P3453Gender difference in impact of ischemic heart disease on long-term outcome in patients with heart failure reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H J Kim ◽  
M A Kim ◽  
D I Lee ◽  
H L Kim ◽  
D J Choi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Survival Rates ◽  
Free Survival ◽  
Reduced Ejection Fraction ◽  
Clinical Events ◽  
Significant Difference ◽  
Patients With Heart Failure

Abstract Background Ischemic heart disease (IHD) is a major underlying etiology in patients with heart failure (HF). Although the impact of IHD on HF is evolving, there is a lack of understanding of how IHD affects long-term clinical outcomes and uncertainty about the role of IHD in determining the risk of clinical outcomes by gender. Purpose This study aims to evaluate the gender difference in impact of IHD on long-term clinical outcomes in patients with heart failure reduced ejection fraction (HFrEF). Methods Study data were obtained from the nationwide registry which is a prospective multicenter cohort and included patients who were hospitalized for HF composed of 3,200 patients. A total of 1,638 patients with HFrEF were classified into gender (women 704 and men 934). The primary outcome was all-cause death during follow-up and the composite clinical events of all-cause death and HF readmission during follow-up were also obtained. HF readmission was defined as re-hospitalization because of HF exacerbation. Results 133 women (18.9%) were died and 168 men (18.0%) were died during follow-up (median 489 days; inter-quartile range, 162–947 days). As underlying cause of HF, IHD did not show significant difference between genders. Women with HFrEF combined with IHD had significantly lower cumulative survival rate than women without IHD at long-term follow-up (74.8% vs. 84.9%, Log Rank p=0.001, Figure 1). However, men with HFrEF combined with IHD had no significant difference in survival rate compared with men without IHD (79.3% vs. 83.8%, Log Rank p=0.067). After adjustment for confounding factors, Cox regression analysis showed that IHD had a 1.43-fold increased risk for all-cause mortality independently only in women. (odds ratio 1.43, 95% confidence interval 1.058–1.929, p=0.020). On the contrary to the death-free survival rates, there were significant differences in composite clinical events-free survival rates between patients with HFrEF combined with IHD and HFrEF without IHD in both genders. Figure 1 Conclusions IHD as predisposing cause of HF was an important risk factor for long-term mortality in women with HFrEF. Clinician need to aware of gender-based characteristics in patients with HF and should manage and monitor them appropriately and gender-specifically. Women with HF caused by IHD also should be treated more meticulously to avoid a poor prognosis. Acknowledgement/Funding None

Telemedicine reduces long term mortality in patients with heart failure with reduced ejection fraction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
G Koulaouzidis ◽  
D Charisopoulou
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Care Quality ◽  
Aldosterone Antagonists ◽  
Reduced Ejection Fraction ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Telemonitoring was introduced with the potential to improve the medical care, quality of life and prognosis of patients with heart failure (HF). The aim of the study was to assess the effect of home telemedicine (HTM) in long-term mortality in patients with heart failure with reduced ejection fraction (HFrEF). Methods This is a retrospective study of 452 consecutive subjects with HFrEF  who were referred to  HTM service. The HTM service was offered to HFrEF patients who: a) have been recently diagnosed with HF, b) have been recently hospitalized due to HF, c) have worsening HF, d) need frequent medication changes, e) are NYHA class II or III. Most patients (n= 352) accepted HTM (HTM-group), but 100 patients refused and received the usual care (UC-group). The HTM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. A nurse practitioner evaluated the measurements every day using a dedicated clinical user interface. Clinical alerts are dealt with by the HTM nurse calling the patient and then, if necessary, a clinical responder; either a community HF nurse with prescribing qualifications or a cardiologist if long-term changes in therapy are required. Patients in both groups were seen at a specialist HF clinic and the frequency of clinical follow-up was at the discretion of the HF team. The same cardiologists reviewed the patients in both groups. Follow-up period was 60 months. Higher prevalence of male gender was seen in the UC-group (78% vs 67%, p = 0.03). Otherwise there was no significant difference in the demographic characteristics or primary cause of HF between the two groups. Also no differences were seen between the two groups in the treatment with beta blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and aldosterone antagonists. Results The mean follow-up period for survivors was significantly higher in HTM-group compared with UC-group (50.6 ± 18.2 vs. 37.8 ± 25.2, p < 0.001). After 3 month of follow-up, the all-cause mortality was significantly lower in HTM-group than in UC-group (2.8% vs. 14%; p <0.01). This significantly lower mortality in HTM-group compared to UC-group was further observed in 6 months follow-up ( 4.5% vs. 22%, p < 0.0009); in 12 months follow-up (9% vs. 31.2%,  p < 0.0002); in 18 months follow-up (13.4% vs. 38.2%, p < 0.0001); in 24 months follow-up (15.1% vs. 42%, p < 0.0001); in 36 months follow-up (19% vs. 44.5%, p < 0.0002); in 48 months follow-up (23% vs. 46%, p < 0.001); and finally in 60 months follow-up (25.3% vs. 46%, p < 0.003). Conclusion HTM was associated with improved survival. This was observed from the first months of the study and remained present until the end of the study.The reduced mortality in the HTM patients may reflect the fact that HTM improves patient HF knowledge and self-care behaviors.

