Abstract P256: Association Between Antidepressants Use and Intracerebral Hemorrhage: Florida Stroke Registry

Introduction: SSRIs, the most commonly prescribed antidepressants (AD) in the US, are linked to an increased intracerebral hemorrhage (ICH) risk possibly related to impaired platelet function. In the Florida Stroke Registry (FSR), we studied the proportion of cases presenting with ICH amongst AD users and the rate of SSRI prescription amongst stroke patients discharged on AD. Methods: From Jan 2010 to Dec 2019 we included 127,915 cases from FSR in whom information on AD use was available. Multivariable logistic regression was used to evaluate ICH proportions amongst AD and non-AD users and rates of prescribed SSRIs at discharge. Results: The rate of ICH amongst prior AD users (n=17,009, median age 74, IQR=19) and non-AD users (n=110,906, median age 72, IQR=21) were 11% and 14% respectively. Prior AD users were more likely to be female (17% vs. 10% male), non-Hispanic White (16% vs. 8% non-Hispanic Black vs. 12% Florida Hispanic vs. 6% Puerto Rican Hispanic), have hypertension (HTN) (14.% vs. 10%), diabetes mellitus (DM) (16% vs.12%), use oral anticoagulants (OAC) (17 % vs. 13%), antiplatelets (AP; 17% vs. 11%), and statins (17% vs. 10%) prior to hospital presentation. In multivariable analysis adjusting for age, race, prior history of HTN, DM, prior OAC, AP and statin use, AD users just as likely to present with spontaneous ICH as compared to non-AD users (OR=0.92, 95% CI 0.85, 1.01). A total of 3.4% of all ICH patients and 9% of those in whom AD information was available were discharged home on an AD (74 % SSRI, 24% other AD). Conclusion: In this large population-based study, we did not find an association between prior AD use and an increased rate of ICH. Importantly AD (mostly SSRIs) are commonly prescribed to patients with ICH in routine clinical practice. The association between types, duration, and safety of antidepressant use in ICH patients deserves further studies.

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The effect of warfarin on the risk of prostate cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14524 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14524-14524

Author(s):

V. Tagalakis ◽

H. Tamim ◽

J. Collet ◽

S. R. Kahn ◽

M. Blostein ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Diagnosis ◽

Conditional Logistic Regression ◽

Oral Anticoagulants ◽

Large Population ◽

Population Based ◽

Cumulative Exposure ◽

Prolonged Treatment ◽

History Of ◽

Reduced Risk

14524 Background: The anticancer activity of oral anticoagulants has been a matter of debate for several years. Recent evidence suggests that prolonged treatment with warfarin may be associated with a reduced incidence of newly diagnosed urogenital cancer during long-term follow-up of patients with venous thromboembolism. The aim of this study was to assess whether exposure to warfarin was associated with reduced risk of prostate cancer in a large population-based cohort. Methods: We conducted a matched case-control study nested within the population of beneficiaries of the Saskatchewan Prescription Drug Plan aged 50 years and older from 1981–2002 with no history of cancer since 1967. New cases of prostate cancer diagnosed between 1981 and 2002 were identified using the linked Saskatchewan Cancer Agency registry. Six controls per case matched on age, gender, and sampling time were randomly selected. The cumulative exposure to warfarin in the five years preceding the cancer diagnosis was assessed. Prescription counts were used to define warfarin exposure. Exposure in the year immediately preceding the cancer diagnosis was excluded to control for detection bias. Conditional logistic regression analysis was used to assess confounding by other drugs such as nonsteroidal anti-inflammatory medications. Results: Among 11502 cases and 69012 controls, 7.4% of cases and 7.1% of controls had a history of any warfarin use. Compared to men who had never used warfarin, adjusted odds ratio (OR) for prostate cancer among ever-users in the 5 year period was 0.94 (95% confidence interval (CI), 0.86–1.03). In those who accumulated 1, 2, 3 and 4 years of warfarin use, the adjusted ORs were 1.01 (95% CI, 0.89–1.16), 1.00 (95% CI, 0.82–1.23), 0.81 (95% CI, 0.60–1.09), and 0.80 (95% CI, 0.65–0.99), respectively (p-trend=0.03). Conclusion: Our results suggest that cumulative use of warfarin of at least 4 years may be associated with a reduced risk of prostate cancer. However, confounding by other determinants of prostate cancer associated with warfarin use is possible. Nonetheless, confirmation of these findings by prospective studies may provide the evidence necessary to consider the use of warfarin in prostate cancer prevention. No significant financial relationships to disclose.

