Gender Specific Registry in Subjects Hospitalized With Heart Failure in Santiago

Study Overview
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Brief Summary
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This is an observational registry, which main purpose is to assess sex-related differences in heart failure (HF) presentation, management, and prognosis in patients admitted to a hospital with a certain diagnosis of HF. The diagnosis will be based on European Society of Cardiology (ESC) definition of HF ( clinical syndrome characterized by symptoms and/or signs caused by a cardiac abnormality, that results in elevated intracardiac pressure and/or inadequate output at rest or exercise ). The sample will be obtained prospectively by recruitment of patients of two hospitals of Santiago de Chile.

Detailed Description
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-Methods Study design and participants Observational and prospective registry led by the Chilean Society of Cardiology and Cardiac Surgery Foundation (Fundación SOCHICAR), that will be held at hospitals of different communes in urban Santiago. This project will incorporate two hospitals in a period of one year. The hospital selection will be based on the purpose of having the most clinical information of the patient regarding his/her cardiac condition. Both participating centers must have coronary units, cardiac surgery, and interventional cardiology. Also, both hospitals must have medical teams with expertise in cardiac imaging, and have access to a local laboratory that performs biomarkers (i.e. NT-terminal pro-brain natriuretic peptide (NTpro-BNP), usTroponin). The registry consists of a descriptive cross-sectional survey. Thereby, this study is a one-time assessment, with no visit schedule. Ethics consideration The registry must be approved by the Ethics committee of each clinical center, or in case of not having one, by the Metropolitan Region Ethics Committee respective of each area. Each patient must be informed about the study's rationale and his/ her potential willingness of participation. Written informed consent will be obtained from all participants before data collection. Study population: approximately 500 patients hospitalized in the two recruiting centers during one year who comply with all the eligible criteria and without exclusion criteria. -Data source Data will be obtained from the medical files, and will be collected prospectively by a center coordinator using a tablet electronic survey. The survey will be created using a Google form questionnaire, easy to fill in and register. The confidentiality of the patient will be protect, using patients´ identification based on their initials (first name - first last name - second last name) plus an odd or even sequential number according to the belonging hospital (ie: Mary Jo Salas Gómez MSG1). The registry will include: demographic, cardiovascular (CV) risk factors, medical history, comorbidities, blood biochemical parameters, diagnostic imaging determinants, treatment, and outcomes data. The information about Patient Healthe Questionnaire (PHQ) 9 questionnaire will be answered confidentially by the patient in the tablet Study assessment The registry consists of a descriptive cross-sectional survey. Thereby, this study is a one-time assessment, with no visit schedule Study limitations The main study limitation will be the failure to recruit 500 patients in the one-year period. With respect to data limitation, the investigators will be conditioned by the information available in the medical file, and the laboratory and imaging exams requested by the head and referral physicians. STATISTICAL METHODS Sample size and statistical power; precision assessment The sample size was estimated considering the data reported in one of the largest trials that have addressed sex differences in heart failure (HF-Action Trial by Sex, Am Heart J. 2009 Oct; 158(40): S16-S23.) 20. This trial shows that the prevalence of Heart Failure of ischemic cause (one of the main objectives of our trial) was 59% in males and 32% in females. The calculation of the sample size was carried out to find significant differences between the prevalence of heart failure from ischemic etiology in female patients consecutively hospitalized compared to male, based on Chi-square test for comparison of proportions, considering a significance of 95% and power of 90 %. Therefore,the investigators will included in our study approximately 500 patients knowing that to get a significance of 95 % and a power of 90% the investigators must recruit at least 156 patients (52 females and 104 males) considering 2:1 male-to-female proportion. In order to perform a stratified analysis, the investigators estimated that the lowest sample size for each center should be 78 patients.( with 2:1 male -to - female proportion) -Statistical considerations Data management: The data completeness and accuracy will be addressed through out-of-range alerts and control of unreported data. The nurse coordinator will verify the completeness and accuracy of the information and send the respective queries on a daily basis. Missing data will be addressed according to covariate. Given the observational data collection of the registry, few data could be missing. These data will be addressed according the kind of covariate. In general, a multiple imputation strategy will be performed. All the data will be electronically registered in an Excel file. Privileges will be conferred according the role of the personnel on the study. The Principal Investigators will have access to all data. -Statistical Analyses: All the important covariates will be recorded. Specifically, information on patients' characteristics, demographics, basal functional capacity, complete blood test analyses, EKG, echocardiography, and relevant clinical information will be registered at baseline according to the protocol of each center. For analyses purposes, the prevalence