Global regurgitant volume: approaching the critical mass in valvular-driven heart failure

2019 ◽  
Author(s):  
Philipp E Bartko ◽  
Henrike Arfsten ◽  
Gregor Heitzinger ◽  
Noemi Pavo ◽  
Georg Spinka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Critical Mass ◽  
Regurgitant Volume ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Convergence Method ◽  
Flow Convergence ◽  
Increasing Risk

Abstract Aims Recent progress in the diagnosis of functional valve regurgitation forms a coherent perception of severity thresholds by quantitative assessment. However, thresholds focused on either valve in isolation—not accounting for the global haemodynamic burden arising from concomitant functional regurgitation of the mitral and tricuspid valves. We sought to determine whether the global regurgitant volume is associated with adverse cardiac remodelling and mortality. Methods and results This long-term observational study included 414 patients on guideline-directed medical therapy. Baseline global regurgitant load defined as the sum of mitral and tricuspid regurgitant volume was assessed by the proximal flow convergence method. All-cause mortality during 5 years follow-up served as the primary endpoint. The median global regurgitant load was 30 mL (interquartile range 15–49) with 67% accounting for mitral and 33% accounting for tricuspid regurgitant volume. The global regurgitant load had significant impact on outcome with a crude hazard ratio of 1.46 (1.28–1.66; P < 0.001) for a 1-SD increase in global regurgitant volume, results that remained virtually unchanged after bootstrap or clinical confounder-based adjustment (P < 0.001 for adjusted models). Spline curve analysis showed a linearly increasing risk with a threshold of 50 mL and sustained increasing risk thereafter. Conclusions The present study demonstrates the detrimental effect of the global regurgitant load in patients with heart failure with reduced ejection fraction. The threshold where heart failure is driven by the valve lesions is a global regurgitant volume of 50 mL with continuously increasing risk beyond that threshold. Future studies need to address whether an attempt to reduce the global regurgitant volume can improve outcome.

scholarly journals Reverse remodelling of the heart after atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

Kardiologiia ◽  
2019 ◽  
Vol 59 (8S) ◽  
pp. 37-43
Author(s):  
N. Z. Gasimova ◽  
E. N. Mikhaylov ◽  
V. S. Orshanskaya ◽  
A. V. Kamenev ◽  
R. B. Tatarsky ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Reverse Remodeling ◽  
Left Heart ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Aim. To evaluate the effect of atrial fibrillation (AF) catheter ablation (CA) on long-term freedom from AF and left heart reverse remodeling in patients with heart failure with reduced ejection fraction (HFrEF).Methods. There were 47 patients (mean age 53.3 ± 10 years, 39 males) enrolled into single-center observational study, with left ventricular ejection fraction (LVEF) <40 %. Patients underwent CA for AF refractory to antiarrhythmic drugs. Baseline clinical data and diagnostic tests results were obtained during personal visits and / or via secure telemedical services. Personal contact with evaluation of recurrence of AF and echocardiographic values was performed with 30 (64 %) patients.Results. Paroxysmal AF was present in 12 (40 %) patients, persistent – in 18 (60 %). During mean follow-up of 3 years (0.5–6 years) redo ablation was performed in 9 patients (30 %) with average number of 1.3 procedures per patient. At 6 months 24 (80 %) patients were free from AF, at last follow-up – 16 (53 %). The mean time to first recurrence following CA was 15.6±13.3 months. Follow-up echocardiography revealed significant LVEF improvement (р<0,0001), reduction of left atrium size (р<0,0001), left ventricle end-diastolic volume (р<0,002) and left ventricle endsystolic volume (p<0,0001) and mitral regurgitation (р=0,001).Conclusion. AF CA in patients with HFrEF is associated with improvement in systolic function and left heart reverse remodeling. Durable long-term antiarrhythmic effect often requires repeated procedures.

scholarly journals Growth differentiation factor 15 predicts poor prognosis in patients with heart failure and reduced ejection fraction and anemia: results from RED-HF

2021 ◽  
Author(s):  
Thor Ueland ◽  
Lars Gullestad ◽  
Lei Kou ◽  
James B. Young ◽  
Marc A. Pfeffer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Darbepoetin Alfa ◽  
Iron Status ◽  
Baseline Serum ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Moderate Anemia

