bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of dapagliflozin across the spectrum of baseline risk: a post-hoc analysis of DAPA-HF
Authors: Docherty K.F , Jhund P.S , Bengtsson O , Demets D.L , Inzucchi S.E , Kober L , Kosiborod M.N , Langkilde A.M , Lindholm D , Martinez F.A , Ponikowski P , Sabatine M.S , Sjostrand M , Solomon S.D , McMurray J.J.V 
Published: November 2020

Abstract

Background
In DAPA-HF, compared to placebo, the sodium-glucose cotransporter 2 (SGLT-2) inhibitor, dapagliflozin, reduced the risk of cardiovascular death or worsening heart failure in patients with heart failure with reduced ejection fraction (HFrEF). The majority of patients in DAPA-HF reported mild functional limitation, however there is significant heterogeneity in prognosis among these patients.

Purpose
To examine the effect of dapagliflozin compared with placebo across the spectrum of baseline risk in DAPA-HF.

Methods
The primary composite outcome of DAPA-HF was time-to-first cardiovascular death or worsening heart failure event (hospitalization for heart failure or outpatient visit requiring intravenous therapy). We examined whether the effect of dapagliflozin was modified by baseline risk, as determined by the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) risk score based upon 13 predictive variables giving a potential maximum score of 57. The number needed to treat (NNT) to over a median follow-up of 18.2 months was calculated by applying the overall relative risk reduction in DAPA-HF (26%, 95% CI 15–35) to the proportion of patients with a primary outcome event in the placebo group of each MAGGIC risk score category (defined by quintiles of score).

Results
The MAGGIC risk score was calculable for 4740 of 4744 patients in DAPA-HF. The median score was 22 (range 3–43). The event rate for the primary outcome was 7.2 per 100 patient-years in the lowest risk score quintile and 25.7 in the highest. A 1-point increase in score was associated with an 8% increase in the risk of a primary outcome event (p&lt;0.001). Dapagliflozin, compared to placebo, reduced the risk of the primary outcome across quintiles of the MAGGIC risk score (Figure - Interaction p value=0.69) and when the score was analysed as a continuous variable (Interaction p value=0.56). The NNT to prevent one primary event was 39 (95% CI 29–68) in the lowest quintile of risk scores, compared with 14 (11–25) in the highest quintile (Figure).
Similar results were found for the individual components of the primary composite outcome and for all-cause mortality.

Conclusions
DAPA-HF included patients with a wide spectrum of risk. Treatment with dapagliflozin, compared to placebo, reduced the risk of cardiovascular death or worsening heart failure, irrespective of baseline risk as measured by the MAGGIC risk score.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): DAPA-HF was funded by AstraZeneca
The effect of dapagliflozin in patients with HFrEF and COPD: a post-hoc analysis of DAPA-HF
Authors: Dewan P , Jhund P.S , Bengtsson O , Demets D.L , Inzucchi S.E , Kober L , Kosiborod M.N , Langkilde A.M , Lindholm D , Martinez F.A , Ponikowski P , Sabatine M.S , Sjostrand M , Solomon S.D , McMurray J.J.V 
Published: November 2020

Abstract

Background
Chronic obstructive pulmonary disease (COPD) is an important comorbidity in HFrEF, associated with worse outcomes and suboptimal treatment due to under-prescription of beta-blockers. Consequently, additional effective therapies are especially relevant in patients with COPD. In DAPA-HF, compared to placebo, the sodium-glucose cotransporter 2 (SGLT-2) inhibitor, dapagliflozin, reduced risk of cardiovascular (CV) death or worsening heart failure (HF) in patients with HF with reduced ejection fraction (HFrEF).

Purpose
To examine effect of dapagliflozin, compared with placebo, in patients with and without COPD.

Methods
Primary composite outcome of DAPA-HF was time-to-first CV death or worsening HF event (hospitalization for HF or outpatient visit requiring intravenous therapy). We examined whether effect of dapagliflozin was modified by investigator reported COPD at baseline.

Results
Overall, 585 (12.3%) of the 4744 patients randomized had an investigator-reported history of COPD, 299 (12.6%) in dapagliflozin group and 286 (12.1%) in placebo group. Incidence of primary composite outcome, in the placebo group, was higher in patients with COPD than in those without (22.8; 95% CI 18.4–28.3 vs. 14.9; 13.5–16.4) (Table). Hazard ratio (HR) for the effect of dapagliflozin, compared with placebo, on the primary outcome, was consistent in patients with and without COPD (Table); P-value for interaction was 0.467. Findings for other outcomes were similar (Figure).

