bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anemia and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction: Findings from the China Cardiovascular Association Database-Heart Failure Center Registry
Authors: Qiu W , Cai A , Xia S , Yang J , Feng Y , Li L 
Published: November 2023

Abstract

Background
Little evidence exists regarding the association of anemia and clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose
To determine the associations of anemia and clinical outcomes in HFpEF.

Methods
Data were from 575 China Cardiovascular Association Database-HF Center certified secondary and tertiary hospitals across overall 31 provinces of mainland China. Between January 2017 and December 2021, 48,992 HFpEF patients with an left ejection fraction (LVEF) ≥50% and hemoglobin (Hb) data were included. According to the World Health Organization criterion (Hb &lt;12g/dL for women and &lt;13 g/dL for men), participants were categorized into two groups (with and without anemia). The primary outcome was a composite of hospitalization for HF and cardiovascular (CV) death, and the secondary outcomes were all-cause hospitalization and all-cause death.

Results
Among the overall patients, 50.0% were men, the mean age was 72.2 years, and 48.1% (n = 23,570) had anemia. Compared with individuals without anemia, participants with anemia were older and more symptomatic, more likely to have New York Heart Association class III/IV, and had greater comorbid burden. At 1-year’s follow-up, anemia was independently associated with an increased risk of primary outcome (hazard ratio [HR]: 1.08, 95% CI: 1.03-1.12), all-cause death (HR: 1.30, 9%% CI: 1.21-1.38), and all-cause hospitalization (HR: 1.06, 95% CI: 1.02-1.10). There was a trend toward increased risk of primary and secondary outcome with increasing severity of anemia (all P-trends were &lt;0.05). The results were consistent in all the subgroups analyses (sex, age (≥75 and &lt;75 years old), NYHA class (Ⅰ/Ⅱ and Ⅲ/Ⅳ), eGFR (≥60 and &lt;60 ml/min/1.73m2)). The restricted cubic spline showed significant nonlinear relationships between primary outcome and hemoglobin as continuous variable, with a risk nadir around 13-15g/dL.

Conclusion
Anemia was common in Chinese HFpEF patients and was an independent risk factor for adverse clinical outcomes at 1 year’s follow-up. Further studies are needed to evaluate whether ameliorating anemia can improve outcome in HFpEF patients.Graphic Abstract
Impact of cardiac power output, invasively measured by right heart catheterization, on exercise capacity and clinical outcomes in patients with chronic heart failure
Authors: Shimono Y , Ishizaka S , Omote K , Nakamura K , Yasui Y , Mizuguchi Y , Takenaka S , Aoyagi H , Tamaki Y , Kobayashi Y , Tada A , Sato T , Kamiya K , Nagai T , Anzai T 
Published: November 2023

Abstract

Background
Cardiac power output (CPO) is a novel hemodynamics parameter that is derived from both flow and pressure, and therefore it represents the cardiac pumping ability. CPO is strongly associated with outcomes in patients with cardiogenic shock. Nevertheless, less data is available about the impact of CPO on exercise capacity or clinical outcomes in patients with chronic heart failure (CHF).

Purpose
The present study aimed to investigate the impact of CPO on exercise intolerance or morbidity and mortality in patients with CHF who underwent invasive right heart catheterization.

Methods
The study enrolled 280 consecutive patients with CHF who underwent cardiopulmonary exercise testing and right heart catheterization between 2013 and 2018. The primary outcome was composite of heart failure hospitalization and death. CPO was calculated as (mean arterial pressure × cardiac output [CO])/451. Study population was divided into 2 groups according to the established cut-off value of CPO (= 0.53 W).

