bluuebunny/crossref_metadata_2025 huggingface dataset:
A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations
Authors: Jimenez S , Cainzos-Achirica M , Monterde D , Garcia-Eroles L , Enjuanes C , Garay A , Yun S , Alcoberro L , Moliner P , Hidalgo E , Calero E , Marin R , Corbella X , Comin-Colet J
Published: November 2020

Background

Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts.

Purpose

To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions.

Methods

In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN).

Results

The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase).

Conclusion

In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.
Temporal trends in incidence of heart failure in relation to age and gender in western Sweden 2008–2017
Authors: Wideqvist M , Rosengren A , Schaufelberger M , Pivodic A , Fu M
Published: November 2020

Background

During the last decades we have witnessed gradually improved cardiovascular primary and secondary prevention, while life expectancy is increasing, with a growing population of elderly people. Heart failure is a disease of the elderly and end stage of other cardiac diseases. Accordingly, trends in incidence of heart failure are dynamic and may differ by age and gender

Purpose

To investigate overall trends in incidence for HF over the last decades in Western Sweden. Additionally we wanted to study incidence in relation to age and gender.

Method

The VEGA database is an administrative database of all patients managed in hospital care (through direct linkage to the Swedish nationwide patient registry) and/or in primary care facilities (private and public) living in Western Sweden. All patients with a main or contributory diagnosis of HF (I50) >18 years of age between 2008 and 2017 were included in our cohort. HF incidence was calculated based on the entire population of Vastra Gotaland (a region of Western Sweden).

Results

The adult population in Western Sweden increased by 8% from 2008 (n=1,234,609) to 2017 (n=1,338,906), with 69% <60 years of age and 50% female, both constant over time.

In total, 62,229 incident cases of HF were identified during 2008–2017. In 2008 we identified 6464 cases with a mean age of 78.7 (11.5) and 49.8% (n=3222) male patients, while in 2017 5,727 cases were identified with a mean age of 78.3 (11.8) and 52.5% (n=3006) male cases.

The yearly incidence rate of HF remained constant over the 10-year period but with large variations by age and gender. A constantly higher incidence of HF was seen for men compared to women in all age categories. Although overall incidence remained constant in the last decade, we did observe decreasing incidence among those >80 years of age with incidence rates dropping from 4.4% to 3.0% between 2008–2017 (80–90 years) and from 7.8 to 5.5% in the same period (>90 years of age). A similar pattern was seen in both men and women in these age groups with incidence decreasing over the last ten years.

Conclusion

The overall incidence of HF remained unchanged over the last decade. However a declining trend in incidence was observed in the oldest part of the population, who, however, constitutes only approximately 5% of the population. Our findings emphasize the need for implementation of effective preventive strategies for HF.

Trends in HF incidence 2007-2018

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swedish agreement between the government and the county councils concerning economic support for providing an infrastructure for research and education of doctors (ALF), and the Regional Development Fund, Västra Götaland County, Sweden (FOU-VGR)
Population prevalence of atrial fibrillation and QRS prolongation and mortality in people with suspected heart failure
Authors: Friday J.M , Pellicori P , Hillen N , McAllister D , Kean S , Wolters M , Cleland J.C.F
Published: November 2020

Background

The 12-lead electrocardiogram (ECG) is an essential tool for the diagnosis and management of heart failure (HF). There are few population-based studies on the prevalence and prognostic implications of ECG abnormalities in patients with HF. There are also no robust diagnostic criteria for HF. We explored these issues in a large administrative database.

Methods

The National Health Service Greater Glasgow and Clyde Health Board serves a population of ∼1.1 million. We obtained de-identified administrative data, including investigations, diagnosis and prescriptions, linked to hospital admissions and deaths, for anyone with a diagnosis of vascular disease or HF or prescribed loop diuretics (LD) or neuro-endocrine antagonists between 1st January 2012 and 1st April 2018. People were classified into 5 exclusive groups: a) prevalent HF; b) incident (or latent) HF with onset during follow-up; c) people taking LDs but with no diagnosis of HF at any time; d) new prescription of LDs during follow-up but with no diagnosis of HF at any time and d) people to whom none of the above applied. ECGs were classified according to heart rhythm (sinus, AF or flutter or pacemaker/CRT/ICD) and QRS duration <100ms, 100–130ms or >130ms. Follow-up for each group started on 1st of January 2012 (prior to the onset of the classifying event for incident groups).

Results

During the observation period, of 316,350 people included, 158,421 had a recorded ECG (mean of 3.2 per person with an ECG), including 8,768 prevalent and 13,195 incident cases of HF. Of those who never got a diagnosis of heart failure, 11,508 were receiving and a further 14,633 were newly prescribed LD during follow-up. There were 110,317 people who did not fall into the above groups, of whom 51,089 were aged ≥60 years. A higher proportion of those who were prescribed loop diuretics without a diagnosis of heart failure were women. A similar proportion of those with heart failure and those prescribed diuretics alone had, lung disease and renal dysfunction but patients with heart failure had more ischaemic heart disease, more often had a heart rhythm other than sinus and had longer QRS duration. By three years, 8,816 people (11%) had died, of whom 2,919 (33%) had a diagnosis of heart failure and 2,694 (31%) had been prescribed LD without a diagnosis of HF, together accounting for 64% of all deaths. Patients with a rhythm other than sinus had a worse prognosis in all 5 groups of patients. QRS duration >130ms was associated with a worse prognosis in patients with HF or taking LD.

