052110414

Author(s):

Jing Lin ◽

Liu He ◽

Qing Qiao ◽

Xin Du ◽

Chang-Sheng Ma ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Sensitivity Analysis ◽

Propensity Score ◽

Cox Regression ◽

Renin Angiotensin System ◽

Angiotensin System ◽

Renin Angiotensin ◽

All Cause Mortality ◽

Β Blocker

Objective The effect of renin–angiotensin system inhibitors (RASIs) in patients with heart failure (HF) and atrial fibrillation (AF) remains unclear. This study aimed to investigate associations between RASI use and all-cause mortality and cardiovascular outcomes in patients with AF and HF. Methods Using data from the China Atrial Fibrillation Registry study, we included 938 patients with AF and HF with a left ventricular ejection fraction <50%. Cox regression models for RASIs vs. non-RASIs with all-cause mortality as the primary outcome were fitted in a 1:1 propensity score-matched cohort. A sensitivity analysis was performed by using a multivariable time-dependent Cox regression model. As an internal control, we assessed the relation between β-blocker use and all-cause mortality. Results During a mean follow-up of 35 months, the risk of all-cause mortality was similar in RASI users compared with non-users (hazard ratio: 0.92; 95% confidence interval: 0.67–1.26). Similar results were obtained in the sensitivity analysis. In contrast, β-blocker use was associated with significantly lower all-cause mortality in the same population. Conclusions RASI use was not associated with better outcomes in patients with AF and HF in this prospective cohort, which raises questions about their value in this specific subset. Trail Registration: ChiCTR-OCH-13003729.

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Prognostic Value of Emerging Neurohormones in Chronic Heart Failure during Optimization of Heart Failure–Specific Therapy

Clinical Chemistry ◽

10.1373/clinchem.2009.125856 ◽

2010 ◽

Vol 56 (1) ◽

pp. 121-126 ◽

Cited By ~ 32

Author(s):

Stephanie Neuhold ◽

Martin Huelsmann ◽

Guido Strunk ◽

Joachim Struck ◽

Christopher Adlbrecht ◽

...

Keyword(s):

Heart Failure ◽

Natriuretic Peptide ◽

Primary Endpoint ◽

Cox Regression ◽

Specific Therapy ◽

Cox Regression Analysis ◽

Endothelin 1 ◽

All Cause Mortality ◽

Serial Measurements

Abstract Background: Serial measurements of neurohormones have been shown to improve prognostication in the setting of acute heart failure (HF) or chronic HF without therapeutic intervention. We investigated the prognostic role of serial measurements of emerging neurohormones and BNP in a cohort of chronic HF patients undergoing increases in HF-specific therapy. Methods: In this prospective study we included 181 patients with chronic systolic HF after an episode of hospitalization for worsening HF. Subsequently, HF therapy was gradually increased in the outpatient setting until optimized. We measured copeptin, midregional proadrenomedullin, C-terminal endothelin-1 precursor fragment, midregional proatrial natriuretic peptide, and B-type natriuretic peptide before and after optimization of HF therapy. The primary endpoint was all-cause mortality at 24 months. Results: Angiotensin-converting enzyme/angiotensin receptor blocker and β-blockers were increased significantly during the 3-month titration period (P < 0.0001 for both). In a stepwise Cox regression analysis adjusted for age, sex, glomerular filtration rate, diabetes mellitus, and ischemic HF, baseline and follow-up neurohormone concentrations were predictors of the primary endpoint as follows (baseline hazard ratios): copeptin 1.92, 95% CI 1.233–3.007, P = 0.004; midregional proadrenomedullin 2.79, 95% CI 1.297–5.995, P = 0.009; midregional proatrial natriuretic peptide 2.05, 95% CI 1.136–3.686, P = 0.017; C-terminal endothelin-1 precursor fragment 2.24, 95% CI 1.133–4.425, P = 0.025; B-type natriuretic peptide 1.46, 95% CI 1.039–2.050, P = 0.029. Conclusions: In pharmacologically unstable chronic HF patients, baseline values and follow-up measures of copeptin, midregional proadrenomedullin, C-terminal endothelin-1 precursor fragment, midregional proatrial natriuretic peptide, and B-type natriuretic peptide were equally predictive of all-cause mortality. Relative change of neurohormone values was noncontributory.