of HF phenotype (ie. with preserved, mildly and reduced ejection fraction), and etiology (ie. ischemic and non ischemic) will be considered as primary outcomes. All the variables will be tested for normality using Shapiro-Wilk test. The investigatorswill compare the percentages of heart failure with preserved ejection fraction (HFpEF), with mildly reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) phenotypes according to gender, using Chi-square test. Also, the investigators will compare the percentages of HF etiology (ie. Ischemic and non ischemic) according to gender, using Chi-square test. Moreover, T-test statistics will be used according the variable. The demographic variables that will be incorporated are: Age Sex Educational Level: years of education < 8, > 8 and/or < 12, >12 years Married, single, divorced, widowed Race and Ethnic origin Insurance status Family income: ≤ $ 326.000 pesos (basic income) or less U$ 500 $ 326.000 -$ 652.000 $ 652.000 - $ 1.000.000 $ 1.000.000 -$2.000.000 $ ≥ 2.000.000- <3.000.000 $ ≥ 3.000.000 Employed, non employed, retired The medical history that will be asked are: Anemia Smoking Diabetes Obesity Depression Hyperlipidemia Hypertension Atrial fibrillation /atrial flutter Ventricular arrhythmias Coronary disease Ischemic heart disease /Previous myocardial infarction (MI) Chronic obstructive pulmonary disease (COPD) / asthma Cerebrovascular disease: Ischemic Stroke /Haemorrhagic stroke / transient ischaemic attack (TIA) Peripheral vascular disease Renal insufficiency (MRDR: less 60 ml /min /m2) Dialysis (peritoneo/ Hemodialysis) Preeclampsia / Gestational Diabetes / Premature delivery Premature or late menarche Premature of late menopause Hyperkalemia Previous hospitalization Malignancies Autoimmune diseases ( i.e. Erythematosus Systemic Lupus, Rheumatoid Arthritis, Chron Disease, Vasculitis , etc) Genetic and Metabolic Disease (i.e. Fabry Disease, Muscular Dystrophies) HF Characteristics. Preserved Mildly Reduced Reduced HF cause: ischemic, non ischemic and hypertensive. Decompensating HF clinical factors. Medication and diet non-adherence Atrial fibrillation /flutter Arrhythmias (other than AF) including bradyarrhythmias Infections Acute renal failure Acute coronary syndrome Anemia Pulmonary thromboembolism Others: specified Precipitating clinical factors. Respiratory ( pneumonia and others) Arrhythmias Medication non-compliance Diet non-compliance Uncontrolled Hypertension Renal Failure Myocardial Ischemia (ACS) Questionnaires: Quality of life Kansas City Cardiomyopathy Questionnaire. Depression: Patient Health Questionnaire 9 (PHQ-9(scale) HFpEF approach: The new H2FPEF (Heavy, 2 or more Hypertensive drugs, atrial Fibrillation, Pulmonary hypertension [pulmonary artery systolic pressure > 35 mmHg], Elder age > 60 years, and elevated Filling pressures [E/e´>9] ) score in patients hospitalized with HFpEF Frailty Score: The Frail Score Laboratory Determinations: Nt-pro BNP Hemoglobin levels White blood count Creatinine Blood urea nitrogen (BUN) Plasma Electrolytes Troponin US Albumin Lipid profile Thyroid stimulating hormone (TSH) Hemoglobin A 1 C (if appropriate) Ferritin and Iron levels Imaging Determinations Echocardiography: Ejection Fraction Left Atrial volume Left ventricular dimensions ( Systolic, Diastolic) and /or volumes. LV segmentary motility (septal, anterior, inferior, posterior, lateral): akinesia,hypokinesia, dyskinesia( Yes/No for each one), Presence of left ventricule (LV) thrombus Pulmonary systolic arterial pressure Mitral E/e´ratio Global Longitudinal Strain Valvular Regurgitations Valvular Stenosis Tricuspide annular plane systolic excursion (TAPSE) Thoracic Radiography (RX) Pulmonary congestion Left Ventricular enlargement Right Ventricular enlargement Pleural effusion Magnetic cardiac resonance Late Gadolinium enhancement Left ventricular volumen and ejection fraction Right ventricular volumen and ejection fraction Infiltrative cardiomyopathy pattern Constrictive pericarditis Thrombus Hypertropic cardiomyopathy Coronary angiogram Coronary stenosis ≥ 50 %: one vessel, two vessels or three vessels Coronary stenosis ≥ 70 %: Coronary Occlusion Ventriculography (Yes or No): ejection fraction and motility description. Treatment 1- Pharmacological: names and daily doses B -blockers (total daily dose): bisoprolol, metoprolol,carvedilol, nebivolol, others Angiotensin converting enzyme (ACE) inhibitors (total daily dose): enalapril, ramipril, captopril, perindopril, lisinopril, others/ Angiotensin 2 Receptors blockers (total daily dose): losartan, valsartan, telmisartan, candesartan, Olmesartan, others Angiotensin receptor/neprilysin inhibitor (ARNI) (total daily dose): Sacubitril / Valsartan Mineralocorticoid antagonist receptors (total daily dose): spironolactone /eplerenone/finerenone Sodium glucose cotransporter 2 (SGLT 2) Inhibitors (total daily dose): dapagliflozin, empagliflozin. Diuretics (total daily dose): furosemide (Intravenous /oral) metolazone, hydrochlorothiazide,chlortalidone, indapamide, others Vericiguat Ivabradine Digoxin Calcium Channel Blockers: amlodipine, others Nitrites: Intravenous nitroglycerine/ Isosorbide dinitrate / Isosorbide mononitrate Other vasodilators: hydralazine Statins: atorvastatin, rosuvastatin, simvastatin, others Ezetimibe Anti diabetic drugs: metformin, glibenclamide, glipizide, insulin, dipeptidyl peptidase 4 (DPP4) such as sitagliptin, saxagliptin, linagliptin, vildagliptin and glucagon like peptide 1 (GLP1) analogues such as semaglutide, liraglutide, dulaglutide. Anticoagulants: vitamin K antagonists (VKA), direct oral anticoagulants (OACs): apixaban, rivaroxaban, dabigatran. Platelet inhibitors: aspirin, clopidogrel, ticagrelor. Intravenous Iron Therapy Intravenous Inotropic therapy: dobutamine, milrinone, levosimendan. 2. Non pharmacological Cardiovascular Rehabilitation (Yes /No) Devices: Pacemaker / Cardiac resynchronization therapy/ (ICD) implantable cardioverter-defibrillator.