Conclusions

Most people with cardiovascular disease who die will first develop HF or be prescribed a LD (indicating possible undiagnosed HF). Patient characteristics of those prescribed LD suggest that many might have HF with preserved left ventricular ejection fraction (HFpEF).

Baseline characteristics and HR

Funding Acknowledgement

Type of funding source: None
Late mortality with a 3-year follow-up of hospitalized patients with heart failure with normal, mid-range or reduced ejection fraction
Authors: Dutra G , Ferraz De Oliveira Gomes B , Moreira Curcio T , De Oliveira Pereira L , Ferreira Da Silva Mendes B , Paiter Nascimento J.H , Moreira Bastos Da Silva T , Menezes I.R.R , Fernandes Petriz J.L , Resende Do Carmo Junior P , De Braganca Pereira B , Moraes Oliveira G.M
Published: November 2020

Introduction

In 2016, the European Society of Cardiology published a new concept of heart failure (HF) inbetween HF with reduced ejection fraction (EF) (HFrEF; EF<40%) and HF with preserved EF (HFpEF; EF>50%), the HF with mid-range EF (HFmrEF; EF between 40% and 49%). There are few studies evaluating its distinct clinical characteristics, especially in Latin America.

Objective

To compare clinical, laboratory and mortality characteristics in individuals with HFpEF, HFmrEF and HFrEF.

Method

Retrospective analysis in a prospective database of Brazilian coronary care unit admissions of patients clinically diagnosed with decompensated HF associated with serum cerebral natriuretic peptide (BNP) levels above 400 mg/dL, between September 2011 and June 2019. The clinical and laboratory characteristics of the patients, as well as the HF classification into HFpEF, HFmrEF and HFrEF, were evaluated with the first echocardiogram of the hospitalization. Analysis of variance (ANOVA) to compare means, the chi-square test for categorical variables, and the Cox regression for survival analysis were performed, with a significance level of 5%.

Results

The analysis included 519 patients (mean age, 74.46±12.75 years; men, 59.6%). Post-discharge follow-up was 2.94±2.55 years. Late mortality according to EF did not statistically differ between groups (53.8% x 52.1% x 57.9%, p=0.5). Multivariate analysis with Cox regression showed the following main predictors of late mortality: age (aHR 1.03; 95% CI: 1.02–1.04) and dementia (aHR 1.85; 95% CI: 1.31–2.62). The HFpEF group (aHR 1.63; 95% CI: 1.08–2.94) had higher mortality as compared to the HFmrEF (aHR 0.59; 95% CI: 0.36–0.97) and the HFrEF (aHR 0.63; 95% CI: 0.32–1.2) groups.

Conclusion

Factors associated with aging, such as dementia, were predictors of higher late mortality. The multivariate analysis of survival, regardless of the risk factors studied, showed a higher 3-year mortality in the HFpEF group as compared to that of the HFmrEF and HFrEF groups.

Funding Acknowledgement

Type of funding source: None
The unsurpassed value of cardiopulmonary exercise testing in assessing the prognosis of heart failure
Authors: Avila D.X , Vivacqua R.C , Serra S , Montera M.W , Tinoco E , Siciliano A
Published: November 2020

Introduction

Cardiopulmonary exercise testing (CPET) has become an important clinical tool to predict outcome in patients with chronic heart failure (CHF) and help to select candidates for heart transplantation (HTx) or left ventricular assist devices (LVAD).

Purpose

To evaluate CPET measurements in advanced CHF patients that are being considered for HTx or LVAD and its association to early mortality regardless of the performed procedure.

Methods

Maximum intensity CPET was performed on a treadmil and ramp protocol in 65 patients with patients with CHF and reduced ejection fraction, NYHA functional classes III and IV between 2012 and 2018. Measurements derived from CPET were the following: peak V'O2, VO2 at the anaerobic threshold (AT), percentage of the VO2 of the anaerobic threshold in relation to the peak, the VE/VCO2 slope, maximum heart rate (HR), respiratory quotient (R), oxygen kinetics, circulatory power (CP), the recovery HR in the first minute and the oxygen uptake efficiency slope (OUES) and the relation (VE/VCO2 slope)/VO2 peak.

Results

Seventy-four percent were male. Mean age of 67±12 years. Amost half (47%) had ischemic etiology. There were no complications related to CPET. Ten patients were transplanted, six had an intracorporeal LVAD implanted and the reminder (49 patients) were kept in supervised physical rehabilitation program. There were 11 deaths, 2 in HTx, 2 in LVAD, 7 in the rehabilitation group. Mean follow-up among the survivors was 43 months ± 40.6 and it was 12.1±10.3 months in those who died. CPET derived measurements between survivors and non-survivors were as follows: V'O2 peak (mL kg–1 min–1): 12.6±4.6 and 8.6±2.7 (p=0.002); the VO2 AT (mL kg–1 min–1): 9.9±3.3 and 6.1±3.0 (p=0.002); VE/VCO2 slope: 34.2±12.1 and 68.1±68.7 (p=0.0003); R peak: 1.1±0.2 and 1.0±0.1 (p=0.009); t1/2, in seconds: 135.8±47.9 and 170.1±82.0 (p=0.03); HR at the first minute 16.6±13 and 7±5 (p=0.009); OUES (L min–1): 1.1±0.4 and 0.9±0.3 (p=0.04) and CP [(ml O2 kg–1 min–1) mmHg] 1.516.2±689. 3 and 960.6±363.6 (p=0.005). and the relation (VE/VCO2 slope)/V'O2 peak were 3.2±2.0 and 11.4±19.5 (p=0.001), respectively.

