bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptoms vs. pathology and outcomes in patients with reduced ejection fraction
Authors: Kanonidis E , Deedwania P , Bhyan P , Lam P H , Raman V K , Faselis C , Aronow W S , Fonarow G C , Ahmed A , Kanonidis I 
Published: November 2023

Abstract

Background
After acute myocardial infarction (AMI), patients have similar mortality regardless of whether AMI is silent or not. Less is known about whether outcomes after left ventricular systolic dysfunction (LVSD) varies by absence or presence of heart failure (HF) symptoms (Stage B and C HF, respectively).

Methods
In Studies of Left Ventricular Dysfunction (SOLVD), patients with EF ≤35% were randomized to enalapril or placebo. We compared 4-year mortality in 2569 patients with HF symptoms (Stage C HF) enrolled in SOLVD-Treatment trial with that in 4228 patients without symptoms (Stage B) in SOLVD-Prevention trial, adjusting for 24 baseline characteristics including age, sex, race, EF, symptoms (as indexed by NYHA class).

Results
Patients in SOVLD-Treatment had a higher risk of death (HR, 2.63; 95% CI, 2.37–2.90; p&lt;0.001), which remained significant after adjustment for 23 covariates except NYHA (HR, 1.35; 95% CI, 1.16–1.60; p&lt;0.001; Figure, left panel). However, when NYHA was added to the model, the significant was lost (adjusted HR, 1.15; 95% CI, 0.97–1.36; p = 0.117; Figure, right panel).

Conclusion
These findings suggest that unlike in patients with AMI, in patients with reduced EF, those with HF symptoms have higher mortality, even after adjustment for other covariates.
Food insecurity is associated with a higher body mass index and lower albumin levels in patients with congestive heart failure in the All of Us research program
Authors: Rtabi H , Driggin E , Kurian D C , Maurer M A , Raiszadeh F 
Published: November 2023

Abstract

Introduction
Congestive Heart Failure (CHF) is an extremely prevalent disorder worldwide with high morbidity and mortality rates. Estimates suggest that approximately 80% of cardiovascular diseases (CVD), including CHF, can be prevented by controlling risk factors and adopting a healthy lifestyle. However, there are substantial barriers to implementing this guidance for many patients, including food insecurity, which is a household-level economic and social condition of limited or uncertain access to adequate food. Food insecurity is also associated with a greater prevalence of overweight and obesity, which plays a role in the pathogenesis of CHF.

Purpose
Our goal is to examine the difference in body mass index (BMI), nutritional and cardiac-specific markers—specifically albumin, B-type natriuretic peptides (BNP), N-terminal pro-B-type natriuretic peptides (NT-proBNP), and troponin I (TnI)—between patients with CHF who are food secure and patients with CHF who are food insecure. To our knowledge, no prior studies have examined this important relationship in a large population-based sample.

Methods
We use the All of Us Research Program (AoURP) to analyze a large cohort of 372,380 participants representing the diversity of the US population in terms of ancestry, demographics, socioeconomic status, and other characteristics. Of the 372,380 participants, 12,529 had CHF, of which 1472 answered the two validated screening questions for food insecurity, also known as the "hunger vital sign". We split the CHF participants between a food-secure group (1297 participants) and a food-insecure group (175 participants), where food security is defined as responding "never" to both questions of the "hunger vital sign".

Results
Our findings indicate that the food insecure participants are younger (p&lt;0.0001), less likely to drink alcohol (p&lt;0.0001), less educated (p&lt;0.0001), and more likely to be black (p&lt;0.0001), female (p&lt;0.0001), and Hispanic (p&lt;0.001). The mean (+-SD) BMI for the food insecure group is 35.0 (+-8.8) kg m-2 compared to 31.3 (+-7.2) kg m-2 for the food secure group (p&lt;0.00001) and the mean (+-SD) albumin level for the food insecure group is 34.2 (+- 2.9) g/L compared to 38.4 (+-4.2) g/L for the food secure group (p&lt;0.0001). The differences in BNP, NT-proBNP, and TnI are not statistically significant.