Official Title
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Gender Specific Registry in Subjects Hospitalized With Heart Failure in Santiago( GENESIS Registry): Pilot Heart Failure Registry Looking for Sex Analysis

Conditions
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Heart Failure

Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Patient with ≥ 18 years old Signed informed consent Admitted to the hospital with a : 1) diagnosis of acute HF as the leading cause of admission, and in which a CV therapy is needed and prescribed (ie. diuretic, vasodilator, inotropic, device), or 2) diagnosis of chronic HF is established during the patient hospitalization based on clinical, biochemical and/or imaging studies, and in which cardiovascular therapy is needed and prescribed (ie. diuretic, vasodilator, inotropic, device ) during the hospitalization. Exclusion criteria: The patient presents a Covid 19 acute infection and/ or severe acute respiratory syndrome (SARS) -CoV 2 pneumonia is confirmed The patient presents a psychiatric decompensated disorder and/or a cognitive impairment which preclude assessment of this survey.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The prevalence of HF phenotype( preserved, mildly reduced or reduced) by sex | The outcome measure will be the prevalence (% of the study population) according to the HF phenotype (preserved, mildly reduced or reduced). The working definition of HF phenotypes will be in accordance to 2021 ESC guidelines of HF, based on the followimg criteria: a. clinical (shortness of breath and/or fatigue and /or ankle swelling, and/or jugular venous distention and /or rales at the lung examination),b. echocardiography: measurement of ejection fraction by transthoracic echocardiogram: HF with Reduced ejection fraction- HFrEF-(< 40%), HF with midly reduced ejection fraction-HFmrEF- (≥ 40 to 49 %) and Preserved Ejection Fraction- HFpEF- (≥ 50%), this last one associated with NT pro BNP (≥ 125 pg/ml in sinus rhythm. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of HF etiologies (ischemic, non ischemic or hypertensive) by sex. | The outcome measure will be the prevalence of HF etiology (ischemic, non ischemic, and hypertensive). With regard to ischemic etiology, the study definition will be based on a definite diagnosis of ischemic heart disease (epicardial coronary artery stenosis greater than 50%, and /or previous myocardial infarction, and/or previous revascularization (CABG or PCI) or a positive imaging stress test, such as echo, nuclear, or cardiac magnetic resonance (CMR) . Hypertensive cardiomyopathy will be defined for HF with reduced , mild reduced or preserved eyection fraction only if long standing hypertension (at least 20 years) , and with cardiac structural changes suitable with hypertensive etiology: presence of diastolic dysfunction, and /or LV hypertrophy. | 12 months | 
| To evaluate socioeconomic level in the study population (patients hospitalized with HF) by sex specific analysis. | To evaluate socioeconomic level in this cohort. The outcome measure will be based on the household average family income per capita based on the Chilean National Socioeconomic Characterization (CASEN) Survey 2020 (low from ∼276 to 340 US dollars; middle: ∼345 to 438 US dollars, and high: ∼459 to 2763 US dollars). The low socioeconomic level represents the minimum wage per capita in Chile in the study period | 12 months | 
| To evaluate educational level in the study population ( patients hospitalized with HF) by sex specific analysis. | To evaluate educational level in this cohort. The outcome measure will be based on the years of education. | 12 months | 
| To assess the prevalence of comorbidities associated with HF by sex-specific analysis | The comorbidities that will be analysed wil be: diabetes ( having a medical diagnosis of diabetes withor without pharmacological treatment or having fastingglucose ≥126 mg/dL), elderly (≥ 60 years of age, chronic renal failure (CKD) 4 or 5 phase, anemia ( hemoglobin value of less than 13.5 gm/dl in a man or less than 12.0 gm/dl in a woman), obesity (≥ 30 mg /kg 2 and Chronic obstructive pulmonary disease (COPD) based on the 2023 Global Initiative for Chronic Obstructive Lung Disease report last definition, which defines COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. | 12 months | 
| To determine the main decompensating risk factors in HF patients by sex-specific analysis | The prevalence of decompensating risk factors that wil be assessed will be: medication and diet non-adherence, atrial fibrillation, infections, acute renal failure and acute coronary syndromes | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Heart Failure,, Gender, Women, Epidemiology