Results
Patients with low CPO (n = 99) were older and lower body mass index and displayed poorer kidney function, higher plasma brain natriuretic peptide (BNP) levels and lower left ventricular ejection fraction (LVEF) as compared to patients with high CPO (n = 181). CPO was correlated with peak oxygen consumption (Peak V̇O2), peak workload achievement, and ventilatory efficiency (V̇E/V̇CO2 slope) (Figure 1), while each of CO or mean arterial pressure was not. There were 48 patients with events over a median follow-up period of 3.5 (Interquartile range 1.0-6.0) years. Patients with low CPO had a 2.0-fold higher risk of events as compared to those with high CPO (HR 1.97; 95%CI, 1.12-3.48, P = 0.02, Figure 2). In multivariable Cox regression, 0.1-decreased in CPO was associated with 19% increased adverse events even after adjustment for gender, BNP, renal function, LVEF, and pulmonary capillary wedge pressure (HR 0.81; 95%CI, 0.67-0.99, P = 0.04).

Conclusions
CPO was associated with reduced exercise capacity and poor clinical outcomes, suggesting that CPO is useful for risk stratification in patients with CHF. Further study is required to identify therapies targeting CPO to improve the exercise capacity or clinical outcomes in patients with CHF.Figure1Figure2
A prospective, observational multicenter registry of heart failure patients in Germany: preliminary results of the ongoing H2-registry
Authors: Leiner J , Koenig S , Nitsche A , Mouratis K , Seyfarth M , Baberg H , Schade A , Neuser H , Staudt A , Tebbenjohanns J , Andrie R , Niehaus M , Ferrari M W , Kuhlen R , Bollmann A 
Published: November 2023

Abstract

Background
Heart failure (HF) is a highly prevalent condition affecting 1-2% of the adult population in Europe. Despite pioneering improvements in HF treatment during the last two decades, hospitalization and mortality rates remain relatively high. Gathering real-world data on HF populations is crucial especially in the light of newly emerging therapeutic approaches.

Purpose
The H2-registry was set up in 2021 to provide up-to-date, real-world data on a contemporary cohort of hospitalized HF patients in Germany using a standardized set of outcome measures.

Methods
The ongoing H2-registry represents a prospective, investigator-initiated, multicenter observational registry. Inpatients ≥18 years of age with a present diagnosis of chronic or acute HF are recruited in secondary and tertiary hospitals throughout Germany. Patients are excluded if they present in any kind of shock during index hospitalization, or if they previously underwent heart transplantation or ventricular assist device therapy. Routine follow-up (FU) is conducted every 6 months. A standardized set of variables according to the International Consortium of Health Outcome Measurements (ICHOM) including a pre-defined selection of questionnaires to collect patient-reported outcome measures (PROMs) is used to objectively monitor the course of disease.

Results
Until the reference date 12/31/22, a total of 2,190 patients were included in ten active study centers. Mean age was 72 years, 36.8% were female, and mean left-ventricular ejection fraction (LVEF) was 43.4% (38.1% had an LVEF of ≤ 40%). In-hospital mortality at index case was 1.3%. Within the cohort with completed 6-month FU comprising of 976 patients, all-cause mortality was 11.3% (110). In addition, 24.2% (209) in the survival cohort had at least one HF-related re-hospitalization. Numbers for all-cause mortality and re-hospitalizations at 12-month FU were 21.3% (71) and 32.8% (86), respectively. Evaluations of Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores showed a significant improvement overall and in all sub-categories (p &lt; 0.001) at 6- and 12-month FU.

Conclusions
The H2-registry currently represents the largest ongoing prospective registry of HF inpatients in Germany. Our preliminary data highlights the pronounced mortality risk and healthcare burden in this cohort. However, HF-related therapies initiated during the course of a hospitalization have the potential to significantly improve patients’ quality of life. In the near future, it its foreseeable that the actively recruiting H2-registry based on ICHOM-standards will markedly contribute to the collection of real-world data on HF patients.
Educational level and risk of all-cause death in patients with heart failure with reduced ejection fraction (HFrEF): a report from the WARCEF Trial
Authors: Corica B , Romiti G F , Simoni A H , Mei D A , Thompson J L P , Homma S , Proietti M , Lip G Y H 
Published: November 2023

Abstract

Background
The influence of social determinants of health (SDOH) on the prognosis of patients with Heart Failure and Reduced Ejection Fraction (HFrEF) is increasingly reported; however, the contribution of educational level to this risk of adverse outcomes in HFrEF is unclear.

Purpose
We aimed to explore the role of the educational level on the risk of adverse outcomes.

