The association of ischaemic stroke in patients with heart failure without atrial flutter/fibrillation

PurposeThis study evaluated the association between ischaemic stroke (IS) and heart failure (HF) in the absence of atrial fibrillation (AF) or atrial flutter (AFL) using a population-based nation-wide cohort database.MethodNewly diagnosed patients with HF without previous stroke and acute myocardial infarction (AMI) were enrolled. Based on the propensity scores matching age, sex and all comorbidities, our studies comprised 12 179 patients with HF and 12 179 patients without HF. Cox proportion hazard regression models and competing-risk regression models were used to evaluate the risk of IS among patients with HF without AF or AFL.ResultsIn the multivariable analysis, older age (adjusted HR (95% CI)=1.05 (1.04 to 1.05)), male sex (adjusted HR (95% CI)=1.36 (1.24 to 1.50)), diabetes (adjusted HR (95% CI)=2.22 (1.97 to 2.49)) and hypertension (adjusted HR (95% CI)=1.60 (1.41 to 1.82)) were markedly associated with IS in patients with HF. The HF group had a markedly higher risk of IS than did the non-HF group (subdistribution HR (SHR)=1.51, 95% CI: 1.37 to 1.66) and AMI (SHR=3.40, 95% CI: 2.71 to 4.28). Additionally, according to the Kaplan-Meier analysis, patients with HF were at a significantly higher risk of cumulative incidence of IS and AMI than did patients with non-HF (p value of log-rank test <0.001).ConclusionThis study indicated that HF is a strong independent risk factor for IS, even in the absence of AF or AFL. Clinical physicians should investigate IS through routine screening and careful monitoring of patients with HF.

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Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.026 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Galli ◽

Y Bouali ◽

A Gallard ◽

A Hubert ◽

C Leclercq ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Multivariable Analysis ◽

Rank Test ◽

P Value ◽

Reduced Ejection Fraction ◽

Funding Sources ◽

Increase Risk ◽

Echocardiographic Examination ◽

Constructive Work

Abstract Funding Acknowledgements Type of funding sources: None. Background the non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs). Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients. Methods 79 patients with HFrEF (mean age: 66 ± 12 years; LV ejection fraction: 28 ± 9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Results Sacubitril/Valsartan significantly increased myocardial constructive work (CW) (1023 ± 449 vs 1424 ± 484 mmHg%, p < 0.0001) and myocardial work efficiency (WE) [87 (78-90) vs 90 (86-95), p < 0.0001]. During FU (2.6 ± 0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, global myocardial constructive work (CW) was the only predictor of MACEs [HR 0.99 (0.99-1.00), p = 0.05]. (Table 1). A CW < 910 mmHg (AUC = 0.81, p < 0.0001, Figure 1, left panel) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45-98.94), p = 0.002, log-rank test p < 0.0001] (Figure 2, Right panel). Conclusions in patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs. Univariable analysis Multivariable analysis HR (95% CI) p-value HR (95% CI) p-value Age, per year 0.99 (0.95-1.04) 0.81 Ischemic cardiomyopathy 1.07 (0.36-3.21) 0.89 LVEDVi*, per ml/m2 1.01 (1.00-1.03) 0.03 LVESVi, per ml/m2 1.01 (1.00-1.03) 0.009 1.01 (0.99-1.02) 0.35 LVEF, per % 0.91 (0.85-0.98) 0.01 1.02 (0.93-1.12) 0.71 CW, per mmHg% 0.99 (0.99-1.00) 0.002 0.99 (0.99-1.00) 0.04 WE, per mmHg% 0.91 (0.86-0.96) 0.001 0.95 (0.88-1.02) 0.16 Predictors of MACEs at univariable and multivariable analysis Abstract Figure 1 A and B

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Outcome of Adolescents and Young Adults with Acute Myeloid Leukemia (AML) As Compared to Pediatric AML Patients: Real World Data from SEER Registry

Blood ◽

10.1182/blood.v126.23.4484.4484 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4484-4484

Author(s):

Smith Giri ◽

Nunnery Sara ◽

Syed S. Nasir ◽

Michael G Martin

Keyword(s):

