Incidence Rates Of Heart Failure Research Articles

Long-term risk of heart failure in adult cancer survivors: a systematic review and meta-analysis

BackgroundCancer survivors are at increased risk of heart failure (HF). While cardiotoxicity is commonly sought at the time of cancer chemotherapy, HF develops as a result of multiple ‘hits’ over...

The cold temperature associated with new-onset heart failure after incorporating dynamic status of multimorbidity: nationwide cohort, Taiwan 2012-2019.

Cold temperatures are known to affect heart failure (HF) hospitalizations, but the dynamic status of multi-morbidity of HF was rarely incorporated. We investigated the relationship between temperature and new-onset HF by risk strata. This nationwide cohort study analysed daily data on ambient temperature, the dynamic status of risk factors (age, diabetes, chronic obstructive pulmonary disease, coronary artery disease, chronic kidney disease, hypertension, myocardial infarction, and atrial fibrillation), and new-onset HF among the Taiwan population from 2012 to 2019. Poisson regression, Austin's algorithm, and classification and regression tree (CART) were used to determine risk strata and obtain the predicted HF rate. 148 708 patients developed new-onset HF over 152.52 million person-years. Three risk strata for HF were identified: Stratum 1 was predominantly those without any comorbidity (89.9%); Stratum 2 was those aged 60-69 with 2-3 comorbidities or aged 70+ with 1-2 comorbidities (9.0%), and Stratum 3 was those aged 70+ and had four or more comorbidity (1.1%). The HF incidence rates for these three strata were 25.54, 555.27, and 2315.52 per 100 000 person-years, respectively. The R2 of the Poisson regression with the three risk strata and the daily minimum temperature on the ln HF incidence rates was 77.99%. The risk of HF increased as temperatures decreased, and the slopes were 1.032, 1.040, and 1.034 for Strata 1-3, respectively. The rate ratios of HF at the winter median temperature of 17°C vs. the summer median temperature of 29°C were 1.45, 1.58, and 1.49 for Strata 1-3, respectively. Cross-validation reveals a good fit and predicted HF rates by ambient temperature for the three strata were provided. Cold temperatures are associated with an increased risk of new-onset HF. Stratum 2 (aged 60-69 with 2-3 comorbidities or aged 70+ with 1-2 comorbidities) are particularly susceptible to cold-related new-onset HF.

Evaluating the incidence of complications among people with diabetes according to age of onset: Findings from the UK Biobank.

To examine the impact of current age, age at diagnosis, and duration of diabetes on the incidence rate of complications among people with type 2 diabetes. Baseline data from 19,327 individuals with type 2 diabetes in the UK Biobank were analysed. Poisson regression was used to model incidence rates by current age, age at diagnosis, and duration of diabetes for the following outcomes: myocardial infarction (MI), heart failure (HF), stroke, end-stage kidney diseases (ESKD), chronic kidney diseases (CKD), liver diseases, depression, and anxiety. The mean age at baseline was 60.2 years, and median follow-up was 13.9 years. Diabetes duration was significantly longer among those with younger-onset type 2 diabetes (diagnosed at <40 years) compared to later-onset type 2 diabetes (diagnosed at ≥40 years), 16.2 and 5.3 years, respectively. Incidence rates of MI, HF, stroke, and CKD had strong positive associations with age and duration of diabetes, whereas incidence rates of ESKD liver diseases, and anxiety mainly depended on duration of diabetes. The incidence rates of depression showed minor variation by age and duration of diabetes and were highest among those diagnosed at earlier ages. No clear evidence of an effect of age of onset of diabetes on risk of complications was apparent after accounting for current age and duration of diabetes. Our study indicates age at diagnosis of diabetes does not significantly impact the incidence of complications, independently of the duration of diabetes. Instead, complications are primarily influenced by current age and diabetes duration.

Effects of a collaborative health management model on peoplewith congestive heart failure: A systematic review and meta-analysis.