Conclusion

The predisposition to early death could be stratified by V'O2 peak, VO2 of the ventilatory threshold, VE/VCO2 slope, t1/2, recovery HR, OUES, CP, and by the relation (VE/VCO2 slope)/V'O2 peak.

Funding Acknowledgement

Type of funding source: Private hospital(s). Main funding source(s): own financing
Serially measured cytokines and cytokine receptors in relation to clinical outcome in patients with stable heart failure
Authors: Bouwens E , Schuurman A , Akkerhuis K.M , Baart S.J , Caliskan K , Brugts J.J , Van Ramshorst J , Germans T , Umans V.A.W.M , Boersma H , Kardys I
Published: November 2020

Background

Activation of the inflammatory response in heart failure (HF) may initially serve as a compensatory mechanism. However, on the longer term, this physiological phenomenon can become disadvantageous. Temporal patterns of inflammatory proteins other than CRP have not yet been investigated in patients with stable HF.

Purpose

We aimed to evaluate the association of 17 serially measured cytokines and cytokine receptors with clinical outcome in patients with stable heart failure.

Methods

In 263 patients, 1984 serial, tri-monthly blood samples were collected during a median follow-up of 2.2 (IQR: 1.4–2.5) years. The primary endpoint (PE) composed of cardiovascular mortality, HF-hospitalization, heart transplantation, and LVAD. We selected baseline blood samples in all patients, as well as the two samples closest to the primary endpoint, and the last sample available in event-free patients. Thus, in 567 samples we measured 17 cytokines and cytokine receptors using the Olink Proteomics Cardiovascular III multiplex assay. Associations between biomarkers and PE were investigated by joint modelling.

Results

Median age was 68 (IQR: 59–76) years, with 72% men, 74% NYHA class I-II and a median ejection fraction of 30% (23–38%). 70 patients reached a PE. After adjustment for clinical characteristics (age, sex, diabetes, atrial fibrillation, NYHA class at baseline, diuretics and systolic blood pressure), 7 biomarkers were associated with the PE (Figure). Interleukin-1 receptor type 1 (IL1RT1) showed the strongest association: HR 2.65 [95% CI: 1.78–4.21]) per standard deviation change in level (NPX) at any point in time during follow-up, followed by Tumor necrosis factor receptor 1 (TNF-R1): 2.25 [1.66–3.08], and C-X-C motif chemokine 16 (CXCL16): 2.18 [1.59–3.04]. After adjustment for baseline N-terminal pro–B-type natriuretic peptide, high-sensitive troponin T and C-reactive protein however, only IL1RT1 and TNF-R1 remained significantly associated with the PE.

Conclusion

Repeatedly measured levels of several cytokines and cytokine receptors are independently associated with clinical outcome in stable HF patients. These results suggest that repeated measurements of these biomarkers, in addition to established cardiac biomarkers, may contribute to personalized risk assessment and herewith better identify high-risk patients.

Figure 1. Associations between levels of cytokines and cytokine receptors and the primary endpoint.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): This work was supported by the Jaap Schouten Foundation and the Noordwest Academie.
Estimation of left ventricular filling pressures in transplanted hearts by echocardiography – do current guidelines work?
Authors: Kubiak G.M , Ciarka A , Janssens S , Van Cleemput J , Voigt J.-U
Published: November 2020

Introduction

End-stage heart failure (HF) can be successfully treated with heart transplantation (HTx), which reduces mortality and improves quality of life (QoL). Diastolic dysfunction and subsequently increased left ventricular (LV) filling pressures can be an early sign of rejection, while later after HTx, they can be suggestive for other insults to the myocardium, for example related to transplant vasculopathy. Therefore, right heart catheterization (RHC) remains a standard follow-up examination in patients after HTx. It has been questioned, whether echocardiography can accurately predict the LV filling pressures in HTx patients, and whether echocardiographic diastolic parameters correlate with hemodynamics in this population. Therefore, our study aimed to investigate the correlation between invasive measurements and echocardiographic estimates of LV filling pressures in HTx patients.

Methods

We analyzed 461 consecutive HTx patients who underwent RHC and transthoracic echocardiography on the same day. Patients were classified as having elevated LV filling pressures when the pulmonary capillary wedge (PCWP) was ≥15 mmHg. Standard echocardiographic parameters of systolic and diastolic function were measured and the decision tree of the recommendations on diastolic dysfunction assessment of the American and European imaging societies (ASE/EACVI) was applied to detect elevated LV filling pressures and determine the diastolic dysfunction grade.