Conclusion
Our findings–demographic differences, higher mean BMI, lower albumin levels in CHF patients who are food insecure–indicate the necessity to reevaluate our approach to care for historically underserved patients.
Predictive utility of health-related quality of life and the 6-minute walking test in transthyretin amyloid cardiomyopathy - a comparison
Authors: Poledniczek M , Duca F , Willixhofer R , Kronberger C , Camuz Ligios L , Kastner J , Bergler-Klein J , Kammerlander A , Badr Eslam R 
Published: November 2023

Abstract

Introduction
Both health-related quality of life (HR-QoL) as well as submaximal physical performance as assessed using the 6-minute walking test (6-MWT) have been shown to predict outcome in heart failure. However, it is currently unclear how the predictive utility of different HR-QoL measurement tools compares to the 6-MWT in transthyretin amyloid cardiomyopathy (ATTR-CM).

Aims
To evaluate predictive utility of the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the EuroQol Five Dimensions Questionnaire (EQ-5D) in comparison to the 6-MWT in patients with ATTR-CM.

Methods and results
186 patients diagnosed with ATTR-CM were included and data from 474 visits (2.55 per patient) was analysed. All scores and distance walked in the 6-MWT were transformed into Z-values by subtracting the mean and dividing by the standard deviation.
In a cox regression analysis for all-cause mortality adjusted for age and sex, the KCCQ [Hazard Ratio (HR): 0.560, p = &lt; 0.001], the EQ-5D visual analogue scale (HR: 0.712, p = 0.005) and the MLHFQ (HR: 0.613, p = &lt; 0.001) proved predictive of outcome. For heart failure hospitalisation, the KCCQ (HR: 0.455, p = &lt; 0.001), the EQ-5D overall score (HR: 0.753, p = 0.007), the EQ-5D visual analogue scale (HR: 0.631, p = &lt; 0.001) and the MLHFQ score (HR: 0.466, p = &lt; 0.001) were shown to be of high predictive utility. In comparison, the 6-MWT HRs were 0.434 and 0.544 for mortality and heart failure hospitalisation, respectively (p = &lt; 0.001).

Conclusion
Prognostic utility of the KCCQ and MLHFQ scores is non-inferior to the 6-MWT in ATTR-CM. While much more simplistic, the EQ-5D is lacking behind the other tested questionnaires with regard to predictive utility.
Epidemiology of acute heart failure admissions in Iceland: phenotype distribution and prognostic implications
Authors: Agnarsson H R , Hansen J S , Gunnarsson D A , Einarsson H , Gunnthorsdottir I , Ingimarsdottir I 
Published: November 2023

Abstract

Background/Introduction
Contemporary data that describe underlying causes of acute heart failure (AHF) epidemiology in a nation-wide unselected real-life cohort is lacking. Advances in diagnostics, including imaging and genetics, have facilitated the identification of the underlying cause of heart failure (HF). This is the first Icelandic nation-wide study on HF epidemiology of patients hospitalised for AHF.

Purpose
Investigate the underlying causes of AHF in Iceland and the patients‘ prognosis according to phenotypes.

Methods
This study used data from the Icelandic Heart Failure Registry (IHFR) and included all hospital admissions for AHF at Landspitali University Hospital from January 2020 to June 2022 (n = 1723). Differences in survival between HF phenotypes were analysed using a multivariate log-rank test, both after diagnosis and after the first discharge.

