Abstract 14658: Comparative Effectiveness of Torsemide versus Furosemide in Acute Heart Failure Patients: Insights from ASCEND-HF

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Robert J Mentz ◽  
Vic Hasselblad ◽  
Adam D DeVore ◽  
Paul W Armstrong ◽  
Justin A Ezekowitz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Comparative Effectiveness ◽  
Loop Diuretic ◽  
Probability Weighting ◽  
Lower Blood Pressure ◽  
Post Discharge ◽  
Inverse Probability ◽  
Lower Blood ◽  
The Relationship ◽  
Selection Of

Introduction: Furosemide is the most commonly used loop diuretic in heart failure (HF) patients despite potential pharmacologic and anti-fibrotic benefits with torsemide. Hypothesis: We hypothesized that the comparative benefits of post-discharge use of torsemide would be superior to furosemide in a large acute HF trial. Methods: We investigated HF patients in ASCEND-HF who were discharged on either torsemide or furosemide. Given regional variation in torsemide use, we restricted analyses to the 6 countries with at least 20 patients on one of the diuretics and patients on torsemide. Using inverse probability weighting (IPW) to account for selection of diuretic, we assessed the relationship between diuretic at discharge with 30-day mortality or HF hospitalization, and 30- and 180-day mortality. Results: Of 7,141 patients in the trial, 3,282 patients were included in this analysis, of which, 88% (n=2,893) received furosemide and 12% (n=389) received torsemide. Torsemide-treated patients had lower blood pressure, and higher creatinine and BUN at baseline compared with furosemide-treated patients. On adjusted analysis, torsemide use was associated with a trend toward lower 30-day mortality or HF hospitalization (OR 0.62, 95% CI: 0.37-1.04; P=0.067). Torsemide was associated with similar 30-day mortality (OR 0.77, 95% CI: 0.28-2.09; P=0.60), and significantly reduced 180-day mortality (HR 0.56, 95% CI: 0.36-0.87; P=0.038) compared with furosemide (Figure). Conclusion: In this acute HF trial, a minority of patients received torsemide and commonly had indicators of higher risk. After risk-adjustment, torsemide was associated with lower risk of 180-day mortality. These data should be considered as hypothesis-generating and prospective, randomized comparative effectiveness trials are needed to investigate the optimal diuretic choice between torsemide vs. furosemide.

Ins and Outs: Perspectives of Inpatient Prescribing for Sacubitril/Valsartan

2020 ◽  
pp. 106002802096492
Author(s):  
Michael Gillette ◽  
Biykem Bozkurt
Keyword(s):  
Heart Failure ◽  
Health Concern ◽  
Evidence Based ◽  
Preserved Ejection Fraction ◽  
Lower Blood Pressure ◽  
Public Health Concern ◽  
Underrepresented Populations ◽  
Risk Of Death ◽  
Lower Blood ◽  
Hospitalization From Heart Failure

Heart failure is a major public health concern with a rising prevalence and significant financial detriment. Although sacubitril/valsartan was shown to reduce the risk of death and hospitalization from heart failure in a contemporary cohort, it continues to remain substantially underutilized. A recent article in the Annals highlights the evidence behind inpatient initiation of sacubitril/valsartan. We provide further considerations and summarize the evidence for inpatient initiation of other guideline directed medical therapies. Overall, there is a need to improve methods to identify ideal populations and increase utilization in those who may benefit from sacubitril/valsartan. Further research is also needed to identify the risks versus benefits among underrepresented populations (i.e., advanced heart failure, heart failure with preserved ejection fraction, in conjunction with other contemporary evidence-based therapies that can lower blood pressure, etc.).

scholarly journals Comparative effectiveness of the BNT162b2 vs ChAdOx1 vaccine against Covid-19

2021 ◽  
Author(s):  
Junqing Xie ◽  
shuo feng ◽  
Xintong Li ◽  
Ester Gea Mallorqui ◽  
Albert Prats-Uribe ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Direct Evidence ◽  
Hazard Ratio ◽  
Evidence Based ◽  
Probability Weighting ◽  
Uk Biobank ◽  
Cox Models ◽  
Inverse Probability ◽  
Related Hospitalisation ◽  
Vaccination Campaigns

Although pivotal trials with varying populations and study methods suggest higher efficacy for mRNA than adenoviral Covid-19 vaccines, no direct evidence is available. Here, we conducted a head-to-head comparison of BNT162b2 versus ChAdOx1 against Covid-19. We analysed 235,181 UK Biobank participants aged 50 years or older and vaccinated with one or two doses of BNT162b2 or ChAdOx1. People were followed from the vaccination date until 18/10/2021. Inverse probability weighting was used to minimise confounding and the Cox models to derive hazard ratio. We found that, compared with two doses of ChAdOx1, vaccination with BNT162b2 was associated with 30% lower risks of both SARS-CoV-2 infection and related hospitalisation during the period dominated by the delta variant. Also, this comparative effectiveness was consistent across several subgroups and persisted for at least six months, suggesting no differential waning between the two vaccines. Our findings can inform evidence-based Covid-19 vaccination campaigns and booster strategies.

