PULSE PRESSURE PREDICTS HEART FAILURE IN OLDER PEOPLE

It remains debated whether pulse pressure is associated with left ventricular traits and adverse outcomes over and beyond mean arterial pressure (MAP) in patients with heart failure (HF) with preserved ejection fraction. We investigated these associations in 3428 patients with HF with preserved ejection fraction (51.5% women; mean age, 68.6 years) enrolled in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). We computed association sizes and hazards ratios with 1-SD increase in MAP and pulse pressure. In multivariable-adjusted analyses, association sizes ( P ≤0.039) for MAP were 0.016 cm and 0.014 cm for septal and posterior wall thickness, −0.15 for E/A ratio, −0.66 for E/e′, and −0.64% for ejection fraction, independent of pulse pressure. With adjustment additionally applied for MAP, E/A ratio and longitudinal strain increased with higher pulse pressure with association sizes amounting to 0.067 ( P =0.026) and 0.40% ( P =0.023). In multivariable-adjusted analyses of both placebo and spironolactone groups, lower MAP and higher pulse pressure predicted the primary composite end point ( P ≤0.028) and hospitalized HF ( P ≤0.002), whereas MAP was also significantly associated with total mortality ( P ≤0.007). Sensitivity analyses stratified by sex, median age, and region generated confirmatory results with exception for the association of adverse outcomes with pulse pressure in patients with age ≥69 years. In conclusion, the clinical application of MAP and pulse pressure may refine risk estimates in patients with HF with preserved ejection fraction. This finding may help further investigation for the development of HF with preserved ejection fraction preventive strategies targeting pulsatility and blood pressure control.

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Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.09.187 ◽

2018 ◽

Vol 254 ◽

pp. 203-209 ◽

Cited By ~ 5

Author(s):

Tiew-Hwa Katherine Teng ◽

Wan Ting Tay ◽

Ulf Dahlstrom ◽

Lina Benson ◽

Carolyn S.P. Lam ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Pulse Pressure ◽

Preserved Ejection Fraction

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Women and older people less likely to receive blockers for heart failure, study finds

BMJ ◽

10.1136/bmj.b235 ◽

2009 ◽

Vol 338 (jan27 1) ◽

pp. b235-b235

Author(s):

R. Dobson

Keyword(s):

Heart Failure ◽

Older People ◽

To Receive

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CARMIE

International Journal of E-Health and Medical Communications ◽

10.4018/ijehmc.2017100102 ◽

2017 ◽

Vol 8 (4) ◽

pp. 21-37 ◽

Cited By ~ 4

Author(s):

Joana Lobo ◽

Liliana Ferreira ◽

Aníbal JS Ferreira

Keyword(s):

Heart Failure ◽

Chronic Disease ◽

Speech Recognition ◽

Older People ◽

Home Environment ◽

System Architecture ◽

Usability Study ◽

Conversational Agent ◽

Android Application ◽

Prescribed Medicines

The incidence of chronic diseases is increasing and monitoring patients in a home environment is recommended. Noncompliance with prescribed medication regimens is a concern, especially among older people. Heart failure is a chronic disease that requires patients to follow strict medication plans permanently. With the objective of helping these patients managing information about their medicines and increasing adherence, the personal medication advisor CARMIE was developed as a conversational agent capable of interacting, in Portuguese, with users through spoken natural language. The system architecture is based on a language parser, a dialog manager, and a language generator, integrated with already existing tools for speech recognition and synthesis. All modules work together and interact with the user through an Android application, supporting users to manage information about their prescribed medicines. The authors also present a preliminary usability study and further considerations on CARMIE.

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A3420 Nocturnal pulse pressure was associated with adverse outcomes in heart failure with preserved ejection fraction of clinical scenario 1

Journal of Hypertension ◽

10.1097/01.hjh.0000548595.42163.ae ◽

2018 ◽

Vol 36 ◽

pp. e147

Author(s):

Takahiro Komori ◽

Satoshi Hoshide ◽

Toshinobu Saito ◽

Kazuomi Kario

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Pulse Pressure ◽

Adverse Outcomes ◽

Clinical Scenario ◽

Preserved Ejection Fraction

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Inclusion of Older People Reflective of Real‐World Clinical Practice in Cardiovascular Drug Trials

Journal of the American Heart Association ◽

10.1161/jaha.120.016936 ◽

2020 ◽

Vol 9 (21) ◽

Author(s):

Gillian E. Caughey ◽

Maria C. Inacio ◽

J. Simon Bell ◽

Agnes I. Vitry ◽

Sepehr Shakib

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Clinical Trials ◽

Venous Thromboembolism ◽

Older People ◽

Real World ◽

Product Information ◽

Drug Product ◽

New Drugs ◽

Efficacy And Safety

Background Underrepresentation of older people in clinical trials remains. This study aimed to examine the inclusion of older people and associated safety and efficacy reports from clinical trials of new molecular entities for cardiovascular disease indications since commencement of the US Food and Drug Administration Drug Trial Snapshot (DTS) Program. The DTS provides concise information on participants included in clinical trials supporting US Food and Drug Administration approval of new drugs. Methods and Results A cross‐sectional analysis between January 1, 2015 and April 30, 2019 of DTS data including approval date, indication, number of trials and participants, age distribution, efficacy, and safety statements was conducted. Participation‐to‐prevalence ratio (PPR) was used to describe representation of older participants in trials relative to disease population. Efficacy and safety statements regarding age were compared with drug prescribing information. A total of 72 079 participants from 10 DTS reports were identified and 39 625 (55.0%) were aged ≥65 years old. Overall, 63.6% of cardiovascular disease DTS reports were representative of people aged ≥65 years old for specific cardiovascular disease conditions. Underrepresentation was observed in 4 DTS: 2 for heart failure (PPR 0.48 and 0.62), 1 for pulmonary arterial hypertension (PPR 0.72), and 1 for venous thromboembolism (PPR 0.38). Participants in clinical trials for new drugs for the treatment of atrial fibrillation (PPR 0.99 and 1.21) and hypercholesterolemia (PPR 0.84 and 0.97) were reflective of the older population for these diseases. An increased risk of adverse events in older participants was reported in 40% DTS safety statements but no differences were reported in the drug product information. Conclusions Despite the fact that >60% of cardiovascular disease trial participants for new molecular entities included in the DTS program were representative of the older population in real‐world clinical practice, concerns remain for conditions including heart failure or venous thromboembolism. Drug product information safety statements regarding age differences in adverse events were not reflective of trial findings. An increased directive is needed to facilitate the generation of real‐world evidence and appropriate reporting within drug product information for these potentially at‐risk patient populations.

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