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Abstract TP178: Relationship Between Deprivation and Outcome for Stroke Patients: Data From the UK National Stroke Registry

Stroke ◽

10.1161/str.47.suppl_1.tp178 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Emma Vestesson ◽

Benjamin Bray ◽

Martin James ◽

Lizz Paley ◽

Pippa Tyrrell ◽

...

Keyword(s):

Social Deprivation ◽

Multivariable Analysis ◽

Stroke Onset ◽

Independent Effect ◽

Prior History ◽

Stroke Registry ◽

Crude Mortality ◽

Younger Age ◽

History Of ◽

The Uk

Introduction: Previous studies have identified that social deprivation is associated with the onset of stroke, with people from areas of higher deprivation being more likely to have a stroke at a younger age. Methods: Data were extracted from the national stroke register (Sentinel Stroke National Audit Programme (SSNAP)) of adults with acute ischemic stroke treated in all hospitals in England and Wales from April 2013-March 2014. The patient’s zip code of residence was used to link the data with an index of multiple deprivation, which groups zip codes into quartiles of deprivation. Results: Of the 66798 adults with acute stroke discharged from 266 hospitals, deprivation data was available for 63007 patients (94.3%).The median age of stroke onset for the most deprived quartile was 5 years lower than for the least deprived quartile (74, 77, 79 and 79 years respectively, Kruskal-Wallis test p<0.001). For patients in the most deprived quartiles compared to the least deprived, the rate of primary intracerebral hemorrhage was lower (9.9%, 10.5%, 10.7% and 11.7% respectively, chi2 p<0.001), the rate of diabetes was higher (22.7%, 20.6%, 17.9% and 15.8%, chi2 p<0.001), and the prevalence of congestive heart failure, hypertension and previous stroke/TIA were similar for all groups. The rate of atrial fibrillation (AF) prior to stroke was lower for more deprived patients (17.6%, 19.8%, 22.9% and 22.6%, chi2 p<0.001), but the percentage of patients on anticoagulants if in AF was similar for all groups. Mortality at 30 days was lower in the most deprived group compared to the least deprived group (12.8%, 14.6%, 15.7% and 15.4%, chi2 p<0.001). Conclusions: Patients living in more deprived areas have stroke at a younger age and are more likely to have a prior history of diabetes mellitus. Outcomes are similar for all groups but crude mortality at 30 days was lower for the most deprived group. This may be due to the lower median age of stroke onset, and the higher proportion of ischemic strokes. Predictive models for stroke outcome need to consider levels of deprivation and we are currently working on multivariable analysis to identify any independent effect of deprivation on mortality.

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Atrial Fibrillation in Spontaneous Intracerebral Hemorrhage, Dijon Stroke Registry (2006–2017)

Journal of the American Heart Association ◽

10.1161/jaha.120.020040 ◽

2021 ◽

Author(s):

Amélie Gabet ◽

Valérie Olié ◽

Yannick Béjot

Keyword(s):