Results
The study found that 39.8% of the cases had heart failure with reduced ejection fraction (HFrEF), 17.4% had HF with mildly reduced ejection fraction (HFmrEF), 40.3% had HF with preserved ejection fraction (HFpEF), 0.9% had HF with improved ejection fraction (HFimpEF), and 1.5% had unknown ejection fraction (EF). The average length of hospital admission varied by phenotype, ranging from 8.1 to 15.9 days. Women accounted for 41.15% of all admissions, with the most common phenotype amongst women being HFpEF (57.8%) and the least common being HFrEF (25.1%). The mean age at admission was 75.8 years. Roughly 79% of the whole cohort had NYHA class III-IV at admission; 33% of HFrEF, 13% of HFmrEF and 32% of HFpEF admissions. The most common underlying cause of AHF was coronary artery disease (CAD, 30.9%) followed by atrial fibrillation (15.0%), hypertension (9.8%), diastolic dysfunction (9.4%) and valvular heart disease (9.2%). Other more rare causes were dilated cardiomyopathy (4.4%), amyloidosis (3.2%), broken heart disease (1.5%), myocarditis (0.4%), postpartum cardiomyopathy (0.2%) and Fabry disease (0.1%). During the study period, 422 mortalities were recorded, with 106 in-hospital deaths. After excluding in-hospital mortalities, no significant difference in survival between phenotypes was observed after the first discharge. However, a significant difference in survival was observed with respect to the date of diagnosis (p = 0.0191).

Conclusion
This study provides new insights into the underlying causes of AHF and patients' prognosis according to phenotypes in Iceland. Our results demonstrate that the most common underlying cause of AHF was CAD, followed by atrial fibrillation and hypertension and that the cohort was highly symptomatic, with a large proportion of patients having NYHA class III-IV at admission. Our findings also highlight significant differences in the prevalence of HF phenotypes between genders, with women more commonly presenting with HFpEF and less commonly with HFrEF.
Impact of hypochloremia on mortality in heart failure patients: systematic review and metanalysis
Authors: Stankowski K , Villaschi A , Cannata F , Figliozzi S , Tartaglia F , Pini D , Stefanini G , Condorelli G 
Published: November 2023

Abstract

Background
Electrolyte imbalances are common in patients with heart failure (HF). Several studies have shown that low serum chloride level is associated with adverse outcomes in patients who are hospitalised with acute HF as well as in outpatients with chronic HF, however the exact prognostic value of hypochloremia has not been quantified.

Objectives
We performed a systematic review and meta-analysis to assess the impact of hypochloremia on all-cause mortality in HF patients.

Methods
Data search was conducted from inception through February 1, 2023, using the following MeSH terms: ("chloride" OR "hypochloremia") AND "heart failure". Studies reporting serum chloride measurement and cardiovascular outcomes in HF patients were included. The pre-defined primary outcome was all-cause mortality. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effect model; fixed-effect model and leave-one-out sensitivity analysis were also performed.

Results
A total of fifteen studies, involving 25,848 patients, were included for quantitative analysis. Prevalence of hypochloremia ranged from 7.4% to 26.1%. Median follow-up time ranged from 6 to 67 months. Hypochloremia as a categorical variable was associated with an increased risk of all-cause mortality (HR 1.56; 95% CI: 1.38 to 1.75; p &lt; 0.001; figure 1). As a continuous variable, serum chloride was associated with all-cause mortality (HR per mmol/l decrease in serum chloride: 1.06; 95% CI 1.05 to 1.07; p &lt; 0.001; figure 2). Fixed-effect model and leave-one-out sensitivity analyses confirmed such findings.

Conclusions
Hypochloremia exhibits a substantial prognostic value in HF patients. Serum chloride can be used as an effective tool for risk stratifying patients with HF.Hypochloremia and all-cause mortalitySerum chloride and all-cause mortality
Relationship between change in Kansas City Cardiomyopathy Questionnaire scores and outcomes in patients with HFrEF
Authors: Yang M , Kondo T , Mcdowell K , Campbell R T , Desai A S , Vaduganathan M , Solomon S D , Jhund P S , Mcmurray J J V 
Published: November 2023

Abstract

Background
Although a 5-point change in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores is widely recognized as representing a clinically meaningful change in symptoms and quality of life, it is not known how changes KCCQ scores relate to risk of hospitalization and death.