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P252 Identifying predictors for all-cause mortality at admission, 1 and 3 years after admission for acute decompensated heart failure amongst patients with atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehz872.080 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

H B Koh ◽

S S Lim ◽

J Jaafar ◽

M A Sulong ◽

I S Sabian ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Multivariate Analysis ◽

Cox Regression ◽

Enzyme Inhibitor ◽

Acute Decompensated Heart Failure ◽

Inpatient Mortality ◽

Mineralocorticoid Receptor Antagonist ◽

All Cause Mortality ◽

Acute Decompensation

Abstract Background Heart failure (HF) and atrial fibrillation (AF) commonly co-exist, each, predisposing the other. AF may inflict haemodynamic disturbances, leading to reduced cardiac output and hence acute decompensation. Ultimately mortality risk is further increased. Identifying contributing factors is thus vital lest increasing risk of poor outcome. Purpose Identify predictors of all-cause mortality in AF patients after admission for acute decompensation HF (ADHF) at admission, 1 and 3 years. Methods A retrospective observational study of 810 AF patients" first admission from 2009 to 2018, analysed using descriptive, ROC curve and Cox regression. Results Mortality at admission, 1 and 3 years following ADHF were 5.1%, 14.4% and 40.5% respectively. Majority of AF patients were male (64.7%) but there was no significant statistical difference between gender with associated mortality during those timelines. Using multivariate analysis, predictors associated with increased in-hospital mortality were Hyponatraemia, Na < 135mmol/L (adjusted Odds Ratio, aOR 2.49; 95% Confidence Interval, CI 1.91-5.20; p0.015), Uric Acid ≥ 675 (aOR 2.75; CI 1.31-5.79; p0.008), Ejection Fraction, EF < 40% (aOR 3.93; CI 1.63-9.49; p0.002). Medications on admission associated with reduced inpatient mortality were Angiotensin Converting Enzyme inhibitor (ACEi) / Angiotensin Receptor Blocker (ARB) + Beta Blocker (BB) + Mineralocorticoid Receptor Antagonist (MRA) (aOR 0.07; CI 0.02-0.30; p < 0.001). At 1 year, multivariate analysis showed an associated increase in mortality when NTProBNP ≥ 7500pg/ml (adjusted Hazard Ratio, aHR 1.64; CI 1.02-2.65; p0.042) and Urea > 7mmol/L (aHR 1.86; CI 1.04-3.32, p0.036). Medications on discharge comprising ACEi/ARB + BB + MRA were the only combination that showed a reduction in mortality (aHR 0.23; CI 0.09-0.60; p0.003). At 3 years, background coronary artery disease (aHR 1.72; CI 1.09-2.71; p0.02), hypernatraemia, Na > 145mmol/L (aHR 14.89; CI 3.17-69.86; p0.001), EF < 40% (aHR 2.00; CI 1.28-3.12; p0.002) were associated with increased mortality. Medications on discharge namely ACEi/ARB (aHR 0.14; CI 0.03-0.70; p0.013), BB (aHR 0.23; CI 0.10-0.51; p < 0.001), ACEi/ARB + BB (aHR 0.16; CI0.06-0.41; p < 0.001), ACEi/ARB + MRA (aHR 0.34; CI 0.14-0.85; p0.021), BB + MRA (aHR 0.38; CI 0.17-0.83; p0.016), ACEi/ARB + BB + MRA (aHR 0.193; CI 0.09-0.43; p < 0.001) showed an associated reduction in mortality. Conclusions In this single centre study, patients with AF who presented with ADHF had a variety of mortality predictors that influence at different timelines. They had higher risk of inpatient mortality with hyponatraemia, hyperuricaemia and EF < 40%. Elevated NTProBNP and Urea levels seemed to have more effect on mortality at 1 year compared to 3 years. Having 3 disease-modifying heart failure medications at discharge exerted the most benefit up to 3 years of follow up. Abstract P252 Figure.

