Beta-Blockers and Cardiovascular Outcomes in Acute Heart Failure with a History of Coronary Artery Disease and an Ejection Fraction ≥ 40%

The prognostic impact of beta-blockers (BB) in coronary artery disease (CAD) is controversial, especially in the post-reperfusion era. We studied in-hospital cardiovascular events in patients hospitalized for acute HF, a previous history of CAD and a left ventricular ejection fraction (LVEF) ≥40%, in relation to BB on admission; and 1-year outcome in relation to BB on discharge, in the GULF aCute heArt failuRe (GULF-CARE) registry. From a total of 5005 patients included in the GULF-CARE registry, 303 patients with a previous history of CAD and a LVEF ≥40% on BB were propensity-matched to 303 patients without BB on admission. In-hospital mortality (OR= 0.82; 95% CI [0.35-1.94]), stroke and cardiogenic shock were not reduced by BB. On discharge, 306 patients on BB, including the ones newly diagnosed with myocardial infarction as a precipitating cause of HF, were propensity-scored matched with 306 patients without BB. Mortality (OR= 0.86; 95%CI [0.51-1.45], hospitalization for HF or PCI/CABG at 1 year were also not reduced by BB at discharge. In summary, our data show that BB have a neutral effect on in-hospital and 1-year outcomes in acute heart failure patients with a previous history of CAD and a LVEF ≥40%.

Download Full-text

Symptomatic and Asymptomatic Patients in the Polish Atrial Fibrillation (POL-AF) Registry

Journal of Clinical Medicine ◽

10.3390/jcm10051091 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1091

Author(s):

Marek Kiliszek ◽

Beata Uziębło-Życzkowska ◽

Iwona Gorczyca ◽

Małgorzata Maciorowska ◽

Olga Jelonek ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Thromboembolic Event ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Asymptomatic Patients ◽

Artery Disease

Background: Atrial fibrillation (AF) can cause severe symptoms, but it is frequently asymptomatic. We aimed to compare the clinical features of patients with asymptomatic and symptomatic AF. Methods: A prospective, observational, multicenter study was performed (the Polish Atrial Fibrillation (POL-AF) registry). Consecutive hospitalized AF patients over 18 years of age were enrolled at ten centers. The data were collected for two weeks during each month of 2019. Results: A total of 2785 patients were analyzed, of whom 1360 were asymptomatic (48.8%). Asymptomatic patients were more frequently observed to have coronary artery disease (57.5% vs. 49.1%, p < 0.0001), heart failure with preserved ejection fraction (39.8% vs. 26.5%, p < 0.0001), a previous thromboembolic event (18.2% vs. 13.1%, p = 0.0002), and paroxysmal AF (52.3% vs. 45.2%, p = 0.0002). In multivariate analysis, history of electrical cardioversion, paroxysmal AF, heart failure, coronary artery disease, previous thromboembolic event, and higher left ventricular ejection fraction were predictors of a lack of AF symptoms. First-diagnosed AF was a predictor of AF symptoms. Conclusions: In comparison to symptomatic patients, more of those hospitalized with asymptomatic AF had been previously diagnosed with this arrhythmia and other cardiovascular diseases. However, they presented with better left ventricular function and were more frequently treated with cardiovascular medicines.

Download Full-text

A Universal New Definition of Heart Failure With Improved Ejection Fraction for Patients With Coronary Artery Disease

Frontiers in Physiology ◽

10.3389/fphys.2021.770650 ◽

2021 ◽

Vol 12 ◽

Author(s):

Haozhang Huang ◽

Jin Liu ◽

Min Lei ◽

Zhou Yang ◽

Kunming Bao ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Coronary Intervention ◽

Left Ventricular ◽

Reduced Ejection Fraction ◽

History Of ◽

Artery Disease ◽

Definition Of

Aims: The aims of this study were to describe the characteristics and outcomes of the universal new definition of heart failure with improved ejection fraction (HFimpEF) and to identify predictors for HFimpEF among patients with coronary artery disease (CAD).Methods: CAD subjects with heart failure with reduced ejection fraction (HFrEF) (EF ≤ 40%) at baseline were enrolled from the real-world registry of the Cardiorenal ImprovemeNt study from January 2007 to December 2018. The new definition of HFimpEF was defined as left ventricular EF (LVEF) of≤40% at baseline and with improvement of up to 40% and at least a ≥ 10% increase during 1 month to 1 year after discharge.Results: Of the 747 CAD patients with HFrEF (86.7% males, mean age: 61.4 ± 11 years), 267 (35.7%) patients conformed to the new HFimpEF definition. Patients with HFimpEF were younger (adjusted odds ratio [aOR]: 0.98 [0.97–0.99]) and had a higher rate of hypertension (aOR:1.43 [1.04–1.98]), lower rate of percutaneous coronary intervention (PCI) treatment at the time of detection of HFrEF (aOR: 0.48 [0.34–0.69]), history of PCI (aOR: 0.51 [0.28–0.88]), history of acute myocardial infarction (aOR: 0.40 [0.21–0.70]), and lower left ventricular end diastolic diameter (aOR: 0.92 [0.90–0.95]). During 3.3-year follow-up, patients with HFimpEF demonstrated lower rates of long-term all-cause mortality (13.1% vs. 20.8%, aHR: 0.61[0.41–0.90]).Conclusion: In our study, CAD patients with HFimpEF achieved a better prognosis compared to those with persistent HFrEF. Patients with CAD meeting the criteria for the universal definition of HFimpEF tended to be younger, presented fewer clinical comorbidities, and had lower left ventricular end diastolic diameter.