Methods
We used data from the WARCEF trial, which randomised HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational level of patients enrolled was collected at baseline. We defined three levels of education: low, medium and high level, according to the highest qualification achieved or highest school grade attended, consistently to previous classification. The primary outcome for this analysis was the risk of all-cause death; we also analyzed other exploratory secondary outcomes. Outcomes were analysed using adjusted Cox-regression analysis; competing-risk analysis using Fine-Gray regression were additionally performed.

Results
2,295 patients (mean age 60.8 ±11.3; 20% females) were included in this analysis. After a median follow-up time of 3.7 [IQR: 2.0-5.0] years, 546 (23.8%) death were recorded. Highest percentage of females were in the low educational level (21.6%), while in medium education females were 19.3%, and in high educational level were 17.4%. Highest percentage of non-married people were in the low and medium educational level patients (35.7% and 41.0%, respectively), while in high education level patients, non-married were 26.4%.
Patients with low educational level had a high risk of all-cause death (adjusted Hazard Ratio [aHR] 1.44, 95% Confidence intervals (CI) 1.10-1.89) compared to those at high educational level; no statistically significant differences were observed for those with medium educational level (aHR: 1.27, 95%CI: 0.97-1.68). Survival curves for the risk of all-cause death is shown in Figure 1. Similar results were observed for the composite outcome of death, ischemic stroke or intracerebral hemorrhage. No statistically significant differences were observed for the subdistribution hazards of secondary outcomes in the competing-risk analysis.

Conclusions
Low educational status is associated with worse prognosis in HFrEF patients. These findings underline the importance of considering SDOH in the management of these subjects.Kaplan Meier Curves
Suboptimal guideline-directed medical therapy and prognosis in patients with heart failure and reduced ejection fraction: The SMYRNA Study
Authors: Kocabas U , Ergin I , Kivrak T , Yilmaz Oztekin G M , Tanik V O , Ozdemir I H , Avci Demir F , Dogdus M , Sen T , Altinsoy M , Ustundag S , Urgun O D , Sinan U Y , Uygur B , Yeni M 
Published: November 2023

Abstract

Background
Heart failure and reduced ejection fraction (HFrEF) is associated with an increased risk of morbidity and mortality. Despite strong evidence from the randomized-controlled trials and recommendations of guidelines, the use of guideline-directed medical therapy (GDMT) among patients with HFrEF remains suboptimal in a real-life setting.

Purpose
The Suboptimal guideline-directed Medical therapY and prognosis in patients with heaRt failure and reduced ejectioN frAction (SMYRNA) study aims to determine the prognostic significance of GDMT in patients with HFrEF.

Methods
The SMYRNA study is a prospective, multicenter, and observational study that included outpatients with HFrEF. The study population enrolled at 41 cardiology centers between January 2019 and June 2019. Patients were divided into 3 groups: those treated with ≤1 class of HF medication, 2 classes of HF medications, and 3 classes of HF medications. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure, analyzed as the time to the first event.

Results
The study population consisted of 1,062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (20–96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1%, of the patients at the time of study enrollment, respectively. The proportions of patients receiving target doses of medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs (Figure 1). The median follow-up was 24 months. The rate of primary composite outcome was 40.4% among patients treated with ≤1 class of HF medication, 32.0% among patients treated with 2 classes of HF medications, and 32.8% among patients treated with 3 classes of HF medications. Patients treated with 2 or 3 classes of HF medications had a decreased risk of cardiovascular death or hospitalization for heart failure compared to those patients receiving ≤1 class of HF medication (HR, 0.65; 95% CI, 0.49 to 0.85; P = 0.002, and HR, 0.61; 95% CI, 0.47 to 0.79; P&lt;0.001, respectively, Figure 2).