To determine the effects of collaborative health management of congestive heart failure through the rigorous evaluation and extraction of evidence. Over the past two decades, cardiovascular disease has been the leading cause of death worldwide. Multidisciplinary team intervention for congestive heart failure has increased with population ageing and congestive heart failure incidence rate as well as cost of care. However, the effectiveness and feasibility of collaborative health management need to be explored. Systematic review and meta-analysis. We conducted systematic literature searches in the Cochrane Library, PubMed, CINAHL and Medline for articles published between 2002 and 2022. After screening based on the inclusion and exclusion criteria, 13 articles were included in a rigorous review and evidence extraction process, evaluated methodological quality using the Jadad Quality Scale. Statistical heterogeneity was evaluated using Review Manager (RevMan Version 5.4) for the meta-analysis. In this study, a systematic review and meta-analysis were performed on 13 studies regarding the collaborative health management of people with congestive heart failure. The common result is that the collaborative health management model enables the enhancement of self-care and monitoring abilities, the strengthening of cardiac function, the alleviation of physiological and psychological symptoms and the improvement of readmission rates, mortality rate and quality of life. The congestive heart failure collaborative health management model could decrease the hospitalization rate related to congestive heart failure, all-cause mortality rate, and all-cause hospitalization rate, and improve the quality of life. The collaborative health management model could effectively coordinate interdisciplinary team cooperation and provide information, which decreases hospitalization and mortality risks and improves their quality of life. Our paper is a systematic review and meta-analysis, and such details do not apply to our work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The Collaborative Health Management Model provides in-depth insights, aiding in the design tailored to the specific circumstances of each country. Highlighting its critical role in the context of a global shortage of nursing staff, the model emphasizes the integration of multidisciplinary professional roles and the strengthening of collaboration as essential elements in addressing challenges posed by workforce shortages. Implementation of the Collaborative Health Management Model not only enhances patient care outcomes but also relieves pressure on healthcare systems, lowers medical costs, and addresses challenges arising from the shortage of nursing staff. Consequently, this model not only contributes to individual patient care improvement but also holds broader implications for enhancing the efficiency and sustainability of global healthcare systems. The detailed study protocol can be found on the PROSPERO website.

Impact of patient characteristics on heart failure and cardiomyopathy onset related to pregnancy from 1997 to 2019. Swedish nationwide register-based study

Abstract Background The aetiology of heart failure (HF) in young patients is heterogenic. Cardiomyopathies are common causes in young patients, that often unmask in situations of higher physical demands, as pregnancy or delivery, presenting with HF signs and symptoms. Peripartum cardiomyopathy (PPCM) is one form associated with delivery. However, even other, such as dilated or hypertrophic cardiomyopathy may present during pregnancy. Despite major advances in care, there is still a lack of knowledge about factors that trigger heart failure onset during pregnancy and delivery. Aim To evaluate the association of baseline characteristics for HF and cardiomyopathy (CM) onset related to delivery, and investigate incidence rate for HF and cardiomyopathies related to delivery over time. Method All women 18 to 50 years registered in the National Patient Register (NPR) from 1st January 1997 to 31st December 2019 were included. Time of delivery was obtained from the Swedish Medical Birth Register (MBR), time of death from the Cause of Death Register. Women with HF, CM and peripartum cardiomyopathy (PPCM) were identified from the NPR with international classification codes for disease ICD-10: I50, I42, I43 and 090.3, used for the first time 90 days prior or 180 days after delivery, and other comorbidities. Patients were compared with five controls without HF or CM from the Total Population Register matched by age, year of delivery, and county. Linear regression was used to test trend changes in use of ICD codes. The impact of baseline characteristics for onset av HF, CM and PPCM in patient compared to controls is presented as odds ratio (OR). Body mass index (BMI) was registered at the beginning of pregnancy. Results Between 1997 and 2019 we identified 2 347 723 deliveries, and 694 women with HF, CM or PPCM, median age 33 (29; 37) years and 3 465 controls. Out of those 493 (71%) had HF, 201 (29%) had any CM and 195 (28.1%) had PPCM. Over time the incidence rate of all conditions increased significantly, se Figure 1. Median BMI at the start of pregnancy increased significantly over time in patients with HF from 22 (20;28) to 27 (23;32), beta 0.1323 (p = 0.0216). Compared to controls patients with congenital heart disease OR at 18.32 (10.04-33.41), valve disease OR at 22.65 (8.55-60.03), arrythmia OR at 7.45 (4.06-13.67), hypertension OR at 7.89 (4.26-14.63), diabetes mellitus type II OR at 8.07 (2.63-24.74) and gestational diabetes OR at 3.93 (2.54-6.07) (all p&amp;lt;0.001) to for HF, CM or PPCM onset related to delivery, also BMI &amp;gt;22,5 at the beginning of pregnancy, lower education level and income, se Figure 2. Conclusion Over 22 years we observed a significant increase in the incidence rate of HF and CM related to delivery. BMI already &amp;gt;22,5 was associated with higher risk for HF or any CM onset in relation to delivery.