Overall Survival ◽

Pediatric Patients ◽

Survival Curve ◽

Population Based ◽

Early Mortality ◽

Rank Test ◽

P Value ◽

Log Rank Test ◽

Kaplan Meier ◽

Significant Difference

Abstract Background: Limited data exists regarding the characteristics and outcomes of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) which are largely under-represented in both pediatric and adult trials. We sought to compare the characteristics and outcomes of AYAs with AML using a large population based registry in the United States. Methods: We utilized Surveillance Epidemiology and End Results (SEER)-18 registry to identify all pediatric (0-18 years) and AYA (age 19-30 years) patients diagnosed with AML using appropriate histology codes based on the International Classification of Diseases for Oncology, 3rd version. Patients with acute promyelocytic leukemia (APL) were excluded from all analysis. Survival statistics were computed for each group using actuarial (Kaplan-Meier method) and compared using Z test for comparison of population proportions. Early mortality, defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment related mortality. Kaplan Meier survival curves were plotted and compared using log-rank test. Multivariate analysis was done using logistic regression and Cox proportional hazard regression model. All p values were two sided and the level of significance was chosen at 0.05. Results: A total of 6343 eligible patients were identified, which comprised 2836 (44.7%) AYAs. A total of 52% (n=3346) were males, whereas 76%(n=4825) were whites. Histologically, majority of patients (56%; n=3545) were categorized as AML, not otherwise specified, followed by acute monocytic leukemia (9.9%, n=630). Majority (55%; n-3509) of the patients were diagnosed between 2001-2012. The early mortality rate was lower in the pediatric AML patients (pAML) as compared to AYAs (6.2% vs 9.2%; p<0.01). Similarly the 1 year (70.3% versus 62.1%; p <0.01) and 5 year (48.2% vs 36.4%; p<0.01) was higher in pediatric patients as compared to AYAs. Kaplan Meier plot showed worse overall survival of AYAs compared to pAMLs (Figure 1; p value of log rank <0.01). Multivariate logistic regression showed higher early mortality among AYAs as compared to pAML patients (OR 1.48; 95% CI 1.23-1.79; p<0.01). Similarly Cox regression showed worse overall survival among AYAs as compared to pAML (HR 1.34; 95% CI 1.26-1.44; p <0.01) Conclusions: Our population based analysis shows worse overall survival among AYAs as compared to pAML patients. Future clinical trials specifically focused on this age group are warranted to establish appropriate treatment regimens in this population. Figure 1. Kaplan Meier Survival curve showing cumulative survival among pediatric patients with AML as compared to AYAs. Log rank test showed statistically significant difference between the two curves (p value <0.01) Figure 1. Kaplan Meier Survival curve showing cumulative survival among pediatric patients with AML as compared to AYAs. Log rank test showed statistically significant difference between the two curves (p value <0.01) Disclosures No relevant conflicts of interest to declare.

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The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

Journal of Cancer Science and Therapeutics ◽

10.36879/jcst.19.000109 ◽

2019 ◽

pp. 1-5

Keyword(s):

Decision Making ◽

Logistic Regression ◽

Skin Necrosis ◽

Regression Models ◽

Multivariable Analysis ◽

P Value ◽

Flap Necrosis ◽

Single Institution ◽

Logistic Regression Models ◽

The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

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The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

Acta Haematologica ◽

10.1159/000514920 ◽

2021 ◽

pp. 1-9

Author(s):

Leonard Naymagon ◽

Douglas Tremblay ◽

John Mascarenhas

Keyword(s):

Hemophagocytic Lymphohistiocytosis ◽

Proportional Hazards ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Rank Test ◽

Kaplan Meier ◽

Hazard Ratios ◽

Significant Difference ◽

The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

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Abstract 13: Sex Differences in Mortality Among Patients With Covid-19 Related Stroke

Stroke ◽

10.1161/str.52.suppl_1.13 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Farhaan S Vahidy ◽

Jennifer Meeks ◽

Alan Pan ◽

Thomas Potter ◽

Osman Khan ◽

...

