bluuebunny/crossref_metadata_2025_split huggingface dataset:
High prevalence of alcohol- and substance abuse among young heart failure patients in Sweden
Authors: Lindgren M , Habtemichael L , Rosengren A , Schaufelberger M 
Published: November 2020

Abstract

Background
Heart failure in the young is increasing. Increasing prevalence of overweight and obesity may be of importance. While alcohol and drugs are known to have cardiotoxic effects, few studies have investigated the prevalence of alcohol- or substance abuse among young patients with HF.

Aim
To investigate the prevalence of alcohol- and substance abuse in a cohort of young patients with heart failure.

Methods
All patients that received a diagnosis of heart failure at Sahlgrenska University Hosital (Sweden) between 1997 and 2016, ages 18–54, with a previously documented transthoracic echocardiogram were included. A systematic evaluation of participants electronic health records was performed, where predefined details about the use of alcohol, narcotic drugs and anabolic steroids, as well as echocardiographic findings were recorded.

Result
A total of 1363 patients were included (1001 men and 366 women, mean age 45 years), 190 (14%) of which were &lt;34 years, 304 (22%) 35–44, and 869 (64%) 45–54 years. In total, a record of either alcohol- or substance abuse was found in 28% of men and 9% of women, respectively. The prevalence of Anabolic steroids was found to be 2% among men. For substance abuse, the prevalence was found to be 12% in men and 5% in women. Alcohol abuse was found in 24% of men and 5% of women. Both alcohol- and drug abuse was most common in the highest age group.

Conclusion
There was a high prevalence of alcohol- and/or drug-abuse among young adults with heart failure, especially in male patients.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swedish state under the agreement concerning research and education of doctors [grant number ALFGBG-427301]; The Swedish Society for Physicians, the Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Sweden, and the Swedish Heart and Lung Foundation [grant number 2015-0438]
Effects of canagliflozin in patients with type 2 diabetes and chronic heart failure: a randomized trial (CANDLE)
Authors: Tanaka A , Hisauchi I , Taguchi I , Sezai A , Toyoda S , Tomiyama H , Sata M , Ueda S , Oyama J , Kitakaze M , Murohara T , Node K 
Published: November 2020

Abstract

Background
Little is known about the impacts of sodium glucose co-transporter 2 inhibitors on cardiac functional parameters, such as natriuretic peptides, in type 2 diabetes (T2D) patients with concomitant chronic heart failure (CHF).

Purpose
To compare the effect of canagliflozin with glimepiride, based on changes in N-terminal pro-brain natriuretic peptide (NT-proBNP), in that patient population.

Methods
This trial was an investigator-initiated, multicenter, prospective, randomized, open-label, blinded-endpoint trial at 34 centers in Japan. Patients with T2D and clinically stable CHF excluding NYHA class IV, randomized to receive canagliflozin 100 mg or glimepiride (starting dose: 0.5 mg), were examined using the primary endpoint of non-inferiority of canagliflozin versus glimepiride, defined as a margin of 1.1 in the upper-limit of the 2-sided 95% confidence interval (95% CI) for the group ratio of percentage change in NT-proBNP at 24 weeks.

Results
Data analysis of 233 patients (mean age 68.6±10.1 yrs; 75% male) showed mean left ventricular ejection fraction (LVEF) at randomization was 57.6±14.6%, with 71% of patients having a preserved LVEF (≥50%). The ratio of NT-proBNP percentage change was 0.48 (95% CI, −0.13 to 1.59, P=0.226), and therefore did not meet the prespecified non-inferiority margin. However, data stratified according to baseline NT-proBNP levels showed a trend that canagliflozin treatment reduced NT-proBNP levels to a greater extent than in subgroups with elevated levels of NT-proBNP (Figure A). Furthermore, NT-proBNP levels in the canagliflozin group did show a nonsignificant trend lower in the subgroup with preserved LVEF (Figure B), but not in the subgroup with reduced LVEF (Figure C). Additionally, the changes in the NYHA class were comparable between groups (P=0.061) in the overall cohort, whereas in the subgroup with a preserved LVEF canagliflozin caused a significant improvement in NYHA classes compared to that found for glimepiride treatment (P=0.027).