Atrial Fibrillation ◽

Intracerebral Hemorrhage ◽

Scale Score ◽

Oral Anticoagulants ◽

Temporal Trends ◽

Population Based ◽

Modified Rankin Scale ◽

Newly Diagnosed ◽

Spontaneous Intracerebral Hemorrhage ◽

Stroke Registry

Background Atrial fibrillation (AF) represents a major indication for oral anticoagulants (OAC) that contribute to spontaneous intracerebral hemorrhage (ICH). This study evaluated AF prevalence among patients with ICH, temporal trends, and early functional outcomes and death of patients. Methods and Results Patients with first‐ever ICH were prospectively recorded in the population‐based stroke registry of Dijon, France, (2006–2017). Association between AF and early outcome of patients with ICH (ordinal modified Rankin Scale score and death at discharge) were analyzed using ordinal and logistic regressions. Among 444 patients with ICH, 97 (21.9%) had AF, including 65 (14.6%) with previously known AF treated with OAC, and 13 (2.9%) with newly diagnosed AF. AF prevalence rose from 17.2% (2006–2011) to 25.8% (2012–2017) ( P ‐trend=0.05). An increase in the proportion of AF treated with OAC (11.3% to 17.5%, P ‐trend=0.09) and newly diagnosed AF (1.5% to 4.2%, P ‐trend=0.11) was observed. In multivariable analyses, after adjustment for premorbid OAC, AF was not significantly associated with ordinal modified Rankin Scale score (odds ratio [OR], 1.29; 95% CI, 0.69–2.42) or death (OR, 0.89; 95% CI, 0.40–1.96) in patients with ICH. Nevertheless, adjusted premorbid OAC use remained highly associated with a higher probability of death (OR, 2.53; 95% CI, 1.11–5.78). Conclusions AF prevalence and use of OAC among patients with ICH increased over time. Premorbid use of OAC was associated with poor outcome after ICH, thus suggesting a need to better identify ICH risk before initiating or pursuing OAC therapy in patients with AF, and to develop acute treatment and secondary prevention strategies after ICH in patients with AF.

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Immune-Related and Inflammatory Conditions Likely Play a Role in the Development of Lymphoplasmacytic Lymphoma/Waldenström’s Macroglobulinemia

Blood ◽

10.1182/blood.v112.11.3758.3758 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3758-3758

Author(s):

Sigurdur Y Kristinsson ◽

Magnus Bjorkholm ◽

Jill Koshiol ◽

Lynn R. Goldin ◽

Mary L. McMaster ◽

...

Keyword(s):

Infectious Diseases ◽

Large Population ◽

Population Based ◽

Birth Date ◽

Prior History ◽

Hospital Inpatient ◽

Lymphoplasmacytic Lymphoma ◽

Inflammatory Conditions ◽

Increased Risk ◽

History Of

Abstract Introduction: Certain autoimmune and infectious conditions are associated with increased risks of subtypes of non-Hodgkin lymphomas (NHL). A few prior studies suggest that chronic immune stimulation may particularly elevate risk for the NHL subtype lymphoplasmacytic lymphoma (LPL)/Waldenström’s macroglobulinemia (WM). To improve our understanding on the role of immune-related and inflammatory conditions in LPL/WM pathogenesis, we conducted a large population-based study including close to 2,500 LPL/WM patients diagnosed in Sweden and almost 10,000 matched controls. Methods: Using both the central Cancer registry and local hospital-based registries, we identified all LPL/WM patients diagnosed in Swedish hospitals 1958–2005. From the Swedish Population Registry we identified four matched controls per LPL/WM patient. Through data linkage with the central Inpatient registry, we gathered information on hospital inpatient discharges that listed autoimmune-, infectious-, and other inflammatory/allergic diseases present at least 1 year prior to LPL/WM. Using Poisson regression, we calculated rate ratios (RR) and 95% confidence intervals (CI) adjusted for categorical year of birth, date of diagnosis, gender, and county. Results: A total of 2,470 LPL/WM patients (647 LPL and 1,823 WM), and 9,698 population-based matched controls were included in the study. We found an increased risk of developing LPL/WM among individuals with a prior history of systemic sclerosis (RR=4.7; 1.4–15.3), Sjögren’s syndrome (RR=12.1; 3.3–45.0), autoimmune hemolytic anemia (AIHA) (RR=24.2; 5.4–108.2), polymyalgia rheumatica (RR=2.9; 1.6–5.2), and temporalis arteritis (RR=8.3; 2.1–33.1). We also found excess risk of LPL/WM among persons with a history of pneumonia (RR=1.4; 1.1–1.7), septicaemia (RR=2.4; 1.2–4.3), pyelonephritis (RR=1.7; 1.1–2.5), sinusitis (RR=2.7; 1.4–4.9), herpes zoster (RR=3.4; 2.0–5.6), and influenza (RR=2.9; 1.7–5.0). Importantly, when we assessed the associations by latency (time between immune-related or inflammatory conditions and LPL/WM), for most autoimmune- and infectious diseases the excess LPL/WM risk remained significant at >5 years latency. We found no significant increased risk for LPL/WM among individuals with prior chronic inflammatory or allergic conditions. Conclusions: In the largest investigation of risk factors for LPL/WM to date, we found a personal history of certain autoimmune and infectious diseases to be associated with excess LPL/WM risk. Immune-related conditions might act as potential LPL/WM triggers or they could represent premalignant immune disruptions preceding LPL/WM. Our results provide novel insights into the as yet unclear pathogenesis of LPL/WM.