Conclusions
Patients in DAPA-HF with COPD were at substantially higher risk than those without. Treatment with dapagliflozin, compared to placebo, reduced risk of CV death and worsening HF, similarly, in patients with and without COPD.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): DAPA-HF was funded by AstraZeneca
Coronary sinus fetuin and sodium levels are independently associated with all-cause mortality in patients awaiting heart transplantation
Authors: Szczurek W , Gasior M , Skrzypek M , Romuk E , Zembala M , Malyszek-Tumidajewicz J , Szygula Jurkiewicz B 
Published: November 2020

Abstract

Background
Risk stratification is a critical component of selection process of the patients with end-stage heart failure (HF) who are considered for heart transplantation (HT). Due to the constantly increasing number of the patients placed on the transplant waiting lists and a global shortage of organs available for HT, the key issue becomes an accurate risk stratification of death and proper organ allocation to these patients who will benefit the most from this form of treatment.

Purpose
The aim of this study was to identify the factors associated with mortality during a 1.5-year follow-up in patients with end-stage HF awaiting HT.

Methods
We prospectively analysed 72 patients with advanced HF awaiting HT at our institution between 2015 and 2016. At the time of inclusion in the study routine laboratory tests, cardiopulmonary exercise test, echocardiography, and right heart catheterisation were performed in all patients. During right heart catheterisation, 10 ml of coronary sinus blood was collected. Fetuin serum concentration was measured by the sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit.The end-point was defined as all-cause mortality during a 1.5 years follow-up. Our medical university local Institutional Review Board approved the study protocol, and all patients provided informed consent. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Results
Patients' median age was 53.00 (46.00–58.00) years, and 91.7% were men. During the 1.5-year follow-up, 31 (43.1%) patients died. The area under the receiver operating characteristic curve indicated a good discriminatory power of fetuin (AUC: 0.917 [95% CI: 0.858–0.977]). The cut-off point for fetuin (&lt;632.36) had a sensitivity of 87% and a specificity of 83%. Patients with a lower fetuin level had a significantly worse 1.5-year survival compared to the group with a higher fetuin level (20.6% versus 89.5%; (long rank p&lt;0.001). Fetuin OR 0.990 (0.986–0.996); p&lt;0.001) and plasma sodium levels (OR, 0.640 [0.464–0.882]; p&lt;0.001) were independent predictors of death during 1.5-year follow-up period.

Conclusions
Our study demonstrated that a low coronary sinus fetuin and peripheral blood sodium levels are associated with mortality patients with advanced HF accepted for HT. In addition, fetuin level, with excellent prognostic strength, allows for the risk stratification of death in analysed group of patients.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia
Real world experience on angiotensin receptor and neprilysin inhibition in reduced ejection fraction heart failure patients with advanced chronic kidney disease
Authors: Hsu C.Y , Chang H.Y 
Published: November 2020

Abstract

Background
Angiotensin receptor and neprilysin inhibition (ARNI) reduces the risk of cardiovascular mortality among patients with heart failure with reduced ejection fraction (HFrEF) as compared with enalapril in the PARADIGM-HF trial. However, patients with glomerular filtration rate (GFR) less than 30 ml/min/1.73 m2 or systolic blood pressure less than 100 mmHg were excluded from the PARADIGM-HF trial. We assessed the potential beneficial effects of ARNI in HFrEF patients with advanced chronic kidney disease (GFR&lt;30 ml/min/1.73 m2) by using a multicenter real-world data in Taiwan.

Methods
The TAROT-HF (Treatment with Angiotensin Receptor neprilysin inhibitor for Taiwan Heart Failure patients) study is a multicenter study which enrolled 1,694 HFrEF patients on ARNI treatment from 9 hospitals between March 2017 and December 2018. The data was compared to the outcome from the TSOC (the Taiwan Society of Cardiology)-HFrEF registry which enrolled 1,509 HFrEF patients from 21 hospitals between 2013 and 2014 prior to era of ARNI. After 1:1 propensity score matching, a total of 1,198 patients from the TAROT-HF study and 1,198 patients from the TSOC-HFrEF registry were included for analysis.