Conclusions
This trial did not meet the predefined primary endpoint of changes in NT-proBNP levels, with 24 weeks of treatment with canagliflozin relative to glimepiride which together with other recent studies would question the value of continuing to monitor NT-proBNP levels after the initial diagnosis of heart failure. Nevertheless, in a subgroup with preserved LVEF, there was a non-significant trend for canagliflozin treatment to reduce NT-proBNP levels and improve symptoms even in stable HF patients. Further research is therefore warranted to determine whether patients with preserved LVEF, regardless of diabetes status, could potentially benefit from treatment with SGLT2 inhibitors.
Changes in NT-proBNP

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Mitsubishi Tanabe Pharma Corporation
Discharge heart rate and clinical outcomes in hospitalized heart failure patients with coexisted atrial fibrillation
Authors: Xing F , Bai X , Li J 
Published: November 2020

Abstract

Background
Whether discharge heart rate for hospitalized heart failure (HF) patients with coexisted atrial fibrillation (AF) is associated with long-term clinical outcomes and whether this association differs between patients with and without beta-blockers have not been well studied.

Purpose
We investigated the associations between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF, while stratified to beta-blockers at discharge.

Methods
The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. We analyzed association between outcome and heart rate at discharge with restricted cubic spline and Cox proportional hazard ratios (HR).

Results
The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, the relationship between discharge heart rate and clinical outcome may be nonlinear (P&lt;0.01). Based on above result, these patients were divided into 3 groups: lowest &lt;65 bpm, middle 65–86 bpm and highest ≥87 bpm, clinical outcomes occurred in 128 (64.32%), 624 (53.42%) and 156 (59.32%) patients in the lowest, middle, and highest groups respectively. In the Cox proportional hazard analysis, the lowest and highest groups were associated with increased risks of clinical outcome compared with the middle group (HR: 1.289, 95% confidence interval (CI): 1.056 - 1.573, p=0.013; HR: 1.276, 95% CI: 1.06 - 1.537, p=0.01, respectively). And a significant interaction between discharge heart rate and beta-blocker use was observed (P&lt;0.001 for interaction). Stratified analysis showed the lowest group was associated with increased risks of clinical outcomes in patients with beta-blockers (HR: 1.584, 95% confidence interval (CI): 1.215–2.066, p=0.001).

Conclusion
There may be a U-curve relationship between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF. They may have the best clinical outcomes with heart rates of 65 - 86 bpm. And strict heart rate control (&lt;65 bpm) may be avoided for patients who discharge with beta-blockers.
Figure 1

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).
Cause-specific mortality and heart failure readmissions according to the HFA-PEFF algorithm in patients hospitalised for heart failure with preserved ejection fraction
Authors: Verbrugge F.H , Reddy Y.N.V , Carter R.E , Borlaug B.A 
Published: November 2020

Abstract

Background
The HFA-PEFF algorithm has been recently developed and is recommended by the European Society of Cardiology to make a diagnosis of heart failure with preserved ejection fraction (HFpEF). Based on functional echocardiography criteria, morphological criteria, and natriuretic peptide levels, a score from 1 to 6 is obtained with higher scores indicating a higher probability of HFpEF.

Purpose
This study investigates the prognostic value of the HFA-PEFF score in HFpEF patients hospitalised for decompensation.

Methods
This retrospective cohort study includes consecutive patients with HFpEF, admitted to Mayo Clinic Rochester between 2010–2015 and requiring treatment with intravenous loop diuretics for congestion. The HFA-PEFF score was calculated for all patients with echocardiography data available within 1 year and natriuretic peptide levels obtained upon admission. The study population was subsequently stratified according to HFA-PEFF score ≤4 (n=79), =5 (n=93), or =6 (n=271). Incidence rates of recurrent heart failure admissions per 100 patient-years of follow-up, time to all-cause mortality, and mortality causes were compared among strata.