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The association between psoriatic arthritis and venous thromboembolism: a population-based cohort study

Arthritis Research & Therapy ◽

10.1186/s13075-021-02703-8 ◽

2022 ◽

Vol 24 (1) ◽

Author(s):

Tal Gazitt ◽

Jacob Pesachov ◽

Idit Lavi ◽

Muna Elias ◽

Amir Haddad ◽

...

Keyword(s):

Cohort Study ◽

Psoriatic Arthritis ◽

Large Population ◽

Multivariable Analysis ◽

Previous History ◽

Population Based ◽

Janus Kinase ◽

Control Group ◽

Increased Risk ◽

History Of

Abstract Background Although the risk of cardiovascular disease has been discussed extensively in both psoriasis (PsO) and psoriatic arthritis (PsA), very few studies have addressed the occurrence of venous thromboembolic (VTE) events among PsO patients, and even fewer in PsA. Thus, our goal was to assess the association between PsA and VTE events using a large population-based database. Methods This retrospective cohort study includes all 5,275 patients with newly diagnosed PsA from the largest health care provider in Israel between January 2003 and December 2018. Identified PsA patients were matched by age, sex, ethnicity, and index date with 21,011 controls without PsA from the same database. Both groups were followed through June 30, 2019 for the occurrence of VTE event. Cox proportional hazard regression models were used to assess the association between PsA and VTE. Results PsA cohort consisted of 53.2% females with mean age of 51.7±15.4 Sixty-two patients (1.2%) were diagnosed with VTE in the PsA group and 176 patients (0.8%) in the control group (p=0.023, HR=1.40, 95% CI 1.05-1.87). However, there was no increased risk of VTE among PsA patients on multivariable analysis (p=0.16, HR=1.27, 95% CI 0.91-1.80). Within the PsA group, patients with VTE were more often of older age and with history of VTE. Conclusions This study suggests that the increased risk of VTE in PsA patients appears to be related to the underlying comorbidities and not independently associated with PsA. Age and previous history of VTE were the only risk factors associated with increased risk of VTE in patients with PsA. Addressing VTE risk is recommended especially in the era of Janus kinase inhibitors.