Temporal changes in stroke and heart failure following first-time atrial fibrillation/flutter in patients under 65 years of age: A Danish nationwide study

Abstract Background The incidence of atrial fibrillation/flutter (AF) has increased throughout the past two decades - also for patients under 65 years of age. Whether this increment in patients with AF under 65 years of age also influences the subsequent incidence of ischaemic stroke (stroke) and heart failure (HF) is yet to be elucidated. This patient group are of special interest as this population often is considered at low risk of stroke. Methods Using Danish nationwide registries, we identified all patients from 18–65 years with a first-time AF-diagnosis in 2000-2018. The cohort was categorised according to calendar periods into five groups: 2000-200, 2003-2006, 2007-2010, 2011-2014, and 2015-2018. Crude incidence rate (IR) of stroke and HF per 1,000 person years (PY) were calculated. The cumulative incidence (CI) of stroke and HF during one year of follow-up was computed accounting for death as a competing risk. The reverse Kaplan-Meier estimator was used to examine mortality during one year follow-up. Multivariable Cox proportional hazard analysis was used to compare outcomes between calendar periods with 2000-2002 as comparative reference. Hazard ratios (HR) were reported with 95% confidence intervals (95% CI). Results In this study 51,137 patients were included; 6,911 (median age 56, 64.5% males, 22.0% on OAC) in 2000-2002, 9,964 (median age 58, 65.5% males, 26.4% on OAC) in 2003-2006, 11,538 (median age 58, 64.7% males, 23.9% on OAC) in 2007-2010, 11,764 (median age 58, 63.6% males, in 29.2% on OAC) in 2011-2014, and 10,960 (median age 56, 65.9% males, 39.5% on OAC) in 2015-2018. For stroke, crude IR/1,000 PY [95% CI] declined through calendar time as seen in the Figure. The crude IR were 10.4 [8.0;13.5] in 2000-2002 and 6.3 [4.9;8.0] in 2015-2018 with corresponding CIs of 1.0%, 0.9%, 0.9%, 0.8%, and 0.6%, respectively (p-value for difference=0.08). The corresponding adjusted HRs [95% CI] were 0.94 [0.66;1.35] for calendar period 2003-2006, 0.87 [0.61;1.24] for 2007-2010, 0.86 [0.61;1.23] for 2011-2014, and 0.61 [0.41;0.91] for 2015-2018 as compared with 2000-2002. As seen in the Figure crude IR [95% CI] for HF were stagnant over time with 37.2 [32.4;42.8] in 2000-2002 and 38.3 [34.7;42.3] in 2015-2018 with corresponding CIs of 3.4%, 3.3%, 3.5%, 3.4%, and 3.3%, respectively (p-value for difference=0.89). The corresponding adjusted HRs [95% CI] were 0.93 [0.79;1.10] for calendar period 2003-2006, 0.99 [0.84;1.17] for 2007-2010, 0.99 [0.84;1.16] for 2011-2014, and 1.02 [0.86;1.20] for 2015-2018 as compared with 2000-2002. Mortality with one year of follow-up was 3.8%, 4.4%, 4.4%, 4.5%, and 3.7% in calendar period 1-5 respectively (p-value for difference=0.38). Conclusion From nationwide registries in patients with atrial fibrillation/flutter under 65 years of age, we found a stepwise decline in one-year rates of ischaemic stroke with more recent calendar periods. Heart failure and mortality incidence were stable across calendar time.Incidence rates of ischemic stroke

Sex difference in incidence, risk factors of heart failure and subsequent mortality in general population: Results from the China PEACE million persons project