Keyword(s):

Sex Differences ◽

Sensitivity Analyses ◽

Rank Test ◽

P Value ◽

Matched Sample ◽

Healthcare Organizations ◽

Time To Death ◽

Kaplan Meier ◽

Laboratory Confirmation ◽

Icd 10

Introduction: Overall poor COVID-19 outcomes have been reported among males. We evaluated sex differences in mortality among patients with stroke related to COVID-19. Methods: Utilizing pooled deidentified data from 30 healthcare organizations, we identified COVID-19 patients via ICD-10 diagnosis or documented laboratory confirmation of SARS-CoV-2 RNA or antibodies. Patients with ICD-10 diagnoses of ischemic stroke or intracerebral hemorrhage within 30 days before or after the COVID-19 event were flagged. Male and female patients were propensity score (PS) matched on other demographic and comorbidity variables. Risk Ratio (RR) and 95% Confidence Interval (CI) for association between sex and 90-day mortality is reported. Kaplan-Meier analyses with log rank test (LRT) were conducted for time-to-death. As a sensitivity analysis, we only included a smaller sub-set with first instance of IS or ICH ± 30-days of COVID-19 diagnosis. Results: Among 149,410 COVID-19 patients, 1,618 (1.1%) had a stroke diagnosis ± 30-days of confirmed COVID-19. Of whom, 1,609 patients (847 males and 762 females) were included in primary analyses. Females were older (67.7 vs. 65.7 years) and were more likely to be of black race (34.1% vs. 27.6%). Females had a significantly higher proportion of chronic pulmonary disease (38.8% vs. 28.8%) and obesity (34.2% vs. 24.8%); whereas males had higher proportion of alcohol abuse (8.5% vs. 3.8%). A 1:1 PS algorithm yielded an optimally matched sample of 634 males and females each, balanced on all covariates. In the matched sample, 11.7% of females and 15.8% of males experienced 90-day mortality; RR (CI): 1.35 (1.02 - 1.78), LRT p value 0.04. Higher risk of 90-day mortality among males with COVID-19 and stroke was maintained in the sensitivity analyses, RR (CI): 1.47 (1.06 - 2.00), LRT p value = 0.03 (graphic). Conclusion: Future studies examining the socio-demographic and biological mechanisms for poor stroke outcomes among males with COVID-19 are needed.

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HUBUNGAN SELF CARE DENGAN KUALITAS HIDUP PASIEN GAGAL JANTUNG DI RSD MANGUSADA

Care Jurnal Ilmiah Ilmu Kesehatan ◽

10.33366/jc.v8i1.1326 ◽

2020 ◽

Vol 8 (1) ◽

pp. 39

Author(s):

Ida Ayu Agung Laksmi ◽

Made Ani Suprapta ◽

Ni Wayan Surinten

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Functional Status ◽

Service Providers ◽

Self Care ◽

Rank Test ◽

Average Score ◽

P Value ◽

Heart Failure Patients

Long term of heart failure symptoms will affect the patient functional status and ability to do self-care appropriately. Decreasing functional status and self-care ability will certainly affect the quality of life of patients. This study aimed to determine the relationship of self-care with the quality of life of heart failure patients that undergoing treatment at Heart Polyclinic of Mangusada Hospital. The research design was descriptive correlational using cross sectional approach. The study was conducted in January-February 2019. Total respondent participated were 61 respondents and were taken using a purposive sampling technique. Self care of heart index (SCHFI) questionnaire and the Minnesota Living With Heart Failure Questionnaire (MLHFQ) were used. The results showed that the average of self-care score was 45.25 and the average score of the quality of life was 60.67. Analysis using the Spearman Rank test obtained p-value = 0,000 and r = 0.506. It can be concluded that self care had a significant correlation on quality of life patients with heart failure in Mangusada Hospital. We recommended that nursing service providers play an active role in providing education and motivation to heart failure patients to improve self-care abilities.

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Abstract 16663: Premature Ventricular Contractions and Incident Heart Failure: Identifying Risk Factors via Interaction Analyses

Circulation ◽

10.1161/circ.132.suppl_3.16663 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Vratika Agarwal ◽

Eric Vittinghoff ◽

Isaac R Whitman ◽

Thomas A Dewland ◽

Jonathan Dukes ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Case Reports ◽