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Abstract WP344: Lower Hemoglobin A1c is Associated With Higher In-Hospital Mortality in Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.wp344 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sudeepta Dandapat ◽

Fazeel M Siddiqui ◽

Gregg C Fonarow ◽

Deepak L Bhatt ◽

Haolin Xu ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Prior History ◽

Stroke Registry ◽

Increasing Trend ◽

History Of ◽

Multivariable Regression ◽

Multivariable Regression Models ◽

Relationship Of ◽

The Relationship

Introduction: Relationship of prior glycemic status to outcomes in intracerebral hemorrhage (ICH) is not established. Hypothesis: Higher hemoglobin (Hb) A1c is associated with worse outcomes in ICH. Methods: Data harvested from GWTG-Stroke registry on patients with ICH between April 1, 2003 and September 30, 2015. Four ordinal groups made based on HbA1c values of <5.7%, 5.7-6.4%, 6.5-8.0% and >8.0%. Outcomes analyzed overall and separately for patients with or without history of diabetes using unadjusted and adjusted multivariable regression models. Results: Among 75,455 patients with ICH from 1,336 sites, the prevalence of diabetes was 36.2% and prediabetes (no prior history of diabetes and HbA1c between 5.7-6.4%) was 41.9%. An increasing trend in the median BMI values was noted across the groups, with worse HbA1c associated with higher BMI. Lower HbA1c was associated with higher in-hospital mortality (3947/25473 {15.5%} overall, 542/2852 {19.0%} in patients with history of diabetes, and 3405/22621{15.1%} in patients without history of diabetes) (Table), higher mRS, less chance of going home, and lower likelihood of having independent ambulatory status, also seen in unadjusted and adjusted outcomes (Figure). Only in patients with no prior diabetes history, both higher HbA1c and lower HBA1c were associated with higher in-hospital mortality. Conclusions: In this large cohort of ICH patients, contrary to our original hypothesis, lower HbA1c (rather than higher HbA1c) was associated with higher in-hospital mortality. Further studies are needed to better define the relationship between HbA1c and outcomes, for it may have important implications for care of ICH patients.

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Melanoma is associated with an increased risk of bullous pemphigoid: a large population-based longitudinal study

Archives of Dermatological Research ◽

10.1007/s00403-021-02211-4 ◽

2021 ◽

Author(s):

Khalaf Kridin ◽

Jennifer E. Hundt ◽

Ralf J. Ludwig ◽

Kyle T. Amber ◽

Dana Tzur Bitan ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Statistical Significance ◽

Large Population ◽

Underlying Mechanism ◽

Population Based ◽

Control Subjects ◽

Increased Risk ◽

Bidirectional Association ◽

History Of ◽

Incident Cases

AbstractThe association between bullous pemphigoid (BP) and melanoma is yet to be investigated. We aimed to assess assess the bidirectional association between BP and melanoma and to delineate the epidemiological features of patients with both diagnoses. A population-based cohort study was performed comparing BP patients (n = 3924) with age-, sex- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of melanoma. A case–control design was additionally adopted to estimate the risk of BP in individuals with a preexisting diagnosis of melanoma. The prevalence of preexisting melanoma was higher in patients with BP than in control subjects (1.5% vs. 1.0%, respectively; P = 0.004). A history of melanoma confers a 50% increase in the risk of subsequent BP (OR 1.53; 95% CI 1.14–2.06). This risk was higher among males (OR 1.66; 95% CI 1.09–2.54) and individuals older than 80 years (OR 1.63; 95% CI 1.11–2.38), and persisted after adjustment for multiple putative confounders including PD-1/PDL-1 antagonists (adjusted OR 1.53; 95% CI 1.14–2.06). Conversely, the risk of melanoma among patients with BP was slightly elevated, but did not reach the level of statistical significance (adjusted HR 1.13; 95% CI 0.73–1.74). Patients with a dual diagnosis of BP and melanoma were older at the onset of BP and had lower body mass index. A history of melanoma is associated with a 50% increase in the incidence of subsequent BP. Physicians managing patients with both conditions should be aware of this association. Further research is warranted to reveal the underlying mechanism of these findings.

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Genetic and Environmental Risk Factors for Intracerebral Hemorrhage

Stroke ◽

10.1161/str.32.suppl_1.321 ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 321-321

Author(s):

Daniel Woo ◽

Laura Sauerbeck ◽

Brett M Kissela ◽

Jane C Khoury ◽

Rakesh Shukla ◽

...