Purpose
To evaluate how changes in KCCQ summary scores relate to subsequent risk of hospitalization and death in a large cohort of patients with heart failure and reduced ejection fraction (HFrEF).

Methods
We used individual patient data from 3 HFrEF trials (ATMOSPHERE, PARADIGM-HF, and DAPA-HF) to examine the association between changes in KCCQ summary scores between baseline and 8-months and the subsequent risk of cardiovascular death or HF hospitalization, using Cox-proportional hazard models. Change in score was categorized as very small (&gt;0 &lt;5), small (&gt; = 5 &lt;10), moderate (&gt; = 10 &lt;20), and large (&gt; = 20) points. We examined the KCCQ total symptom score (KCCQ-TSS), KCCQ clinical summary score (KCCQ-CSS), and KCCQ overall summary score (KCCQ-OSS).

Results
Among 15,892 participants with HFrEF, 1403 patients (8.8%) had a large deterioration in KCCQ score, 1688 (10.6%) a moderate deterioration, 1442 (9.1%) a small deterioration, 1527 (9.6%) a very small deterioration, and 2326 (14.6%) no deterioration. Conversely, 1836 patients (11.6%) had a very small improvement, 1732 (10.9%) a small improvement, 2202 (13.9%) a moderate improvement, and 1736 (10.9%) a large improvement. Patients with larger changes in KCCQ scores were older and more often female and had lower baseline summary scores and worse heart failure characteristics. Worsening heath status i.e., decrease in the KCCQ-TSS, was associated with a higher risk of the composite outcome (and each of its components), as well as all-cause mortality (Figure 1). On the contrary, improvements in KCCQ-TSS were not associated with better clinical outcomes (Figure 1). The findings were similar for 4-month changes of KCCQ-TSS, and changes in other KCCQ scores (KCCQ-CSS and KCCQ-OSS) at both 4 and 8-months.

Conclusion
Decreases (deterioration) in KCCQ summary scores during follow-up were associated with worse outcomes in patients with HFrEF but no association was seen between improvement in KCCQ scores and outcomes. These findings have potential implications for the interpretation of the effect of treatment on KCCQ scores.
Trends in heart failure mortality in the USA 1999 to 2020
Authors: Gonuguntla K , Chobufo M D C , Sama C S , Shaik A S , Sattar Y S , Thyagaturu H T , Raina S R 
Published: November 2023

Abstract

Background
Heart failure (HF) is a complex clinical syndrome which is a public health challenge in the US. Despite advancements in HF treatment strategies the mortality reduction has been far from ideal. We aimed to study the trends of HF mortality stratified by race and gender from 1999 to 2020.

Methods
The CDC WONDER multiple cause of death dataset was used to analyze trends in mean age at death (MAD) and age adjusted mortality rate (AAMR, expressed per 100,000 persons) for patients dying from HF (underlying cause of death) and dying with HF (co-morbid HF) in the USA.

Results
From 1999 to 2020, the AAMR and MAD for patients dying from HF were 19.3 (Men, Women; 21.3, 17.7) and 83.2 (Men, Women; 85.3, 80.4; p &lt;0.01). The AAMR and MAD for patients dying with HF were 72.4 (Men, Women; 85.8, 63.0) and 81.1 years (Men, Women; 83.2, 78.6; p &lt;0.01). The AAMR and MAD remained stable in both genders between the years 1999 and 2020. The AAMR and MAD among White, Black and other race patients dying with HF were (73.3, 75.1, and 37.7; p&lt;0.01) and (81.4, 74.0 and 79.8; p&lt;0.01). The AAMR and MAD among White, Black and other race patients dying from HF were (20.2, 22.5, and 8; p&lt;0.01) and (84, 76.1 and 85.1; p&lt;0.01). While there was no statistically significant change in AAMR and MAD among persons dying from HF, there was a significant decline in AAMR among persons dying with HF with an AAPC of -0.5(-0.8 to -0.1). Black patients witnessed a statistically significant decline in MAD from 77.8 in 1999 to 74.3 in 2020, MAD remained stable in Whites and Other Races.