Results

The invasive measurements showed elevated LV filling pressures in 303 (66%) of HTx patients. Based on the echocardiographic parameters, HTx patients were classified into the following groups: normal diastolic function (n=151, 33%), grade I (n=87, 19%), grade II (n=21,5%), and grade III (n=151, 33%) diastolic dysfunction, and indetermined group (n=51, 11%). The PCWP values differed between the groups: 14.4±0.3 mmHg vs. 13.3±0.4 vs. 20.5±0.9 mmHg vs. 22.2±0.3 mmHg vs. 17.7±0.6 mmHg, p=0.0001, accordingly (Figure A). The PCWP showed moderate correlation with E/A (r=0.49, p=0.0001) and E/e' (r=0.40, p=0.0001) (Figures B and C, resp.). The decision tree of the ASE/EACVI recommendations predicted elevated LV filling pressures with a sensitivity of 64%, specificity of 98%, negative predictive value of 59% and positive predictive value (PPV) of 98%.

Conclusions

Our study is the first to demonstrate a correlation between the LV filling pressures estimated from echocardiography and invasively measured during RHC in large HTx population. Echocardiography alone can reliably describe elevated LV filling pressures with a high PPV. The sensitivity of the algorithm, however, is limited. Additional parameters need to be identified to increase the sensitivity of the current recommendations for detection of elevated filling pressures this patients population.

Figure 1

Funding Acknowledgement

Type of funding source: None
Right ventricular myocardial work: new method for non-invasive assessment of right ventricular function in HFrEF
Authors: Butcher S.C , Fortuni F , Montero J.M , Ajmone Marsan N , Delgado V , Bax J.J
Published: November 2020

Background

The prognostic significance of speckle tracking echocardiography derived right ventricular (RV) strain has been repeatedly demonstrated in the heart failure with reduced ejection fraction (HFrEF) patient group. Nevertheless, assessing RV systolic function in the context of afterload is vital as even minimal increases in pulmonary pressures may result in a substantial reduction in RV stroke volume. The novel assessment of Right Ventricular Myocardial Work (RVMW) through the evaluation of pressure-strain loops derived by echocardiography, provides a comprehensive evaluation of RV systolic function, integrating both RV strain and afterload.

Purpose

To explore the relationship between the non-invasive estimation of RVMW with invasive indices of right heart catherization (RHC) in a cohort of patients with HFrEF.

Methods

Noninvasive analysis of RVMW was performed in 23 HFrEF patients (median age 60.4 [58.0 to 66.0] years, 74% male) who underwent echocardiography and invasive RHC within 48 hours. The novel indices of RV global constructive work (RVGCW), RV global work index (RVGWI), RV wasted work (RVWW) and RV global work efficiency (RVGWE) were analysed utilizing proprietary software originally developed for the assessment of left ventricular myocardial work by speckle tracking echocardiography. These indices and other standard measurements of RV systolic function were then compared with invasively measured cardiac index (CI), derived by thermodilution during RHC.

Results

Mean left ventricular ejection fraction was 18.7% (±6.7), with a mean cardiac index of 2.2 L/min/m2(±0.7) and a mean pulmonary arterial pressure of 32 mm Hg (±13). None of the standard echocardiographic parameters of RV systolic function, including fractional area change, RV global longitudinal strain, RV free wall strain and TAPSE were significantly correlated with cardiac index in this cohort of HFrEF patients. In contrast, two of the novel indices derived non-invasively by pressure-strain loops, RVGCW and RVGWI, demonstrated a moderate correlation with invasively measured CI (r=0.55, p=0.006 and r=0.49, p=0.018).

Conclusion

RVGCW and RVGWI are novel parameters that provide integrative analysis of RV systolic function and correlate more closely with invasively measured CI than other standard echocardiographic parameters. Their potential role in aiding clinical decision-making merits further investigation.

Funding Acknowledgement

Type of funding source: None
Lung water quantification by cardiac magnetic resonance imaging: a novel prognostic tool in hf
Authors: Rocha B.M.L , Lopes Da Cunha G.J , Freitas P , Lopes P , Santos A.C , Guerreiro S , Tralhao A , Ventosa A , Andrade M.J , Aguiar C.M.T , Abecasis J , Saraiva C , Mendes M , Ferreira A
Published: November 2020

Background

Cardiac magnetic resonance (CMR) imaging has recently been proposed to quantify lung water density (LWD, %) non-invasively. Given that pulmonary congestion plays a key role in the pathophysiology of Heart Failure (HF), we designed a study to assess the prognostic significance of a simplified LWD measure in patients with HF and reduced left ventricular ejection fraction (LVEF).

Methods

We conducted a single-center retrospective study of consecutive patients with HF and LVEF <50% who underwent CMR on a 1.5T scanner. Those with severe interstitial lung disease or chronic liver disease were excluded. All measurements were performed in a parasagittal plane at the right midclavicular line on a standard HASTE sequence, which is widely available in all CMR studies. As previously reported, LWD was determined by the lung-to-liver signal ratio multiplied by 0.7. A cohort of 102 healthy controls was used to derive the upper limit of normal (mean ± 2SD) of the LWD (21.2%). The primary endpoint was a composite of all-cause death or HF hospitalization.