Abstract Background Epidemiological study of sex differences in incidence and risk factors of heart failure (HF), and subsequent mortality attributed to HF in the Chinese general population is lacking. Purpose To assess the sex differences in the incidence and risk factors of HF, and evaluate the population attributable fractions (PAFs) for the subsequent mortality among the Chinese general population. Methods Data were from a sub-cohort of the Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project in Southern China. Between 2016 and 2020, 102,358 community residents aged 35 to 75 from 8 sites in Guangdong Province were screened, and 80 individuals with a history of HF were excluded. Participants were divided into two groups by sex and the study outcome was HF incidence. Fine and Gray models were conducted to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) accounting for the competing risk of all-cause mortality. Propensity score matching analysis and subgroup analyses were used to verify the robustness of the results. Adjusted PAFs of HF for all-cause and cardiovascular mortality were evaluated by sex. Results Of the 102,278 participants, 60.5% were women, and the mean age was 54.3 years. Compared with men, women were younger and less likely to smoke and drink, and had lower socioeconomic status and lower comorbid burdens. After a median follow-up of 3.52 years (343758 person-years), 1588 cases of incident HF (4.62 (95% CI: 4.40-4.85) per 1000 person-year) were identified. Compared with men (6.37 (95% CI: 5.95-6.80) per 1000 person-year), women had a lower incidence rate of HF (3.49 (95% CI: 3.24-3.75) per 1000 person-year, P&amp;lt;0.001). After adjusting for the covariates, women had 31% (95% CI: 0.61-0.79) lower risk for HF than men. The results were consistent in the propensity score matching cohort and across all subgroup analyses (all P sex-subgroups interaction &amp;gt;0.05). Although female was associated with a lower risk of HF, women had a higher PAF (24.2, 95% CI: 16.0-31.6) for subsequent cardiovascular mortality than men (16.5, 9%% CI: 11.3-21.5). Several significant differences in modifiable risk factors for HF were also noted between sexes. Conclusion In the Chinese general population, women were associated with a lower risk of HF but they have a higher cardiovascular mortality fraction attributed to HF than men. Sex-specific prevention strategies and therapies for HF should be warranted in the future.Graphic AbstractHF incidence across subgroups by sexes

Abstract 16789: Modeling the Optimal Strategy of Natriuretic Peptide Testing for Heart Failure Prevention in Diabetes: A Pooled Cohort Analysis

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with heart failure (HF) risk and measurement is recommended in diabetes. Incorporation of NT-proBNP with WATCH-DM, a HF risk score validated in diabetes, improved HF risk prediction in low-risk individuals (score &lt;13). Whether WATCH-DM can improve the yield of NT-proBNP testing and inform allocation of SGLT2 inhibitors is unknown. Methods: Adults with diabetes and free of HF at baseline from ARIC, CHS, CRIC, DHS, FOS, and MESA cohorts were included. Participants without cardiovascular disease (CVD) were stratified into high- vs. low-risk categories based on 4 approaches: 1) WATCH-DM (score ≥ vs. &lt;13); 2) NT-proBNP (≥ vs. &lt;125 pg/mL); 3) WATCH-DM plus NT-proBNP (both high vs. not); 4) WATCH-DM-based NT-proBNP (if score &lt;13, measure NT-proBNP) (either high vs. not). Five-year cumulative incidence rates of HF, number needed to treat (NNT 5 ) and number needed to screen (NNS 5 ) were estimated based on pooled treatment effects of SGLT2 inhibitors. Results: The study included 6,410 participants (47.5% women, 35.1% Black, 20.5% with CVD) with 428 (6.7%) incident HF events over 5-year follow-up. The 5-year risk of HF was 12.3% among participants with CVD and comparable to those without CVD identified as high-risk based on all 4 approaches ( Figure ). Among participants without CVD, WATCH-DM-based NT-proBNP identified 46% of participants as high-risk and accounted for 80% of HF events. The NNT 5 with an SGLT2 inhibitor to prevent 1 HF event in participants with CVD was 25 and similar to the primary prevention population identified as high-risk ( Figure ). The NNS 5 was lowest in the WATCH-DM-based NT-proBNP strategy ( Figure ). Conclusions: Selective NT-proBNP assessment based on a validated clinical risk score for HF improved the yield of testing and may represent an efficient approach to risk stratification and allocation of therapies among individuals with diabetes.

Abstract 14262: Cancer - A Driver of Heart Failure in People With Diabetes

Introduction: Despite the risk of heart failure (HF) in the survivorship phase of some cancers, the risk is not high enough to justify HF screening. However, people with diabetes mellitus (DM) have an increased risk of both HF and cancer. Examining this at-risk population may allow for better understanding of the effect cancer has on the development of HF. Hypothesis: Among people with DM, HF is more common in those with than without prior cancer. Methods: Data from the Australian National Diabetes Services Scheme (NDSS; 1,114,356 DM, types 1 and 2) from 2010 to 2019, was linked with public hospital data, the National Death Index and national Pharmaceutical Benefits Scheme (PBS) database. People with cancer were identified by the prescription of chemotherapy agents on the PBS dataset or a hospital admission with cancer. Incident HF was detected via first hospitalisation with HF as the primary diagnosis or death due to HF. The model was adjusted for age and sex. Results: Of the total cohort (1,114,356 people with DM), 48,014 experienced HF during 6,663,046 person-years of follow up from 2010-2019. Specifically, of 175,656 people with DM and cancer, 8,464 experienced HF during 644,620 person-years of follow up. The HF incidence rate ratio (IRR) of people with DM and cancer was 1.63 (95%CI: 1.59-1.67), compared to people with DM but no cancer. Cancer admission alone had an IRR of 1.97 (1.90-2.05), with an IRR of 1.50 (1.46-1.54) in DM treated with chemotherapy with or without admission. Conclusion: Cancer diagnosis is associated with an increased incidence of HF among people with DM. The higher IRR of people with cancer admission alone supports the association of cancer with HF irrespective of chemotherapy. Further studies controlling for confounders of cardiovascular risk and refinements by age are required to justify grounds for HF screening.