Results
In 443 patients with HFpEF (78±12 years; 60% women), higher HFA-PEFF score was associated with older age, female gender, higher systolic blood pressure, and worse renal function. Heart failure readmission rates were higher in patients with HFA-PEFF score =5 [46.0 (38.5–53.5)] or HFA-PEFF score =6 [45.0 (40.1–49.8)] versus HFA-PEFF score ≤4 [28.9 (22.7–35.0); P-value&lt;0.001 for differences; see upper panel figure]. Increasing HFA-PEFF score was associated with a shorter median survival (P-value&lt;0.001), which was 65 months (36–89 months) in HFA-PEFF score ≤4, 45 months (26–59 months) in HFA-PEFF score =5, and 28 months (22–42 months) in HFA-PEFF score =6 (see lower panel figure). The proportions of deaths directly related to heart failure were comparable among HFA-PEFF strata (49% versus 49% versus 52%, respectively; P-value=0.903), as was the contribution of cardiovascular death (60% versus 57% versus 63%, respectively; P-value=0.662). Overall, few differences in patterns of mortality causes were observed among strata. There was a lower contribution of primary respiratory disease (mainly chronic obstructive pulmonary disease) to mortality in patients with a higher HFA-PEFF score (26% versus 19% versus 6%, respectively; P-value&lt;0.001).

Conclusions
Higher HFA-PEFF score in hospitalized patients with HFpEF is associated with increased risk of subsequent heart failure readmissions and all-cause mortality, which includes both heart failure specific and non-heart failure mortality.
Heart failure readmissions & mortality

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Belgian American Educational Foundation (B.A.E.F.); Special Research Fund (BOF) of Hasselt University (Hasselt, Belgium)
Validation and comparison of BIOSTAT risk score and AHEAD score for patients with acute heart failure
Authors: Ishiwata S , Matsue Y , Kasai T , Yatsu S , Matsumoto H , Shitara J , Shimizu M , Kurita A , Kato T , Suda S , Hiki M , Takagi A , Daida H 
Published: November 2020

Abstract

Background/Introduction
Acute heart failure (AHF) is one of the major causes of mortality, and identifying the patients at high risk of mortality at the time of admission is crucial to improve clinical outcomes. Although some risk prediction models for patients with AHF have been proposed mainly from randomized clinical trials, the patients in such studies tend not to be similar to those in the real world. Recently, BIOSTAT risk score and AHEAD score derived from two large-scale registry dataset are proposed as useful risk stratification tools for patients with AHF. However, these scores have not been well externally validated and their prognostic prediction performance has not been directly compared.

Purpose
To validate and compare prognostication of BIOSTAT risk score and AHEAD score in AHF patients.

Methods
Patients who consecutively admitted to the cardiac intensive-care unit in our institution with a diagnosis of AHF from 2007 to 2011 were analyzed. Among them, patients with acute coronary syndrome, dialysis, malignancy were excluded. BIOSTAT risk score was calculated using 5 factors (age, blood urea nitrogen, BNP, hemoglobin, prescription of beta blockers), and AHEAD score was also calculated with 5 factors (atrial fibrillation, hemoglobin, age, creatinine, and diabetes mellitus). We also developed AHEAD + BNP model incorporating BNP into AHEAD score. Endpoint was 1-year all-cause death.