Conclusion
The real-life SMYRNA study showed that suboptimal GDMT is strongly associated with an increased risk of cardiovascular death or hospitalization for heart failure in patients with HFrEF.Figure 1Figure 2
HFrEF phenotyping in real life
Authors: Weidenhammer A , Prausmueller S , Panagiotides N , Arfsten H , Heitzinger G , Spinka G , Barkhudaryan A , Bartko P , Huelsmann M , Pavo N 
Published: November 2023

Abstract

Background
In May 2021 an HFA position paper[1] by Rosano GMC et al. classified patients with heart failure with reduced ejection fraction (HFrEF) into 11 phenotypes based on blood pressure, heart rate, renal function, potassium level and rhythm and assigned them to different prescription attitudes.

Aim
We aim to investigate the distribution of phenotype frequency in our cohort and their respective outcomes.

Methods
From 2016 to 2022 we enrolled 900 advanced HFrEF patients with severely reduced ejection fraction (LVEF &lt;35%) in a prospective registry from our tertiary care heart failure unit. Patients were grouped according to the suggested phenotypes. Distribution and outcome for the different groups was analyzed.

Results
Characteristics of the different phenotypes, the distribution and outcome are shown in Figure 1. 65.8% of patients belong to 5 categories [3, 4, 5, 7b and 9]. Baseline characteristics of these 5 profiles are shown in Table 1. With the exception of Profile 3, which is characterized by a low resting hear rate, these major profiles are all eligible to receive all 4 drugs with class I recommendation at maximal dosages (RASi, BB, MRA, SGLT2i). The 6 remaining categories, all with GDMT limiting features, comprise solely another 3.8% of patients [1.8%, 1.2%, 0.3%, 0.3%, 0.2%, 0%, for the categories 7c, 7a, 1, 2, 6, 8 respectively]. With 30.2% a significant proportion of patients could not be assigned to one profile exclusively mostly because they showed a combination of profile attributes. Thus, of all classifiable HFrEF patients, with 83.4% the majority has no GDMT limiting features and should receive full HFrEF therapy. All-cause mortality did not differ between patient phenotypes [4,5,7b and 9] and the others (p = 0.193), while uncategorizable patients had significantly worse survival (p&lt;0.0001) (Figure 1c).

Conclusion
The study provides insight into heart failure phenotyping in a real-world setting. Most HFrEF patients are eligible for the 4 class I drugs of HFrEF medication, and only a minority may not be able to receive them. However, nearly one-third of all patients could not be categorized, including those with the poorest survival. Given these findings, the added value of the classification of patients according to this pattern seems limited in routine practice, possibly resulting from the complexity of the clinical picture of HFrEF.Figure 1 BL characteristics
Prognostic value of serum bicarbonate in patients hospitalized for acute heart failure
Authors: Martin Dorado E , Hurtado E , Martinez J , Monteiro M , Gomez I , Salvador L , Palanco C , Sanchez S , Lledo M , Martinez-Carapeto A , Cerrato P , Rama J C , Bengla B , Ocampo M , Gordillo E 
Published: November 2023

Abstract

Background
Acute heart failure (AHF) requiring hospitalization is associated with significant morbidity and mortality. Acid-base disorders are very common in patients with AHF due to pulmonary oedema and low tissue perfusion. However, its long-term prognostic significance remains to be clarified. We aimed to determine the relationships between serum bicarbonate (HCO3) levels, which reflect acid–base homeostasis, with long-term outcomes.

Methods
This cohort study included all patients admitted for AHF from June 2021 to August 2022 in a single center. We excluded patients who did not have available gasometric values at admission. All patients had received a primary diagnosis of acute decompensated heart failure, including signs and symptoms of fluid overload and a concentration of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) of 300 pg/mL at least. Clinical and demographic characteristics of all patients were collected during hospitalization. Normal range of HCO33 were defined as 22 to 26 mmol/L. The primary objective was a composite outcome of cardiovascular death and AHF readmission.