New treatment methods for myocardial infarction.

For a long time, cardiovascular clinicians have focused their research on coronary atherosclerotic cardiovascular disease and acute myocardial infarction due to their high morbidity, high mortality, high disability rate, and limited treatment options. Despite the continuous optimization of the therapeutic methods and pharmacological therapies for myocardial ischemia-reperfusion, the incidence rate of heart failure continues to increase year by year. This situation is speculated to be caused by the current therapies, such as reperfusion therapy after ischemic injury, drugs, rehabilitation, and other traditional treatments, that do not directly target the infarcted myocardium. Consequently, these therapies cannot fundamentally solve the problems of myocardial pathological remodeling and the reduction of cardiac function after myocardial infarction, allowing for the progression of heart failure after myocardial infarction. Coupled with the decline in mortality caused by acute myocardial infarction in recent years, this combination leads to an increase in the incidence of heart failure. As a new promising therapy rising at the beginning of the twenty-first century, cardiac regenerative medicine provides a new choice and hope for the recovery of cardiac function and the prevention and treatment of heart failure after myocardial infarction. In the past two decades, regeneration engineering researchers have explored and summarized the elements, such as cells, scaffolds, and cytokines, required for myocardial regeneration from all aspects and various levels day and night, paving the way for our later scholars to carry out relevant research and also putting forward the current problems and directions for us. Here, we describe the advantages and challenges of cardiac tissue engineering, a contemporary innovative therapy after myocardial infarction, to provide a reference for clinical treatment.

The characteristic large-scale annual analysis by gender and age in heart failure patients: cohort for 10 years in Korea.

The prevalence and incidence rate of heart failure (HF) continues to increase along with the aging of the population and the increase of ischaemic heart disease. The morbidity and mortality of HF are also on the rise in the industrialized countries; it can be a great public health problem. A detailed and accurate analysis of the demographical incidence and prevalence of HF is an important first step in predicting the occurrence of the disease in the future and proper preparing for prevention. Here, we aimed to analyse the annual prevalence and incidence of HF by gender and age using long-term national health insurance service data in the Republic of Korea. A total of 47243 patients newly diagnosed with HF between 2006 and 2015 among nationally representative random subjects of 1000000 were included. The data of age and gender were analysed by year, and the total population information of the Ministry of Land, Infrastructure, and Transport of Korea was referred to compare the data of HF patients with the total population (2008-15). Over the decade from 2006 to 2015, the prevalence of HF patients showed tendency of increase (P<0.001). The overall incidence rate was also gradually increasing (P<0.001), but in women, it tended to decrease gradually. Women significantly accounted higher than the male group in incidence of HF over the period (54.6% vs. 45.4%, P<0.001). The mean age at the time of diagnosis gradually increased (P=0.002 for total, P=0.001 for each gender). Total incidence was highest in 70s (27.22%), but males were the most in their 60s and females were in their 70s. Analysis of annual trend by age and gender distribution of HF incidence in men presented highest in the 50s-70s with a similar pattern annually, and the incidence is increasing more recently. Different from that of men, in the case of women, the incidence gradually increased with age in a similar annual pattern, peaking in their 70s and gradually decreasing in recent years. The prevalence and incidence of HF are gradually increasing. It increased rapidly in their 50s and older. It showed an increased incidence of HF especially in men between their 50s and 70s, and more observation and caution for the management of the risk factors may be needed to prevent HF in the male group.