Download Full-text

Characteristics and management of heart failure: a retrospective single center study in Cambodia

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.047 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

YOUHOK Lim

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Public Hospital ◽

Beta Blockers ◽

P Value ◽

Total N ◽

Reduced Ejection Fraction ◽

Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background The most common etiologies of cardiovascular disease (CVD) in Cambodia included heart failure (HF) (52.9%), angina pectoris (11.6%), and acute myocardial infarction (4.11%). Purpose The goal of this study is to describe characteristics, clinical features, evaluation and treatment of patients with HF admitted to one public hospital in Cambodia. Methods This retrospective study included all patients age ≥18 years who were admitted with the diagnosis of HF to the Intensive Care Unit of one public hospital from 1st January 2017 to 31st December 2018. Out of 140 cases, 20 were excluded because they did not meet the inclusion criteria. Characteristics, evaluation, and treatment of the 120 remaining patients were analyzed. Results HF with reduced Ejection Fraction (HFrEF) was present in 15%, with mid-range EF (HFmrEF) in 13.3%, and preserved EF (HFpEF) in 71.7% of patients. Hypertension was more prevalent in HFpEF (89.5%, P <0.001) (table 1). Diabetes was more common in HFpEF and HFmrEF (52.3% and 43.7%, P = 0.316) (table 1). Coronary artery disease was more prevalent in HFrEF (72.2%, P = 0.015) (table 1). Global wall hypokinesia was more common in HFrEF group (72.2%, P <0.001) (figure 1). Patients with HFrEF who were given ACEi/ARB (44.4%, P = 0.324) was lower than those with HFpEF (55.8%, P = 0.324). Oral beta-blockers were commonly used in HFrEF (44.4%, P <0.175). Spironolactone was prescribed more in HFmrEF (56.2%, P <0.001) patients than in those with HFrEF (44.4%, P <0.001). Conclusions HFpEF was the most common types of HF in this population, and was associated with hypertension and diabetes. HFrEF was least common and was associated with CAD. Prevention and treatment of hypertension and diabetes is essential to reduce the incidence of HFpEF while greater use of guideline recommended drugs is needed in HFrEF. TABLE 1: Characteristics of HF Patients Clinical characteristics Total (n = 120) HFrEF (n = 18) HFmrEF (n = 16) HFpEF (n = 86) p value Age (years) 58.8 ± 15.2 57.2 ± 16.3 57.3 ± 16.3 61.8 ± 12.9 0.274 Women, n (%) 57 (47.5) 10 (55.5) 4 (25.0) 43 (50.0) 0.14 Men, n (%) 63 (52.5) 8 (44.4) 12 (75.0) 43 (50.0) 0.14 Hypertension, n (%) 95 (79.2) 7 (38.9) 11 (68.7) 77 (89.5) <0.001 Diabetes, n (%) 58 (48.3) 6 (33.3) 7 (43.7) 45 (52.3) 0.316 CAD, n (%) 55 (45.8) 13 (72.2) 9 (56.2) 32 (37.2) 0.015 Values are shown as n (%) or mean ± SD. HFrEF, heart failure with reduced ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; CAD, coronary artery disease. Abstract FIGURE 1: Proportion of HF and LVWM

Download Full-text

Influence of documented history of coronary artery disease on outcomes in patients admitted for worsening heart failure with reduced ejection fraction in the EVEREST trial

European Journal of Heart Failure ◽

10.1093/eurjhf/hfs139 ◽

2013 ◽

Vol 15 (1) ◽

pp. 61-68 ◽

Cited By ~ 12

Author(s):

Robert J. Mentz ◽

Bradley D. Allen ◽

Mary J. Kwasny ◽

Marvin A. Konstam ◽

James E. Udelson ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Reduced Ejection Fraction ◽

History Of ◽

Artery Disease

Download Full-text

The independent reduction in mortality associated with guideline-directed medical therapy in patients with coronary artery disease and heart failure with reduced ejection fraction

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcaa032 ◽

2020 ◽

Cited By ~ 1

Author(s):

Natasha K Wolfe ◽

Joshua D Mitchell ◽

David L Brown

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Medical Therapy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Antiplatelet Drug ◽

Reduced Ejection Fraction ◽

Artery Disease

Abstract Aims Guideline-directed medical therapy (GDMT) is underutilized in patients with coronary artery disease (CAD). However, there are no studies evaluating the impact of GDMT adherence on mortality among patients with CAD and heart failure with reduced ejection fraction (HFrEF). We sought to investigate the association of GDMT adherence with long-term mortality in patients with CAD and HFrEF. Methods and results Surgical Treatment for Ischaemic Heart Failure (STICH) was a trial of patients with an left ventricular ejection fraction ≤35% and CAD amenable to coronary artery bypass graft surgery (CABG) who were randomized to CABG plus medical therapy (N = 610) or medical therapy alone (N = 602). Median follow-up time was 9.8 years. We defined GDMT for the treatment of CAD and HFrEF as the combination of at least one antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The primary outcome was all-cause mortality. Assessment of the independent association between GDMT and mortality was performed using multivariable Cox regression with GDMT as a time-dependent covariate. In the CABG arm, 63.6% of patients were on GDMT throughout the study period compared to 66.5% of patients in the medical therapy arm (P = 0.3). GDMT was independently associated with a significant reduction in mortality (hazard ratio 0.65, 95% confidence interval 0.56–0.76; P < 0.001). Conclusion GDMT is associated with reduced mortality in patients with CAD and HFrEF independent of revascularization with CABG. Strategies to improve GDMT adherence in this population are needed to maximize survival.

Download Full-text