Results
Total of 153 patients were enrolled. Median age was 75,4 ± 10,8 years and 66 (43%) patients were female. 62 (38%) patients had diabetes and 67(41%) had chronic kidney disease. The median [IQR] of NT-ProBNP at admission was 4525 (IQR 25-75: 2010-7148), 58 (38%) patients had left ventricular ejection fraction (LVEF) ≤ 40%, 90 (56%) patients had atrial fibrillation and 49 (32%) patients had coronary artery disease. Regarding acid-base disorders, 38 (24,8%) patients had high serum HCO3 level, and 53 (34,6%) patients had low serum HCO3 level. During a median follow-up period of 10 months, there were 24 deaths (15%), and 60 patients were readmitted for heart failure. High serum HCO3 level (≥26 mmol/L) was significantly associated with higher incidence of the composite outcome (24/38, 63,2% vs 48/115, 41,7%; OR 2.39, 95% CI: 1.12-5.09, p = 0,017) compared with normal and low HCO3 level. In contrast, low serum HCO3 level had lower incidence of the composite outcome (19/53, 36% vs 53/100, 53%; OR 0.5, 95% CI: 0,25-0,98, p = 0,032) compared with normal and high serum HCO3 level. Moreover, we did not find differences between groups stratified by acidaemia (OR 0.82, 95% CI: 0,32-2,08, p = 0,43), alkalaemia (OR 2,8, 95% CI: 0,69-11,26, p = 0,12) and hyperlactatemia (OR 0,72, 95% CI: 0,34-1,52, p = 0,45).

Conclusions
High serum HCO3 level, but not low serum HCO3 level, on admission was associated with composite outcome cardiovascular death or AHF readmission in patients with acute heart failure. HCO3 level seems to be a useful tool to identify acid-base disorders for stratifying the risk of adverse outcomes in patients with acute heart failure.
Point-of-care aid-to-diagnosis for heart failure using artificial intelligence based on seismocardiography acquired with a smartphone in the emergency department
Authors: Tran T L , El Ahmadie D , Mainil G , Hossein A , Meurant V , Almorad A 
Published: November 2023

Abstract

Background
The number of new heart failure (HF) diagnoses in hospitals constantly increases. The associated clinical signs lead to a delay in treatment. Reliable and rapid diagnostic assistance is needed at earlier stages and can be an added value to accelerate the process. Kinocardiography (KCG), based on Seismocardiography (SCG), allows the computation of non-invasive cardiac kinetic energy that is used to characterize the cardiac function and could detect HF among patients at risk.

Purpose
In a multi-centric study, test the performance of smartphone-based KCG recording in diagnosing HF in the emergency department.

Methods
Adult patients who presented with dyspnea in the emergency department (ED) were recruited. Clinical charactristics were recorded, including demographics, symptoms, medication use, and diagnostic studies. Additionally, a blood sample was collected for NT-proBNP measurement, and a 180-second KCG acquisition was acquired with a smartphone. The patient is placed supine on the back, and the smartphone is placed on his chest to acquire the precordial vibrations due to the heartbeats. From these vibrations, cardiac kinetic energy (CKE) metrics are derived, including diastolic gradient kinetic energy (ΔiKdiastolic). The final HF diagnosis was assessed from the medical record at discharge from the ED. The primary outcome is the performance of an AI based on CKE metrics at classifying HF, measured using metrics including the area under the receiver operating characteristic curve (AUROC), negative predictive value (NPV), and specificity, with two-sided 95% CIs.

Results
295 patients were recruited; among these, 106 patients were diagnosed with HF (78 [69;83] years, 26.9 [23.2;29.3] kg/m2, 42% male, 4933.0 [3299;8055] pg/ml, 67 HFpEF, 10 HFmrEF, 29 HFrEF) and 189 without HF (64 [55;74] years, 28.1 [25.5;31.4] kg/m2, 51% male, 297.0 [90;813] pg/ml). ΔiKdiastolic was significantly lower in patients with HF (0.35 [0.08;0.70] vs. 0.06 [-0.04;0.32] %, p&lt;0.005). The AI approach resulted in an AUROC of 0.82 (0.80–0.89), sensitivity of 82.5% (72·7–90·2), and NPV of 79.3% (77·5–82·6).

Conclusion
This study shows that an AI system applied to SCG acquired during a 3-minutes examination with a smartphone can detect HF among patients presenting dyspnea. These findings highlight the potential for non-invasive, workflow-adapted, point-of-care, aid-to-diagnosis for earlier diagnosis and prognostically beneficial treatment.