Results

A total of 290 HF patients (mean age 64±12 years, 74.8% male, 56.2% of ischemic etiology) with a mean LVEF of 34±10% were included. LWD measurement took on average 35±4 seconds and showed excellent inter-observer agreement (intra-class correlation coefficient >0.90). LWD was increased in 65 (22.4%) patients. Compared to those with normal LWD, the former were more symptomatic (NYHA ≥III: 29.2% vs. 1.8%; p=0.017) and had higher median NT-proBNP [1973 (IQR: 809–3766) vs 802 (IQR: 355–2157pg/mL); p<0.001]. During a median followup of 21 months (IQR: 13–29), 20 (6.9%) patients died and 40 (13.8%) had at least one HF hospitalization. In multivariate analysis, LVEF (HR per 1%: 0.96; CI-95%: 0.93–0.99; p=0.024), creatinine (HR per 1mg/dL: 2.43; CI-95%: 1.25–4.71; p=0.009) and LWD (HR per 1%: 1.06; CI-95%: 1.01–1.12; p=0.013) were independent predictors of the primary endpoint. The findings were mainly driven by an association between LWD and HF hospitalization (HR per 1%: 1.08; CI-95%: 1.03–1.13; p=0.002).

Conclusions

A CMR-derived method for LWD quantification independently predicts an increased risk of death or HF hospitalization in HF patients with LVEF <50%. Our results support LWD measurement as a simple, reproducible and widely available method, further adding to the prognostic role of CMR in this population.

Funding Acknowledgement

Type of funding source: None
Death, hospitalization, emergency department visits and out-patient visits in patients with heart failure in contemporary practice: results from the prospective Europeam 9069-patient ARIADNE registry
Authors: Lund L.H , Zeymer U , Clark A.L , Barrios V , Damy T , Drozdz J , Fonseca C , Kalus S , Koch C , Maggioni A
Published: November 2020

Background

In Europe, heart failure (HF) is managed in variable settings and frequently in office-based practice. In HF with reduced ejection fraction (HFrEF) there is now extensive evidence based therapy, but implementation is inconsistent, variable and overall inadequate. The Assessment of Real lIfe cAre –Describing EuropeaN hEart failure management (ARIADNE) registry aimed to assess in detail how outpatients with HFrEF are managed in Europe in contemporary practice.

Methods

ARIADNE was a prospective non-interventional registry of patients with HFrEF (NYHA class II-IV) treated by office-based cardiologists or selected primary care physicians (recognized as HF specialists) in a real world setting. Patients were enrolled in 687 centres in 17 European countries, and studied at baseline and after 6 and 12 months. Key pre-specified outcomes were deaths, hospitalizations, emergency department visits, and office visits, and their primary reasons.

Results

Over 20 months, we enrolled 9069 patients; median age 69 (19–96) years, 24% women, with 30% older than 75 years, 61% NYHA class II, with a median EF 35% (30–40%).

Over a median follow-up of 353 (1–631) days, 382 patients (4.3%) died, with 171 cardiovascular deaths (1.9%). The rates of total hospitalizations overall, for HF, and for non-HF cardiovascular reasons were 19.3, 8.1, and 4.8 per 100 patient years, respectively; and rates of emergency department visits overall, for HF reasons, and for non-HF CV reason were 7.7, 1.6, and 1.8, respectively. The number of HF office visits were on average 1.0 per patient.

Conclusions

In this large multinational HFrEF registry with detailed data on cause-specific outcomes and health care utilization, incidence of death was low and outpatient HF visits were few, but incidence of HF and CV hospitalization and emergency department visits was high.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Novartis AG, Switzerland
Psychosocial and clinical factors associated with poor self-care in patients with chronic heart failure
Authors: Calero E , Hidalgo E , Rosenfeld L , Fernandez I , Garay A , Alcoberro L , Jimenez S , Yun S , Guerrero C , Moliner P , Delso C , Alcober L , Enjuanes C , Comin-Colet J
Published: November 2020

Background

Self care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease.

Beyond heart failure related factors, the role of psychosocial determinants and its interaction with clinical aspects has not been fully explored.

Aims

The aim of the study was to analyze both clinical and psychosocial factors associated with poor self care in patients with chronic HF.

Methods

Self care was evaluated at baseline with the 9 item European HFR Self Care Behaviour Scale (9 item ESCBS).

Scores were standardized and reversed from 0 (worst self care) to 100 (better self care). This study we analysed the associations between poor self care (defined as scores in the lower tertile of the 9 item ESCBS) with demographic, HF-related (clinical) and psychosocial factors in all patients at baseline.

Results

We included 1123 patients: mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40%) were in NYHA class III or IV. Mean score of the 9-item ESCBS was 69±28. In the clinical multivariate analyses HF-related factors associated with poor self-care were serum albumins level, ckd level and previous admission due to heart failure. In the psychosocial multivariate analyses poor social support, depressive symptoms and needing a caregiver were independently associated with poor self care. In combined models, only psychosocial factors were independently associated with poor self care whereas no clinical factors remain in the model.

Conclusion

Our study showed that psychosocial conditions are the main factors independently associated with poor self-care in patients with chronic heart failure

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital del Bellvitge
Population based study to compare the trends, risk factors and outcomes associated with gastrointestinal bleeding in patients with left ventricular assist devices in the US
Authors: Gonuguntla K , Patil S.P , Rojulpote C , Cowden R.G , Nasir M , Koa B , Zhang V , Schulman P
Published: November 2020

Introduction

Prior to the utilization of continuous flow devices in 2010, Gastrointestinal (GI) bleeding was a common adverse event related to LVADs.