Large Population ◽

Premature Ventricular Contraction ◽

Fold Increase ◽

Population Based ◽

P Value ◽

Premature Ventricular Contractions ◽

Younger Patients

Introduction: Premature ventricular contraction (PVC)-induced cardiomyopathy is a potentially reversible cause of heart failure (HF). The association between PVCs and HF has been limited to case reports and small observational studies. Our objective was to leverage a large population-based database to examine interactions that might prove clinically useful in risk stratification. Methods: We included adult patients free of structural heart disease in the California Healthcare Cost and Utilization Project (HCUP) database from 2005-2009. After excluding patients with prevalent cardiomyopathy or heart failure, we identified patients with a diagnosis of PVCs. The primary outcome was incident systolic HF. Results: Among 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2%) had a PVC diagnosis, and 198,818 (1.2%) developed systolic HF during study follow-up. After adjustment for age, sex, race, income & known HF risk factors, PVCs were an independent predictor of systolic HF [Hazard Ratio (HR) 1.57, 95% CI 1.51-1.63, p-value<0.001]. Interaction analyses revealed that relationship between PVCs and incident systolic HF was especially strong among younger patients and in those without coronary artery disease (CAD), hypertension (HTN), diabetes mellitus (DM) or atrial fibrillation (AF) [Table 1]. In patients <65 years without HTN, DM, CAD or AF, a PVC diagnosis was associated with an over 6-fold increase in incident HF risk (HR 6.5, 95% CI 5.5-7.7, p<0.001). Conclusion: Using a large population-based database, we found that a diagnosis of PVCs predicts incident systolic HF even after adjusting for conventional risk factors. This effect is most pronounced in younger patients, and those without HTN, DM, CAD or AF, suggesting that PVCs impart the greatest risk for heart failure when other cardiac comorbidities are absent.

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A New Biomarker Tool for Risk Stratification in “De Novo” Acute Heart Failure (OROME)

10.21203/rs.3.rs-154510/v1 ◽

2021 ◽

Author(s):

Rosa Agra Bermejo ◽

Carla Cacho-Antonio ◽

Eva Gonzalez-Babarro ◽

Adriana Rozados-Luis ◽

Marinela Couselo-Seijas ◽

...

Keyword(s):

Heart Failure ◽

Predictive Model ◽

De Novo ◽

Acute Phase Reactant ◽

Rank Test ◽

Post Discharge ◽

Kaplan Meier ◽

Acute Phase Reactant Protein ◽

Severity Of The Disease

Abstract Background: Inflammation is one of the mechanisms involved on heart failure (HF) pathophysiology. Thus, the acute phase reactant protein, orosomucoid, was associated with a worse post-discharge prognosis in de novo acute HF (AHF). However, the presence of anti-inflammatory adipokine, omentin, might protect and reduce the severity of the disease. We wanted to evaluate the value of omentin and orosomucoid combination for stratifying risk of these patients.Methods and Results: Two independent cohorts of patients admitted for de novo AHF in two centers were included in the study (n=218). Orosomucoid and omentin circulating levels were determined by ELISA at discharge. Patients were follow-up for 317 (3-575) days. A predictive model was determined for primary endpoint, death and/or HF readmission. Differences in survival were evaluated using a Log-rank test. According cut-off values of orosomucoid and omentin, patients were classified on UpDown (high orosomucoid and low omentin levels), equal (both proteins high or low) and DownUp (low orosomucoid and high omentin levels). The Kaplan Meier determined worse prognosis for the UpDown group (Long-rank test p=0.02). The predictive model that includes the combination of orosomucoid and omentin groups (OROME) + NT-proBNP values achieved a higher C-index=0.84 than the predictive model with NT-proBNP (C-index=0.80) or OROME (C-index=0.79) or orosomucoid alone (C-index=0.80). Conclusions: The orosomucoid and omentin determination stratifies de novo AHF patients in high, mild and low risk of rehospitalization and/or death for HF. Its combination with NT-proBNP improves its predictive value in this group of patients.