Conclusion
Despite advances in guideline directed medical therapy with proven mortality benefit for management of heart failure, the nationwide HF mortality trend has plateaued. Racial disparities with higher HF related mortality in Black patients continue to exist. Therefore, systemic efforts are needed to optimize the HF outcomes by optimizing the preventive and treatment strategies of HF.
Efficacy of intravenous iron therapy in iron-deficient patients with heart failure: an updated systematic review and meta-analysis
Authors: Freitas M , Lucena L , Goncalves T A T , Dantas J M C 
Published: November 2023

Abstract

Background/Introduction
Iron deficiency is a common finding in chronic diseases such as heart failure (HF), as well as being a predictor of worse functional class and a higher risk of death in patients with a reduced/moderated reduced left ventricular ejection fraction (HFrEF/HFmrEF). Despite numerous trials evaluating iron supplementation in patients with HF and iron deficiency, the impact on mortality and hospitalisations is not well-established.

Purpose
The aim of our study was to assess the efficacy of IV iron supplementation on clinical and blood biochemical outcomes in iron-deficient patients with heart failure (HFmrEF and HFrEF).

Methods
We systematically searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs) studying the effects of iron therapy in patients with HF. Statistical analysis was performed using RevMan 5.1.7. Heterogeneity was assessed with I² statistics; p-values inferior to 0.10 and I²&gt;25% were classified with significant heterogeneity.

Results
Ten RCTs were included comprising a total of 3447 participants, of whom 1810 (52.5%) have received iron infusion. The 6-minute walk distance after 12 weeks of treatment was significantly higher in those who received iron supplementation (MD 54.23; 95% CI 25.41-83.05; p = 0.0002; I² = 64%; Fig. number 1A). Hospital admissions for heart failure were significantly lower in patients randomised to iron therapy when compared with the control group (OR 0.57; 95% CI 0.46-0.70; p &lt;0.001; I² = 17%; Fig. number 1B). There was no statistically significant difference among groups regarding cardiovascular death (OR 0.87; 95% CI 0.71-1.07; p = 0.19; I² = 0%; Fig. number 2A ), all-cause hospitalisations (OR 1.00; 95% CI 0.37-2.73; p = 1.00; I² = 81%; Fig. number 2B), and hospital admissions for cardiovascular causes (OR 0.72; 95% CI 0.4-1.33; p = 0.3; I² = 77%). Ferritin levels have shown a significant increase (MD 212.34; 95% CI 127.05-297.62; I² = 98%).

Conclusion(s)
This meta-analysis suggests that intravenous iron supplementation in patients with heart failure and iron deficiency was associated with a lower risk of hospital admissions for heart failure and improved exercise capacity, albeit with inconclusive data about the reduction in cardiovascular mortality.Relevant clinical outcomesSecondary relevant clinical outcomes
Impact of left atrial dysfunction on mortality in patients with atrial fibrillation and heart failure
Authors: Yamamoto J , Hayama H , Yamamoto M , Hara H , Hiroi Y 
Published: November 2023

Abstract

Background
Patients with atrial fibrillation and heart failure have elevated left ventricular end-diastolic pressure in addition to decreased left atrial function, and there are few reports of useful prognostic indices on echocardiography.

Purpose
We investigated the association between left atrial reservoir strains (LArs) and all cause mortality in patients with atrial fibrillation and heart failure.

Methods
We retrospectively enrolled patients aged 18 years or older with acute heart failure complicated by atrial fibrillation who were consecutively admitted to our hospital from January 2014 to December 2018. Exclusion criteria were acute coronary syndromes, no transthoracic echocardiogram performed within 30 days before or after admission, and missing data. All patients had follow-up from admission until death or last contact or March 2022.