Results
Overall, 591 eligible patients were enrolled (mean age was 70±14 years old, 64.8% were male) and 96 patients (16.2%) died during the follow-up of 1-year. The median [interquartile range] of AHEAD score and BIOSTAT risk score were 2 [1–3] and 3 [2–4], respectively. The areas under the curves of receiver operating characteristic curve (AUC) were 0.66 for AHEAD, 0.68 for AHEAD + BNP, and 0.72 for BIOSTAT, respectively. The calibration plots for AHEAD, AHEAD + BNP, and BIOSTAT models showed good calibration (Hosmer-Lemeshow test: p=0.89, 0.74, and 0.74, respectively). The BIOSTAT model's AUC was significantly higher compared to AHEAD (p=0.018) and marginally statistically higher compared to AHEAD + BNP (p=0.054). However, BIOSTAT model showed statistically significant net reclassification improvement compared to both AHEAD (NRI: 0.43, p&lt;0.001) and AHEAD + BNP (NRI: 0.43, p&lt;0.001).

Conclusion
The BIOSTAT score comprised of five readily available clinical variables predict 1-year mortality of patients with AHF with good discrimination and calibration.
ROC curves

Funding Acknowledgement
Type of funding source: None
Early coronary angiography in acute ischemic heart failure is associated with improved survival and lower rates of heart failure hospitalization
Authors: Kosyakovsky L , Wang X , Austin P.C , Abdel-Qadir H , Lawler P.R , Croxford R , Farkouh M.E , Goodman S.G , Spertus J.A , Ross H.J , Lee D.S 
Published: November 2020

Abstract

Background
While coronary ischemia plays a major role in the pathogenesis and prognosis of heart failure (HF), the indications for coronary angiography in acute HF have not been established.

Purpose
To identify the clinical predictors of performing early coronary angiography in acute ischemic HF and determine the association of angiography with all-cause mortality, cardiovascular death, and HF readmissions.

Methods
We identified all acute HF patients who presented to any of 70 emergency departments in Ontario, Canada and determined whether they underwent early coronary angiography (defined as angiography performed within 14 days of hospital presentation) using procedural data contained in the Canadian Institute for Health Information (CIHI) database (April 2010 to March 2013). We selected patients for detailed chart review using stratified random sampling, including only those with acute ischemic HF, which we defined inclusively as those who had at least ONE of the following: previous myocardial infarction (MI), troponin elevation, or active angina on presentation. We excluded patients for whom angiography on the index admission might reasonably have been withheld, including those with recent pre-admission angiography or revascularization procedures, palliative patients, and those with contraindications to invasive angiography such as anaphylaxis to contrast, severe renal impairment, and high-risk bleeding. Predictors of 14-day coronary angiography were determined using multivariable logistic regression. We compared mortality and readmissions up to two-year follow-up. Inverse probability of treatment weighting (IPTW) using the propensity score was used to adjust for differences in baseline characteristics between the two cohorts.

Results
Of 6,172 initially screened patients, 4,118 met criteria for acute ischemic HF. After exclusions, 2,994 were included in the study. Of these, 1,567 (52.3%) underwent early angiography and 1,427 (47.7%) did not (median age 75 [IQR 65–83] years and 40.9% women). Clinical factors associated with greater odds of early angiography included previous MI, anginal symptoms at presentation, New York Heart Association (NYHA) III-IV symptoms, and family history of coronary artery disease. After IPTW, early angiography was associated with lower all-cause mortality (HR 0.74, 95% CI; 0.61–0.90, p=0.002) and cardiovascular death (HR 0.72, 95% CI; 0.56–0.93, p=0.012) at two years. HF readmissions were also lower with early angiography (HR 0.84, 95% CI; 0.71–0.99, p=0.042).

Conclusion
Early coronary angiography in acute ischemic heart failure was associated with lower all-cause mortality, cardiovascular death, and HF readmissions.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institute of Health Research Grant
Prognostic role of sonographic decongestion in patients with acute heart failure with reduced and preserved ejection fraction: a multicentre study
Authors: Pugliese N.R , Mazzola M , Bandini G , Barbieri G , Spinelli S , De Biase N , Masi S , Moggi-Pignone A , Ghiadoni L , Taddei S , Sicari R , Pang P.S , Gargani L 
Published: November 2020

Abstract

Aims
Our aim was to assess the dynamic changes of pulmonary congestion (PC) through variations of sonographic B-lines, in addition to conventional clinical, biohumoral and echocardiographic findings, to improve prognostic stratification of patients admitted for acute heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF).