Chemotherapy and the Risk of Alzheimer's Disease in Colorectal Cancer Survivors: Evidence From the Medicare System

2021 ◽  
pp. OP.20.00729
Author(s):  
Igor Akushevich ◽  
Arseniy P. Yashkin ◽  
Julia Kravchenko ◽  
Miklos D. Kertai
Keyword(s):  
Colorectal Cancer ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cancer Survivors ◽  
Proportional Hazards Model ◽  
Inverse Probability Weighting ◽  
Probability Weighting ◽  
Inverse Probability ◽  
Colorectal Cancer Survivors ◽  
The Relationship

PURPOSE: Evidence on the nature of the relationship between patients receiving chemotherapy as an essential part of guideline-concordant cancer care and the onset of Alzheimer's Disease (AD) and other adverse cognitive outcomes has been mixed. Biological mechanisms were proposed to support both a potentially beneficial and an adverse role. To explore the relationship between chemotherapy and onset of AD and other neurocognitive disorders (ND) in colorectal cancer survivors. METHODS: We conducted a retrospective cohort study of 135,834 individuals older than 65 years diagnosed with colorectal cancer between 1998 and 2007, using SEER-Medicare data. A proportional hazards model was used before and after the use of inverse probability weighting to account for populational differences between the chemotherapy and nonchemotherapy groups. Weights were normalized to the total sample size. RESULTS: After inverse probability weighting, chemotherapy was associated with decreased AD risk (hazard ratio [HR]: 0.791; 95% CI: 0.758 to 0.824) and lower risk for the majority of other ND including AD-related diseases (HR: 0.823; CI: 0.802 to 0.844), dementia (permanent mental disorder) (HR: 0.807; CI: 0.782 to 0.832), and dementia (senile) (HR: 0.772; CI: 0.745 to 0.801). The only adverse effect to remain significant was cerebral degeneration (excluding AD) (HR: 1.067; CI: 1.033 to 1.102). The effects for AD remained after treatment was stratified by chemotherapy agent type and remained significant for up to 6 years past diagnosis. CONCLUSION: Chemotherapy use in colorectal cancer survivors demonstrated an association with reduced risk for AD and other ND.

scholarly journals Rationale and Design of a Prospective, Multicenter, Observational Study Evaluating Iron Deficiency in Patients Hospitalized for Heart Failure (FERIC-RO)

2018 ◽  
Vol 26 (3) ◽  
pp. 271-281
Author(s):  
Elena Laura Antohi ◽  
Gabriel Tatu Chitoiu ◽  
Andrew P Ambrosy ◽  
Ioan M Coman ◽  
Dragos Vinereanu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Iron Deficiency ◽  
Post Discharge ◽  
Multicenter Observational Study ◽  
Discharge Outcomes ◽  
The Relationship ◽  
Prospective Multicenter Observational Study

Abstract Introduction: Several landmark studies, which enrolled heart failure (HF) patients who were ambulatory at the time of inclusion, identified iron deficiency (ID) as an important therapeutic target: intravenous iron administration with ferric carboxymaltose (FCM) improves morbidity, exercise capacity, and quality of life in patients with HF and reduced EF (HFrEF). However, there is still limited knowledge about ID prevalence during hospitalization for Worsening Chronic HF (WCHF) and about the relationship between ID during hospitalization and post-discharge outcomes. Although previous studies documented ID as an independent risk factor for poor outcomes in HFrEF, its prognostic significance in HF patients with EF>40% remains unclear. Method and Results: The FERIC-RO study is a prospective, multicenter, observational study with longitudinal follow up, conducted in 9 Romanian hospitals that will include 200 consecutive patients admitted for worsening HF. A comprehensive description of the Iron metabolism biomarkers will be performed on discharge and 1-month follow up. The primary endpoint is defined as the prevalence of ID on discharge and 1-month post-discharge, and the secondary endpoints include: all-cause re-hospitalization and all-cause-mortality at 1 and 3 months follow up, and quality of life on discharge and 1-month. Conclusions: FERIC-RO will provide new evidence about the prevalence and the predictors of ID in patients hospitalized for WCHF regardless of LVEF. Furthermore, the study will explore the relationship between in-hospital ID and post-discharge outcomes. The results of FERIC-RO will thus be highly relevant to the management of patients hospitalized for AHF.