Results
320 patients (mean age 79 ± 12 years, 163 women) were included in the analysis. During a median follow-up of 473 days, 113 patients were observed with all cause death. Multivariate analysis adjusted for age, gender, body mass index, brain natriuretic peptide, estimated glomerular filtration rate, hemoglobin, oral anticoagulants, antiplatelet agents, and beta-blockers showed that LArs was an independent predictor of all cause death (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.90-0.99, p = 0.016). Furthermore, multivariate adjustment of all cause mortality in the LArs tertile showed that the low LArs group (LArs &lt; 7.16%; HR 1.83, 95% CI 1.15-2.92; p = 0.011) had a significantly increased risk of all cause death compared to the high LArs group (LArs &gt; 10.52%). The results were consistent with no interaction in sub analyses grouped by oral anticoagulant status or left ventricular ejection fraction of 50%.

Conclusions
We found a significant association between LArs and all cause mortality in patients with atrial fibrillation and heart failure. Those with reduced LArs in such patient groups had a poor prognosis, suggesting the need for aggressive treatments and careful follow-up.
The prognostic impact of cardio-renal anaemia syndrome in Japanese acute decompensated heart failure patients stratified by left ventricular ejection fraction
Authors: Moriki T , Hamada T , Kubo T , Takabayashi K , Kawai K , Furuno T , Yabe T , Yamada E , Yamasaki N , Kitaoka H 
Published: November 2023

Abstract

Background
Cardio-renal anaemia syndrome (CRAS) has been reported to be an important prognostic factor for events in heart failure (HF) patients. Previous reports have shown that it has relatively little prognostic impact in patients with preserved left ventricular ejection fraction (LVEF), which remains controversial. We therefore investigated the prognostic impact of CRAS in Japanese acute decompensated heart failure (ADHF) patients according to LVEF.

Methods
We combined two registry studies of ADHF patients in Japan and examined HF events and their associated factors over a 2-year observation period. The prognostic impact of CRAS was also analysed by LVEF. The primary endpoint was defined as all-cause mortality or HF hospitalisation. Renal dysfunction was defined as eGFR &lt;60 mL/min/1.73 m2 and anaemia as haemoglobin &lt;13 g/dl in men and &lt;12g/dl in women. CRAS was defined as the presence of both renal dysfunction and anaemia. Three groups were also created by LVEF (&gt;50%, 40-49% and &lt;40%) and analysed separately.

Results
A total of 2142 patients were enrolled. Mean age was 78.7 years and 49% of the patients was male. Previous coronary artery disease and atrial fibrillation were present in 31% and 44% of the patients, respectively. Medications included beta-blockers in 61% and renin-angiotensin system inhibitors in 53% of the patients. Renal dysfunction was present in 1676 (74%) and anaemia was seen in 1523 (67%) patients. CRAS was present in 1190 (53%) patients. During the mean follow-up period of 623±244 days, the primary endpoint was observed in 1015 patients, with 563 deaths and 737 HF hospitalisations. Multivariate analysis in a Cox proportional hazards model showed that CRAS was an independent prognostic factor in all patients (hazard ratio [HR]1.488;95% confidence interval [CI] 1.292-1.715, p&lt;0.001). Multivariate analysis was also performed in three groups of patients with LVEF &gt;50%, 40-49% and &lt;40%. As with all patients, CRAS was an independent predictor of the primary endpoint in the three groups. (LVEF &gt;50% [1273 patients]: HR1.313[95%CI 1.089-1.583], p = 0.004; LVEF 40-49% [381 patients]:HR,1.907[95%CI 1.323-2.750], p&lt;0.001; LVEF &lt;40% [651 patients]:HR: 1.446[95%CI 1.117-1.872]; p = 0.005)

Conclusion
In the present registry study of Japanese patients with ADHF, CRAS was a important prognostic factor. The results also confirmed a similar trend in patients with any LVEF.