Results
During the 1 -year follow-up, the TAROT-HF cohort showed a significant superior prognosis on cardiovascular (CV) death (6.8% vs 10.6%, p&lt;0.001) and all-cause death (8.5% vs 16.2, p&lt;0.001) as compared with the TSOC-HFrEF study population. The patients were classified into 4 groups according to the renal function with eGFR values of &lt;30, 30–59, 60–89, and ≥90 ml/min/1.73m2, and there was no significant interaction between matched cohorts and renal function. The beneficial effects of ARNI on CV death and all-cause death were consistent across four eGFR groups, including 387 patients with eGFR&lt;30 ml/min/1.73m2 (16.2%).

Conclusions
Our study demonstrated the effectiveness of ARNI on HFrEF patients in real world experience, including those with advanced chronic kidney disease with eGFR&lt;30 ml/min/1.73m2.

Funding Acknowledgement
Type of funding source: None
Risk stratification in hf with mid-range LVEF: the role of cardiopulmonary exercise testing
Authors: Rocha B.M.L , Lopes Da Cunha G.J , Lopes P.M.D , Freitas P.N , Gama F , Brizido C , Strong C , Andrade M.J , Ventosa A , Tralhao A , Aguiar C.M.T , Durazzo A , Mendes M 
Published: November 2020

Abstract

Background
Cardiopulmonary exercise testing (CPET) is recommended in the evaluation of selected patients with Heart Failure (HF). Notwithstanding, its prognostic significance has mainly been ascertained in those with left ventricular ejection fraction (LVEF) &lt;40% (i.e., HFrEF). The main goal of our study was to assess the role of CPET in risk stratification of HF with mid-range (40–49%) LVEF (i.e., HFmrEF) compared to HFrEF.

Methods
We conducted a single-center retrospective study of consecutive patients with HF and LVEF &lt;50% who underwent CPET from 2003–2018. The primary composite endpoint of death, heart transplant or HF hospitalization was assessed.

Results
Overall, 404 HF patients (mean age 57±11 years, 78.2% male, 55.4% ischemic HF) were included, of whom 321 (79.5%) had HFrEF and 83 (20.5%) HFmrEF. Compared to the former, those with HFmrEF had a significantly higher mean peak oxygen uptake (pVO2) (20.2±6.1 vs 16.1±5.0 mL/kg/min; p&lt;0.001), lower median minute ventilation/carbon dioxide production (VE/VCO2) [35.0 (IQR: 29.1–41.2) vs 39.0 (IQR: 32.0–47.0); p=0.002) and fewer patients with exercise oscillatory ventilation (EOV) (22.0 vs 46.3%; p&lt;0.001). Over a median follow-up of 28.7 (IQR: 13.0–92.3) months, 117 (28.9%) patients died, 53 (13.1%) underwent heart transplantation, and 134 (33.2%) had at least one HF hospitalization. In both HFmrEF and HFrEF, pVO2 &lt;12 mL/kg/min, VE/VCO2 &gt;35 and EOV identified patients at higher risk for events (all p&lt;0.05). In Cox regression multivariate analysis, pVO2 was predictive of the primary endpoint in both HFmrEF and HFrEF (HR per +1 mL/kg/min: 0.81; CI: 0.72–0.92; p=0.001; and HR per +1 mL/kg/min: 0.92; CI: 0.87–0.97; p=0.004), as was EOV (HR: 4.79; CI: 1.41–16.39; p=0.012; and HR: 2.15; CI: 1.51–3.07; p&lt;0.001). VE/VCO2, on the other hand, was predictive of events in HFrEF but not in HFmrEF (HR per unit: 1.03; CI: 1.02–1.05; p&lt;0.001; and HR per unit: 0.99; CI: 0.95–1.03; p=0.512, respectively). ROC curve analysis demonstrated that a pVO2 &gt;16.7 and &gt;15.8 mL/kg/min more accurately identified patients at lower risk for the primary endpoint (NPV: 91.2 and 60.5% for HFmrEF and HFrEF, respectively; both p&lt;0.001).

Conclusions
CPET is a useful tool in HFmrEF. Both pVO2 and EOV independently predicted the primary endpoint in HFmrEF and HFrEF, contrasting with VE/VCO2, which remained predictive only in latter group. Our findings strengthen the prognostic role of CPET in HF with either reduced or mid-range LVEF.

Funding Acknowledgement
Type of funding source: None
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

Abstract

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

Abstract

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) &gt;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% &lt;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 &gt;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 (&gt;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

Abstract

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 &lt;100ms, 100–130ms or &gt;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 &gt;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

Abstract

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&lt;40%) and HF with preserved EF (HFpEF; EF&gt;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