Background

Given the drastic increase in the use of new LVADs with continuous flow (CF), we sought to determine if CF-LVADs are associated with an increased number of GI bleeds and higher mortality.

Methods

We analysed the data from a national inpatient sample database using the International Classification of Disease (ICD)-9 procedure code for LVAD use in end-stage heart failure among patients 18 years or older. Included were 2,359 patients with a mean age of 55±13.7 years and 77% males and 59% Caucasians.

Results

The Incidence of GI bleed from 2010 to 2014 was 7.46%. There was no significant yearly change in the incidence over five years (p=0.793). After controlling for age, sex, and length of stay (LOS), hierarchical multivariate logistic regression revealed that significant predictors of GI bleed were acute kidney injury (AOR=1.87, 95% CI: 1.26, 2.80), peripheral vascular disease (AOR=1.77, 95% CI: 1.02, 2.94), body mass index ≥25 (AOR=0.46, 95% CI: 0.22, 0.87), hemiplegia and paraplegia (AOR=3.01, 95% CI: 1.17, 7.05), moderate or severe liver disease (AOR=2.40, 95% CI: 0.97, 5.34), peptic ulcer disease (PUD) (AOR=18.13, 95% CI: 7.86, 42.38), surgical aortic valve replacement (AOR=2.46, 95% CI: 1.12, 5.15), and venous thromboembolism (AOR=2.58, 95% CI: 1.57, 4.15).

Conclusion

Earlier studies showed an increase in the rate of GI bleed in CF-LVADs when compared to pulsatile flow devices. However, our study has indicated that CF-LVADs display no improvement in rates of GI bleed over five years, but that there was an increased likelihood of mortality in patients with GI bleed. These findings pose further questions in regard to considering newer device designs and improved patient selection criteria.

Funding Acknowledgement

Type of funding source: None
Changes in circulating levels and cardiac expression of adiponectin system in children with heart failure after Ventricular Assist Device support
Authors: Ragusa R , Di Molfetta A , Del Turco S , Basta G , Cabiati M , Del Ry S , Amodeo A , Trivella M.G , Caselli C
Published: November 2020

Background

Ventricular Assist Device (VAD) is increasingly used as bridge to transplantation for the treatment adult and pediatric patients with end-stage Heart Failure (HF). Unloading of heart by VAD can lead to significant molecular, structural and functional changes of cardiac muscle in HF adult patients, including an improvement of the inflammatory process. Adiponectin (ADN), an anti-inflammatory adipokine, exerts anti-hypertrophic, anti-fibrotic and anti-apoptotic effects after binding to AdipoR1, AdipoR2 and T-CAD receptors. There is an apparently paradoxical increase of ADN levels in HF adult patients, probably due ADN resistance. VAD treatment leads to an increased cardiac expression of ADN receptors in HF adults. However, little is known about the role of ADN in HF children and the effects of VAD support on ADN system in these patients.

Purpose

The aims of this study were to evaluate: 1) the circulating ADN levels from HF children and a control group of healthy children; 2) the effects of VAD treatment both on circulating levels of ADN and on the cardiac expression of ADN system in pediatric patients with HF.

Methods

Circulating levels of ADN were measured in plasma samples collected from 8 HF children [age:57±33 (mean±SD) months; 2 males; 14.2±13.5 weight; 29±8 LVEF%] before and at 4 hrs, 1, 3, 7, 14 and 30 days after VAD implant. The ADN levels of paediatric patients at baseline were compared with a group of 107 [58±7 months; 67 males] healthy children. Expression levels of AdipoR1, AdipoR2, T-CAD were determined by real-time PCR in cardiac biopsies collected from HF children at the time of VAD implant (Pre-VAD) and at the time of heart transplantation (Post-VAD).

Results

Circulating levels of ADN were significantly higher in HF compared to healthy children (Figure 1A). In HF children, plasma ADN decreased significantly in early post-operative time-course (up to 3 days Post-VAD implant) and returned to pre-operative levels in 1 month (Figure 1B). In cardiac biopsies, mRNA expression of AdipoR1, AdipoR2, T-CAD increased significantly after VAD treatment compared to Pre-VAD (Figure 2A–C).

Conclusion

In pediatric patients, high circulating levels of ADN were associated with presence of HF and were modified by VAD implant, but remained significantly abnormal. On the other hand, an increased cardiac mRNA expression of ADN receptors was observed after VAD. These results could suggest the existence of a fine tuning of the ADN system at cardiac tissue level, able to mitigate plasma abnormality and favour the cardio-protective effect of ADN.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): SensorART-A Remote Controlled Sensorized ARTificial Heart Enabling Patients Empowerment and New Therapy Approaches
Predictors of late right heart failure after mechanical circulatory support
Authors: Felix S , Oerlemans M.I.F , Asselbergs F.W , Van Laake L.W , De Jonge N
Published: November 2020

Introduction

Right heart failure (RHF) is associated with a worse outcome in mechanical circulatory support (MCS). Several studies have identified risk factors for RHF shortly after MCS, though information about late RHF is limited.

Purpose

We aimed to identify risk factors for late RHF in patients with MCS, implanted as a bridge to heart transplantation.