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Complications and prognosis of patients undergoing apical or septal right ventricular pacing

Open Heart ◽

10.1136/openhrt-2018-000962 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000962 ◽

Cited By ~ 1

Author(s):

Nick B Spath ◽

Kelvin Wang ◽

Sowmya Venkatasumbramanian ◽

Omar Fersia ◽

David E Newby ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Clinical Outcomes ◽

Primary Endpoint ◽

Complication Rates ◽

Lead Placement ◽

Ventricular Lead ◽

All Cause Mortality ◽

Secondary Endpoints

ObjectivesOptimal right ventricular lead placement remains controversial. Large studies investigating the safety and long-term prognosis of apical and septal right ventricular lead placement have been lacking.MethodsConsecutive patients undergoing pacemaker insertion for high-degree atrioventricular block at Edinburgh Heart Centre were investigated. Periprocedural 30-day complications were defined (infection/bleeding/pneumothorax/tamponade/lead displacement). Long-term clinical outcomes were obtained from the General Register of Scotland and electronic medical records. The primary endpoint was a composite of all-cause mortality, new heart failure, hospitalisation for a major cardiovascular event, as per the CArdiac REsynchronization in Heart Failure trial. Secondary endpoints were all-cause mortality, new heart failure and their composite.Results820 patients were included, 204 (25%) paced from the septum and 616 (75%) from the apex. All baseline variables were similar with the exception of age (septal: 73.2±1.1 vs apical: 76.9±0.5 years, p<0.001). Procedure duration (58±23 vs 55±25 min, p=0.3), complication rates (18 (8.8) vs 46 (7.5)%, p=0.5) and postimplant QRS duration (152 (23) vs 154 (27) ms, p=0.4) were similar. After 1041 days (IQR 564), 278 patients met the primary endpoint, with no difference between the septal and apical groups in unadjusted (HR 0.86 (95% CIs 0.64 to 1.15)) or multivariable analysis correcting for age, gender and comorbidity (HR 0.97 (95% CI 0.72 to 1.30)). Similarly, no differences were observed in the secondary endpoints.ConclusionsThis large real-world cohort of patients undergoing right ventricular lead placement in the septum or apex demonstrated no difference in procedural complications nor long-term clinical outcomes. Both pacing strategies appear reasonable in routine practice.

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Cardiovascular Outcome in Patients Treated With SGLT2 Inhibitors for Heart Failure: A Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.691907 ◽

2021 ◽

Vol 8 ◽

Author(s):

Gloria M. Gager ◽

Georg Gelbenegger ◽

Bernd Jilma ◽

Dirk von Lewinski ◽

Harald Sourij ◽

...

Keyword(s):

Heart Failure ◽

Primary Endpoint ◽

Meta Analysis ◽

Sglt2 Inhibitor ◽

Sglt2 Inhibitors ◽

Treatment And Prevention ◽

Efficacy Outcome ◽

All Cause Mortality ◽

The Status ◽

Secondary Endpoints

Background: Sodium–glucose co-transporter 2 (SGLT2) inhibitors are an emerging class of glucose-lowering drugs that have become increasingly relevant for the treatment and prevention of heart failure (HF). Therefore, we aimed to investigate various SGLT2 inhibitors in patients with established HF at baseline and focused on the different types of HF.Methods: An extensive search of PubMed and Web of Science until January 2021 was done. Two reviewers, independently and in duplicate, applied the selection criteria. This meta-analysis was conducted according to the PRISMA guidelines. Data were pooled using a random-effects model. Randomized controlled trials (RCTs) of SGLT2 inhibitors vs. a comparator in patients with HF reporting clinical outcomes were included. The primary efficacy outcome was the composite of hospitalization for HF (HHF) or cardiovascular (CV) mortality. All-cause mortality, CV mortality, and HHF were considered as secondary endpoints. Subgroup analyses involving the status of diabetes, type of HF, administered type of SGLT2 inhibitor, sex, age, body mass index (BMI), estimated glomerular filtration rate (eGFR), cause of HF, and concomitant medication were performed.Results: Seventeen RCTs, comprising a total of 20,749 participants, were included (n = 10,848 treated with SGLT2 inhibitors and n = 9,901 treated with a comparator). Treatment with SGLT2 inhibitors in a HF population was associated with a 27% relative risk reduction (RRR) of HHF or CV mortality [risk ratio (RR) = 0.73, 95% CI = 0.68–0.78], 32% RRR of HHF (RR = 0.68, 95% CI = 0.62–074), 18% RRR of CV mortality (RR = 0.82, 95% CI = 0.73–0.91), and 17% RRR of all-cause mortality (RR = 0.83, 95% CI = 0.75–0.91). The effect of SGLT2 inhibitors on the primary endpoint was consistent among the different gliflozines. The effect of SGLT2 inhibitors on the primary endpoint was independent of underlying diabetes mellitus, age, sex, BMI, renal function, and HF type.Conclusions: SGLT2 inhibitors are associated with improved CV outcomes in patients with HF.

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