Abstract 219: Cardiac Stress Testing Does Not Improve Patient Selection or Outcomes Among Patients Undergoing Abdominal Aortic Aneurysm Repair

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Benjamin S Brooke ◽  
Mark R Sarfati ◽  
Yingying Zhang ◽  
Yue Zhang ◽  
Angela P Presson ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Stress Testing ◽  
Postoperative Outcomes ◽  
Probability Weighting ◽  
Cardiac Events ◽  
Cardiac Stress ◽  
Inverse Probability ◽  
Abdominal Aortic ◽  
Adverse Cardiac Events ◽  
Selection Of

Objectives: Cardiac stress testing (CST) is commonly used to help determine whether patients with abdominal aortic aneurysms (AAA) are candidates for an open vs. endovascular repair, although it is unknown whether use of CST achieves its goal of optimizing patient selection and postoperative outcomes. This study was designed to examine whether utilization of CST reduces adverse cardiac events and improves survival following AAA repair. Methods: We retrospectively identified 3,635 patients in the Vascular Quality Initiative (VQI) database (2010- 2012) with an AAA ≥ 5.0cm who were candidates for open or endovascular AAA repair. The Vascular Study Group Cardiac Risk Index (VSG-CRI) was used to stratify patient risk. We applied generalized estimating equations with inverse probability weighting to adjust for patient factors and hospital level CST utilization to evaluate the effect of CST on composite of 30-day major adverse cardiac events or mortality (MACE-M) following AAA repair. Analyses were restricted to hospitals with 20% to 80% CST utilization to facilitate adjustment of the utilization rate. Results: CST was utilized in 1627 (45%) patients during AAA workup, including 451 of 794 (57%) patients selected for open repair and 1176 of 2841 (41%) selected for endovascular repair. After inverse probability weighting, the use of CST was not associated with the probability of patients receiving open vs. endovascular repair (OR: 1.00; 95%CI: 0.77-1.32). As compared to patients without CST during AAA workup, adjusted analyses revealed that CST utilization was not associated with improved MACE or mortality outcomes following AAA repair. Among patients receiving CST, an abnormal CST was not significantly associated with selection of open vs. endovascular repair or with postoperative outcomes after adjustment for the VSG-CRI score. Similar results were found for patients with either low or high VSG-CRI scores. Conclusions: Utilization of CST during workup for AAA is not associated with selection of repair procedure and improved postoperative outcomes. Our results suggest that CST adds no value beyond known clinical risk factors in selecting patients for open or endovascular repair or in predicting post-operative events.

scholarly journals Vascular age concept: role in assessing risk and choosing therapy

2020 ◽  
pp. 51-57
Author(s):  
S. R. Gilyarevsky ◽  
M. V. Golshmid ◽  
N. G. Bendeliani ◽  
I. M. Kuzmina ◽  
G. Y. Zaharova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Arterial Stiffness ◽  
Lower Blood Pressure ◽  
Lower Blood ◽  
Combination Drugs ◽  
Vascular Age ◽  
The Relationship

The article discusses the vascular age concept and modern approaches to assessing vascular age. It describes modern methods for measuring arterial stiffness (applanation tonometry or ultrasonic Doppler examination) as the most frequently used index of vascular age. The authors discuss the role of antihypertensive therapy and statins in preventing early vascular aging, and the relationship between the role of achieving lower blood pressure levels and the choice of certain antihypertensive agents to reduce arterial stiffness and ensure optimal vascular age. Increased arterial stiffness has been reported to be a marker of risk for developing severe complications of cardiovascular diseases, in particular, a meta-analysis showed that after taking into account the known risk factors for developing cardiovascular complications, higher carotid stiffness was associated with an increased risk of stroke. It is stated that in addition to biological age, vascular age may increase due to the cumulative effect of such risk factors as high blood pressure, impaired glucose homeostasis, obesity and hypercholesterolemia. Modern approaches to the preservation and maintenance of vascular age are discussed. The key role of achieving lower blood pressure levels is considered. It is emphasized that the role of combination drugs in preventing complications of cardiovascular diseases is strengthened, and approaches to choosing the optimal components of such combination drugs are also considered. The relationship between increased arterial stiffness and the development of cognitive disorders is discussed. The article describes the role of statins and effectiveness of the concomitant use of statins and combination antihypertensive therapy in reducing the pulse wave velocity.

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