Methods

Data of all patients, who were successfully discharged after MCS implantation in a University Medical Center between 2006–2019 were included and follow-up was completed until March 2019. Late RHF was defined as the occurrence of right ventricular dysfunction associated with symptoms, including jugular venous distension, hepatic congestion and peripheral edema during MCS support, if diagnosed after the index admission for MCS implantation. The primary end point was the diagnosis of late RHF in combination with the need for intensification of diuretics (either with or without hospitalization) and/or the need for inotropes and/or right ventricular assist device. Univariable and multivariable Cox regression analyses were performed to identify risk factors for late RHF.

Results

262 patients (66% male, mean age 51±13 years) had a mean follow-up of 901±643 days. 49 (18.7%) patients suffered from late RHF after a median of 363 (IQR 131–1001) days. Multivariable risk factors for late RHF were a higher body mass index (hazard ratio (HR) 1.05; CI 1.00–1.11), a history of atrial fibrillation (AF) prior to the operation (HR 2.11; CI 1.12–3.96), a lower (i.e. clinically worse) INTERMACS profile and a longer duration on the intensive care unit (HR 1.03; CI 1.00–1.06) during the index admission for MCS implantation (Table 1). The occurrence of early RHF was not associated with late RHF (p=0.211).

Conclusion

Late RHF is a clinically important adverse event in MCS, affecting approximately 20% of patients. Risk factors associated with late RHF most relate to the severity of the clinical situation at the time of implantation.

Funding Acknowledgement

Type of funding source: None
Device thrombosis in the Heartware LVAD treatment decision and role of log files
Authors: Demir E , Nalbantgil S.N , Ozturk P.O , Candemir A.C , Kahraman U.K , Engin C.E , Yagdi T.Y , Saeed O.S , Jorde U.J , Ozbaran M.O
Published: November 2020

Background

Device thrombosis is a significant problem during durable LVAD support, and device-specific diagnosis and treatment algorithms are necessary to optimize outcomes. The HVAD LVAD has a unique and well-developed logfile capability, yet clinical data on it's use are lacking.

Methods and results

We reviewed overall outcomes of 322 consecutive patients implanted at our University Medical Center with the HVAD LVAS with a particular emphasis on device thrombosis events. Thirty days, one year, and two years survival was 85.4%,65.0%, and 53.1%, respectively. One hundred eighty-one device thrombosis events occurred in 76 patients. Based on logfile patterns, events were categorized as gradual build-up or sudden build-up or acute occlusion/ingestion (Jorde U JACC-HF 2015). The first thrombosis event was a gradual build-up in 32, sudden build up in 5, and acute occlusion in 11 pts. An additional 46 gradual build-up, two sudden build-up, nine acute occlusion events occurred as recurrent events. 2-year survival without CVA was 72.8% in patients with gradual onset device thrombosis

72 pts received TPA. TPA was given, after discontinuing anticoagulation, and taking the INR level is under 2.0 and keeping invasively measured mean arterial blood pressure between 65–80 mmHg low dose tenecteplase (1000 units) was then given, and if clinical and logfile improvement did not occur repeated every six hours up to a total fo 4 doses (4000 units) over 24 hours. Successful therapy was defined as clinical resolution of pump thrombosis without recurrence in 30 days, LDH improvement and power consumption returned to normal, and occurred in 74.4% gradual onset, 71.4% sudden onset, and 56.3% acute occlusion. TPA was complicated by severe hemorrhage or death in 6.4% of patienst with a gradual build-up pattern, 14.3% with sudden build-up, and in 33.3% with acute occlusion.

Conclusion

Device thrombosis frequently occurs in HVAD patients, and response to therapy can be predicted by logfile analysis. TPA is an excellent option for gradual onset device thrombosis but should be avoided in the setting of acute occlusions, where early device exchange may be a better first-line strategy. Refinement of logfile analysis including earlier thrombus detection and incorporation of these techniques into clinical practice may significantly improve outcomes with the HVAD LVAD.

Funding Acknowledgement

Type of funding source: None
A nationwide analysis of 16 year trends in cardiac transplantation for acute myocarditis
Authors: Isath A , Perembeti S , Correa A , Haider S , Ho K , Rao S , Chahal A , Narasimhan B , Padmanabhan D , Garg V , Contreras J
Published: November 2020

Background

Orthotopic heart transplant (OHT) is indicated in 1–8% of patients with myocarditis. However, national trends in the utilization of transplantation and outcomes in myocarditis across the United States are not well established.

Purpose

Our objective was to study the trends and baseline characteristic of myocarditis patients undergoing heart transplant in the United States using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) from 1999 to 2014.

Methods

Using NIS data, we identified patients older than 18 years with myocarditis using codes ICD9 codes of 422.0 and 422.9. Among these patients, we identified those who underwent cardiac transplantation using ICD9 procedure codes 37.5 and 33.6. We presented categorical data as percentages and continuous data as mean or median as appropriate.

Results

We identified a total of 62,264 hospitalizations for myocarditis from 1999–2014. 430 (0.69%) myocarditis patients underwent OHT which consisted of 0.82% of all 29990 cardiac transplants identified in the same period. The trends in OHT for myocarditis is as shown in Figure 1.