Keyword(s):

Risk Factors ◽

Intracerebral Hemorrhage ◽

Environmental Risk ◽

Multivariable Analysis ◽

Population Based ◽

Environmental Risk Factors ◽

Degree Relative ◽

Increased Risk ◽

Apo E ◽

Apo E Genotype

27 Introduction: We report a planned midpoint analysis of a prospective, population-based, case-control study of the genetic and environmental risk factors of spontaneous, non-traumatic, intracerebral hemorrhage (ICH). Methods: Cases were matched to two controls by age, race and gender. Data was obtained by direct interview and review of all available medical and neuroimaging data. Apolipoprotein E (Apo E)genotype was determined by polymerase chain reaction. Multivariable analyses were performed using logistic regression modeling. Results: Between 6/97 and 2/00, 189 cases of ICH (150 white/39 black; 68 lobar/121 non-lobar) and 368 controls were enrolled into the study. Independent risk factors for multivariable analysis are listed in the table. Only prior stroke was an independent risk factor for both lobar and non-lobar ICH. Conclusions: The importance of individual genetic and environmental risk factors for ICH vary substantially by location of ICH. A history of a first-degree relative with ICH was associated with an increased risk of lobar ICH, independent of Apo E genotype. This finding indicates that other genetic risk factors may be important in the development of ICH.

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Abstract 493: Correlation Between Cannabis Use and the Prevalence of Cerebrovascular Disease (Cva); Analysis From the National Inpatient Sample (NIS) 2012-2014

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.493 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Samson E Alliu ◽

Adeyinka Adejumo ◽

Modupeolowa Durojaiye ◽

Oluwole Adegbala ◽

Tokunbo Ajayi ◽

...

Keyword(s):

Clinical Information ◽

Cannabis Use ◽

Prior History ◽

National Inpatient Sample ◽

Cognitive Effect ◽

Clinical Literature ◽

The Us ◽

History Of ◽

Amphetamine Use ◽

Inflammatory Effect

Background: With increasing legalization of cannabis, there is a growing number of cannabis users in the US. Cannabidiol - a component of cannabis with no psychoactive or cognitive effect has been proven in animal models to have vasodilatory and anti-inflammatory effect on the blood vessels. However, in clinical literature, the association between cerebrovascular accident (CVA) and cannabis remains inconclusive. Objective: To examine if there is a difference in the prevalence of CVA among patients who use cannabis and non-users. Methods: We identified patients > 18 years (N=12,114,360) from the 2012 -2014 National Inpatient Sample database. Using the ICD-9 code, we categorized patients using cannabis (non-dependent and dependent users) and non-users. Our outcome of interest was prevalence of CVA in this population. Logistic regression analysis was performed to assess the association between cannabis use and CVA. Using multivariate regression model, we adjusted for known confounders of CVA; age, gender, race, insurance type, socioeconomic status, tobacco use, cocaine use, alcohol abuse, amphetamine use, hyperlipidemia, diabetes, hypertension, renal failure, prior history of CVA and family history of CVA. Results: From our study sample (12,114,360 hospitalized patients), 2.1% (253,752) had a diagnosis of CVA, 1.48% (179,576) were non-dependent cannabis users and 0.21% (25,968) dependent users. Among hospitalized patient, non-dependent cannabis use was associated with an 8% increased odds of CVA (AOR 1.08 [1.03-1.13]) compared to non-users. However, dependent cannabis use was associated with a 60% decreased odds of CVA (AOR 0.40 [0.31-0.49]) compared to non-users. Also, In-group comparison shows a 60% decreased odds of CVA among dependent cannabis users (AOR 0.36[0.29-0.46]) compared to non-dependent cannabis users. Conclusions: Non-dependent cannabis use was associated with a slightly increased odd of CVA while dependent cannabis use was independently protective against CVA. Our study used the largest repository of clinical information to explore this association, however we recommend more clinical study to explore this correlation in other to maximize the pharmacological benefit of cannabidiol in cannabis for the prevention of CVA.

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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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