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Abstract 16539: Heart Failure With Mid-Range or Improved Ejection Fraction Improves Cardiovascular Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.16539 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Matthew Cefalu ◽

Jasneet Devgun ◽

Samuel Kennedy ◽

Jeremy Slivnick ◽

Zachary Garrett ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Multivariable Analysis ◽

Cardiovascular Outcomes ◽

Rank Test ◽

Prior History ◽

Reduced Ejection Fraction ◽

Log Rank Test ◽

History Of ◽

The Ohio State University

Heart failure with improved ejection fraction (HFiEF) is a unique and developing clinical entity among the heart failure (HF) spectrum. Prior studies suggest the characteristics, therapy, and prognosis of HFiEF are distinctive from HF with reduced ejection fraction (HFrEF) or mid-range ejection fraction (HFmrEF). We hypothesized that patients diagnosed with acute HF who later progressed to HFiEF would have improved cardiovascular outcomes compared to HFrEF. Our retrospective study included 295 adult patients with no prior history of HF at The Ohio State University diagnosed with acute HF. We defined HFrEF as a persistent ejection fraction < 40%, HFmrEF as persistent ejection fraction 40-49%, and HFiEF as improvement from baseline ejection fraction by > 5%. Nearly 74% of patients were found to have HFiEF while 12% and 14% were classified as HFrEF and HFmrEF respectively. Using a log-rank test, the time to first cardiovascular rehospitalization was significantly longer in HFiEF compared to HFrEF or HFmrEF (p=0.0192, Figure 1). Multivariable analysis, controlled for age and gender, indicated HFiEF had a trend towards significance as an independent predictor for time to cardiovascular hospitalization (p=0.053). Notably amyloid HF, valvular HF, and ischemic HF were all significant independent predictors. Survival analysis demonstrated that HFmrEF had significantly longer survival on log-rank test compared to HFrEF (p=0.0367). Multivariable analysis shows significantly lower hazard of mortality for those with HFmrEF (HR 0.57, 95% CI [0.36-0.92], p=0.017). Our exciting data indicates the progression to HFiEF after the diagnosis of acute HF is associated with reduced cardiovascular rehospitalization, and HFmrEF is associated with increased survival. These data have implications in patient surveillance and risk stratification as well as defining the natural history of HFiEF and HFmrEF as unique entities.

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Abstract 16571: The Potential Impact of Expanding Cardiac Rehabilitation Coverage in Heart Failure: Insights From Get With the Guidelines Heart Failure

Circulation ◽

10.1161/circ.132.suppl_3.16571 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jacob P Kelly ◽

Brad G Hammill ◽

Jacob A Doll ◽

G. Michael Felker ◽

Paul A Heidenreich ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Rehabilitation ◽

Adverse Outcomes ◽

P Value ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Cox Proportional Hazard Models ◽

Expanded Criteria ◽

Get With The Guidelines

Background: In February 2014, coverage for cardiac rehabilitation (CR) was expanded by Centers for Medicare & Medicaid to include patients with chronic symptomatic heart failure (HF) on optimal medical therapy with ejection fraction <35%. Thus, we sought to characterize the patient population newly eligible for CR based on the expanded criteria and their associated outcomes. Methods: We analyzed the Get With The Guidelines-HF registry linked to Medicare claims data from 2008-2012 to assess three groups of patients age 65 or older: previously eligible (due to prior MI, CABG, stable angina, heart valve surgery, or PCI in the previous 12 months), newly eligible, and ineligible for CR. Ineligible patients met neither criteria. Incidence rate was calculated with Kaplan-Meier estimates and Cox proportional hazard models were used to determine the association of events. Results: Among 51,665 HF patients discharged alive, 27.2% (n=14,053) were newly eligible and 14.5% were previously eligible for CR (n=7477). Newly eligible patients were more likely to be black, have atrial fibrillation and EF < 35%, while having fewer previous hospitalizations than patients previously eligible for CR. Newly eligible and ineligible patients had similar risk for 1-year mortality compared with those previously eligible (adjusted Hazard Ratio [HR] 0.95, 95% Confidence Interval [CI] 0.88-1.02, p-value=0.13 and [HR] 1.05, 95% [CI] 0.98-1.13, p-value=0.17, respectively). However, newly eligible and ineligible patients had lower risk for 1-year readmission compared with those previously eligible (adjusted [HR] 0.89, 95% [CI] 0.85-0.93, p-value<0.001 and [HR] 0.94, 95% [CI] 0.90- 0.98, p-value<0.001). Conclusions: The extension of coverage for cardiac rehabilitation has tripled the potentially eligible HF population. As these newly eligible patients are at high risk for adverse outcomes, cardiac rehabilitation should be considered.

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