The mean age was 32.9±2.4 years and 51.1% (n=219) were females. 235 (54.6%) were Caucasians and 60 (13.9%) were Hispanic. Majority of the transplants were performed at medium (16%) and large sized hospitals (80.4%). Cardiac transplants were mainly done at teaching hospitals (98.9%). Further, with regards to the geographical distribution of transplant procedure, most were done in the West (37.2%) followed by South (25.3%), Northeast (21.4%) and Mid-west (16%) of the United States. Private insurance was the major payor source which covered 245 (58%) patients followed by Medicaid covering 112 (26%) patients.

A total of 26 (6%) myocarditis patients died during the same hospitalization for OHT. In terms of discharge following OHT in myocarditis 85.8% (n=369) were discharged home and 8.1% (n=35) to short term hospitalization. The average length of stay for OHT for myocarditis was 64.3±6.3 days. Also, the mean cost of hospitalization for heart transplant in myocarditis when adjusted for inflation was 789,566±93,108 dollars.

In-patient mortality following OHT was not significantly different in large sized hospital compared to small and medium sized hospitals (7.6% vs 5.7%, p=0.54). However, the cost of hospitalization was significantly lesser in small and medium sized hospitals (588,363±154,349 vs 826,864±106,110 dollars, p<0.0001).

Conclusions

Only a small percentage of OHT is done for myocarditis with high proportion done in female when compared to OHT for other etiologies. Further studies need to be done to compare long term outcomes of heart transplant in myocarditis.

Funding Acknowledgement

Type of funding source: None
Quality of life response to BAROSTIM Therapy
Authors: Zannad F , Abraham W.T , Lindenfeld J , Weaver F , Galle E , Rogers T , Zile M
Published: November 2020

Background

Patients with heart failure with reduced ejection fraction (HFrEF) have poor quality of life as measured by both physical and emotional dimensions.

Purpose

Evaluate the quality of life in subjects with and without baroreflex activation therapy (BAT) at six months.

Methods

In a multicenter randomized trial conducted in subjects with NYHA class II (recently III) or III HFrEF, left ventricular ejection fraction ≤35%, stable optimal guideline directed medical HF therapy (GDMT), no Class 1 indication for cardiac resynchronization therapy (CRT), and NT-proBNP<1600 pg/ml, a total of 264 subjects were randomized to BAROSTIM therapy plus GDMT (BAT group) or GDMT alone (Control group). Quality of life was measured at baseline and six months using the Minnesota Living with HF Questionnaire (MLWHF) and the EuroQol 5-Dimension Long (EQ-5D) tool. From the MLWHF questionnaire, both a physical and an emotional dimension was analyzed using subsets of the 21 questions. From the EQ-5D, the five individual dimensions and the overall health status (0–100, where 100 is best) was analyzed.

Results

Of the 264 randomized subjects, 120 BAT and 125 Control subjects had 6-month quality of life data. As shown in the table, treatment with BAT resulted in significant improvements in quality of life overall, as well as in the specific dimensions of the quality of life questionnaires, compared to the Control subjects.

Conclusion

Among subjects with symptomatic HFrEF, treatment with BAT resulted in significant improvement in quality of life at six months.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): CVRx, Inc.
How mortality risk estimated by MAGGIC-HF, SHFM and BCN-Bio HF scores is modified after 12-month management in a multidisciplinary HF Clinic
Authors: Codina P , De Antonio M , Santiago-Vacas E , Domingo M , Zamora E , Santesmases J , Subirana I , Buchaca D , Alonso N , Troya M.I , Velayos P , Pulido A , Nunez J , Lupon J , Bayes-Genis A
Published: November 2020

Background

Heart failure (HF) contemporary management has significantly improved over the past two decades leading to better survival. How application of the contemporary HF management guidelines affects the risk of death estimated by available web-based risk scores is not elucidated.

Objective

To assess changes in mortality risk prediction after a after a 12-month management period in a multidisciplinary HF Clinic.

Methods

Out of 1,689 consecutive patients with HF admitted at our ambulatory HF Clinic from May 2006 to November 2018, those who completed one year follow-up were considered for the study. Patients without NTproBNP measurement or with more than 3 missing variables for risk estimation were excluded. Three contemporary web-based HF risk scores were evaluated: MAGGIC-HF, Seattle HF Model (SHFM) and the Barcelona Bio-HF Calculator containing NTproBNP (BCN Bio-HF). Risk of all-cause death at one year and at 3 years were calculated at baseline and re-evaluated after 12-month management in a multidsisciplinary HF Clinic. Wilcoxon paired data test was used to compare changes in mortality risk estimation over time and test equality of matched pairs for comparing estimated change among tools. 442 patients used to derive the Barcelona Bio-HF Calculator were excluded for discrimination purposes.

Results

1,157 patients were included (age 65.7±12.7 years, 70.4% men). A significant reduction in mortality risk estimation was observed with the three HF risk scores evaluated at 12-months (Table). The BCN Bio-HF model showed significantly different changes in risk estimation, fact that indeed was partnered with numerically better discrimination. AUC at 1 and 3 years, respectively, were: BCN Bio-HF (0.773 and 0.775), MAGGIC HF (0.686 and 0.748) and SHFM (0.773 and 0.739).

Conclusions

The three web-based risk scores evaluated showed a significant reduction in mortality risk estimation after 12 month management in a multidisciplinary HF Clinic. The BCN Bio-HF score showed higher reduction in estimated risk, together with better discrimination, likely because it incorporates contemporary treatment and use of biomarkers.

Funding Acknowledgement

Type of funding source: None