Abstract Aims We aimed to assess the value of GDF-15, a stress-responsive cytokine, in predicting clinical outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and anemia Methods and results Serum GDF-15 was assessed in 1582 HFrEF and mild-to-moderate anemia patients who where followed for 28 months in the Reduction of Events by Darbepoetin alfa in Heart Failure (RED-HF) trial, an overall neutral RCT evaluating the effect darbepoetin alfa on clinical outcomes in patients with systolic heart failure and mild-to-moderate anemia. Association between baseline and change in GDF-15 during 6 months follow-up and the primary composite outcome of all-cause death or HF hospitalization were evaluated in multivariable Cox-models adjusted for conventional clinical and biochemical risk factors. The adjusted risk for the primary outcome increased with (i) successive tertiles of baseline GDF-15 (tertile 3 HR 1.56 [1.23–1.98] p < 0.001) as well as with (ii) a 15% increase in GDF-15 levels over 6 months of follow-up (HR 1.68 [1.38–2.06] p < 0.001). Addition of change in GDF-15 to the fully adjusted model improved the C-statistics (p < 0.001). No interaction between treatment and baseline or change in GDF-15 on outcome was observed. GDF-15 was inversely associated with several indices of anemia and correlated positively with ferritin. Conclusions In patients with HF and anemia, both higher baseline serum GDF-15 levels and an increase in GDF-15 during follow-up, were associated with worse clinical outcomes. GDF-15 did not identify subgroups of patients who might benefit from correction of anemia but was associated with several indices of anemia and iron status in the HF patients. Graphic abstract

scholarly journals Extramedullary Plasmacytoma: Long-Term Clinical Outcomes in a Single-Center in China and Literature Review

2020 ◽  
pp. 014556132095058
Author(s):  
Xiaoli Zhu ◽  
Li Wang ◽  
Yingying Zhu ◽  
Wenwen Diao ◽  
Wuyi Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Regional Lymph Node ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Extramedullary Plasmacytoma ◽  
Free Survival ◽  
Node Metastasis ◽  
Baseline Characteristics

The aim is to analyze the clinical outcomes of patients with extramedullary plasmacytoma (EMP) and review the characteristics of this disease. We retrospectively reviewed the clinical data of a cohort of 22 patients diagnosed with EMP between 1983 and 2017. Baseline characteristics and progression data were collected to calculate the incidence of progression to multiple myeloma (MM) and to analyze survival rates and outcomes. Previous major cohort studies were reviewed and compared with this study. Extramedullary plasmacytomas were located in the head and neck in 17 (77%) of the 22 patients. The median time between onset and diagnosis was 7 months, and the median age at diagnosis was 52.5 years (range 15-72 years). Extramedullary plasmacytoma occurred more frequently in men with an approximate ratio of 2.1:1. The majority of patients underwent surgery (13/22, 59.1%) and half received radiation (11/22, 50%). A small proportion of patients received chemotherapy (2/22, 9.1%). There was a median follow-up time of 98.5 months. The 5-year overall survival, progression-free survival, and MM-free survival rates were 84.2%, 67.3% and 75.9%, respectively. Complete resection without major functional damage is a promising option that can favorably improve prognosis in patients with resectable disease. Patients with regional lymph node metastasis or positive immunoelectrophoresis results require more aggressive treatment and may have poorer prognosis.

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of &lt;17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P&lt;0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

Association of Body Mass Index With Clinical Outcomes in Patients With Heart Failure With Reduced Ejection Fraction Treated With Sacubitril/Valsartan

2021 ◽  
pp. 107424842110244
Author(s):  
Kazuhiko Kido ◽  
Christopher Bianco ◽  
Marco Caccamo ◽  
Wei Fang ◽  
George Sokos
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Normal Weight ◽  
Reduced Ejection Fraction ◽  
Propensity Score Weighting ◽  
Patients With Heart Failure

Background: Only limited data are available that address the association between body mass index (BMI) and clinical outcomes in patients with heart failure with reduced ejection fraction who are receiving sacubitril/valsartan. Methods: We performed a retrospective multi-center cohort study in which we compared 3 body mass index groups (normal, overweight and obese groups) in patients with heart failure with reduced ejection fraction receiving sacubitril/valsartan. The follow-up period was at least 1 year. Propensity score weighting was performed. The primary outcomes were hospitalization for heart failure and all-cause mortality. Results: Of the 721 patients in the original cohort, propensity score weighting generated a cohort of 540 patients in 3 groups: normal weight (n = 78), overweight (n = 181), and obese (n = 281). All baseline characteristics were well-balanced between 3 groups after propensity score weighting. Among our results, we found no significant differences in hospitalization for heart failure (normal weight versus overweight: average hazard ratio [AHR] 1.29, 95% confidence interval [CI] = 0.76-2.20, P = 0.35; normal weight versus obese: AHR 1.04, 95% CI = 0.63-1.70, P = 0.88; overweight versus obese groups: AHR 0.81, 95% CI = 0.54-1.20, P = 0.29) or all-cause mortality (normal weight versus overweight: AHR 0.99, 95% CI = 0.59-1.67, P = 0.97; normal weight versus obese: AHR 0.87, 95% CI = 0.53-1.42, P = 0.57; overweight versus obese: AHR 0.87, 95% CI = 0.58-1.32, P = 0.52). Conclusion: We identified no significant associations between BMI and clinical outcomes in patients diagnosed with heart failure with a reduced ejection fraction who were treated with sacubitril/valsartan. A large-scale study should be performed to verify these results.

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