Methods
In this multicenter, prospective, observational study, lung ultrasound was performed in all patients at admission and before discharge by trained investigators, blinded to clinical findings and outcomes.

Results
We enrolled 208 consecutive patients admitted for acute heart failure (125 HFrEF, 83 HFpEF, mean age 75.9±11.7 years, 36% females, mean ejection fraction 38%). After 180-day follow-up, 38 composite endpoint events occurred (cardiovascular deaths or HF re-hospitalisations). In a multivariate model, B-lines at discharge had independent prognostic value in the overall population together with NT-proBNP, moderate-to-severe mitral regurgitation (MR) and inferior vena cava diameter at admission. When dividing the population in HFrEF and HFpEF, B-lines at discharge was the only independent parameter to predict events in all subgroups. At ROC analysis, a cut-off of B-lines&gt;15 at discharge displayed the highest accuracy in predicting adverse events (AUC=0.80, p&lt;0.0001). The identification of patients unable to halve B-lines during hospitalization (ΔB-lines%), in addition to B-lines &gt;15 at discharge, improved event classification (integrated discrimination improvement=4%, p=0.01; continuous net reclassification improvement=22.8%, p=0.04).

Conclusions
The presence of residual subclinical sonographic PC at discharge predicts adverse events in the whole spectrum of acute HF patients, independently of conventional biohumoral and echocardiographic parameters. The dynamic evaluation of pulmonary decongestion during hospital stay can further improve patient risk stratification.

Funding Acknowledgement
Type of funding source: None
Intramyocardial fast-SENC is less impacted by compensatory mechanisms while monitoring cardiotoxic effects of chemotherapy than echocardiography and conventional CMR: the PREFECT study
Authors: Steen H , Montenbruck M , Gersak B , Schwarz A.K , Esch S , Kelle S , Giusca S , Korosoglou G , Wuelfing P , Dent S , Lenihan D 
Published: November 2020

Abstract

Background
Cancer treatments (CT) have been shown to occasionally elicit a toxic reaction on the heart. Echocardiography (ECHO) and cardiac magnetic resonance imaging (CMR) have been used to monitor cardiotoxicity through left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Fast-SENC (fSENC) CMR testing directly measures intramyocardial contraction to quantify subtle changes in function capable of detecting cardiotoxicity missed by conventional imaging modalities. The PREFECT study compares fast-SENC vs ECHO in terms of sensitivity of predicting and detecting subclinical (sCTX) or clinical cardiotoxicity (cCTX) irrespective of loading conditions or changes in cardiac output.

Methods
A single center, prospective clinical trial of patients receiving anthracycline-based CT had fSENC acquired during CMR exams with a 1.5T scanner. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments.

Results
63 patients had 323 scans; 41% experienced sCTX and 15% cCTX. Figure 1 shows a Box and Whisker's plot for the % of fSENC ≤−17 by cardiotoxicity status. Both fSENC and CMR LVEF detected sCTX and cCTX based on ANOVA analysis (p&lt;0.001) although fSENC had better delineation of both sCTX and cCTX. However, ECHO LVEF and GLS did not detect sCTX or cCTX (p=NS). CMR stroke volume index decreased while blood pressure and heart rate increased for both sCTX and cCTX (p&lt;0.001). Meanwhile, mass index and end-systolic volume index increased for cCTX (p&lt;0.001).

Conclusion
Segmental fSENC detected early CT-induced sCTX regardless of loading conditions. ECHO did not detect sCTX potentially due to compensatory mechanisms or acoustic window limitations in breast cancer and lymphoma patients that had less effect on CMR.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Myocardial solution (MSI)