Trends in heart failure between 2016 and 2022 in Türkiye (TRends-HF): a nationwide retrospective cohort study of 85 million individuals across entire population of all ages

Data on the burden of heart failure (HF) outside western countries are limited, but available data suggest it may present differently in other countries. The aim of this study was to examine the incidence, prevalence, and survival rates of HF in Türkiye, with a specific focus on how these rates vary according to age, sex, comorbidities, and socioeconomic status (SES). We harnessed the extensive National Electronic Database of the Turkish Ministry of Health, covering Turkey's entire population from January 1, 2016, to December 31, 2022, to identify 2,722,151 cases of HF and their associated comorbidities using ICD-10 codes. Analyzing the primary endpoint of all-cause mortality, our study utilized anonymized data to examine patient demographics, comorbidities, socioeconomic status, and survival patterns, employing statistical techniques to delve into relationships and trends. The data were segmented by gender, socioeconomic status, and age, involving cross-tabulations and statistical metrics to explore connections, odds ratios, and survival rates. The estimated prevalence of HF was 2.114% in Türkiye at the end of 2022, with an annual incidence ranging between 3.00 and 6.06 per 1000 person years. Females were older than males (69.8±13.9 years vs. 66.8±13.9 years, respectively). The most common comorbidities were congenital heart diseases and anemia under the age of 20, and hypertension and atherosclerotic cardiovascular disease in the adult population. Only 23.6% (643,159/2,722,151) of patients were treated with any triple guideline-directed medical therapy (GDMT) and 3.6% (96,751/2,722,151) of patients were on quadruple GDMT. The survival rates for patients with HF at 1, 5, and 7 years were 83.3% (95% CI: 83.2-83.3), 61.5% (95% CI: 61.4-61.6), and 57.7% (95% CI: 57.6-57.8) among females, and 82.1% (95% CI: 82.0-82.2), 58.2% (95% CI: 58.1-58.3), and 54.2% (95% CI: 54.0-54.3) among males. Despite a tendency for an increase from the highest to the lowest SES, the prevalence of HF and mortality were paradoxically lowest in the lowest SES region. The prevalence, incidence, and survival rates of HF in Türkiye were comparable to western countries, despite the notable difference of HF onset occurring 8-10 years earlier in the Turkish population. Drug usage statistics indicate there is a need for effective strategies to improve treatment with GDMT. None.

Heart Failure Among Patients with Multiple Myeloma Treated with Carfilzomib-Based Versus Non-Carfilzomib-Based Regimens in the United States by Race.

Carfilzomib treatment for multiple myeloma (MM) can increase heart failure risk. Whether this risk differs by race is unknown. We sought to estimate the incidence rates (IRs) of heart failure hospitalization among mostly 65-years-and-older US patients with MM by race treated with carfilzomib- and non-carfilzomib-based regimens in the real-world using Centers for Medicare & Medicaid Services Medicare Fee-for-Service data, Optum Clinformatics Data Mart, and Humana Research Database. The risk of heart failure hospitalization associated with a carfilzomib-based regimen was evaluated using propensity score matching among Black and White patients receiving second or later lines of therapy. Most patient-episodes (88%) were in persons 65 years or older for the 3 cohorts combined. The IR (95% CI) of heart failure hospitalization was higher for patient-episodes treated with a carfilzomib-based regimen than those with a non-carfilzomib-based regimen for both White (14.5 [12.2-17.0] vs. 10.7 [10.3-11.2] events per person-years) and Black patients (15.8 [10.1-23.5] vs. 12.1 [10.9-13.4] events per person-years) in the Medicare cohort. After propensity score matching, the hazard ratio (95% CI) of increased heart failure hospitalization comparing carfilzomib-based to non-carfilzomib-based regimens for White patients (1.6 [1.3-2.0]) was similar to that of Black patients (1.7 [1.0-2.9]) in the Medicare Database, and in the Humana Database (1.4 [0.8-2.6] and 1.2 [0.4-3.5], respectively). Although the IR of heart failure among patients with MM treated with a carfilzomib-based regimen was slightly higher, no evidence suggested the relative risk was different between White and Black patients with MM.

Development of a tool to predict the risk of incident heart failure in a general population: the HUNT for HF risk score.

Currently, no incident heart failure (HF) risk score that is in regular use in a general population is available. We aimed to develop this and compare with existing HF risk scores. Participants in the third wave (2006-08) of the population-based Trøndelag Health Study 3 (HUNT3) were included if they reported no previous HF. Any hospital diagnoses captured during follow-up (until the end of 2018) of HF, cardiomyopathy, or hypertensive heart disease were assessed by an experienced cardiologist. Valid HF events were defined as symptoms/signs of HF and objective evidence of structural/functional abnormality of the heart at rest. The model was compared with slightly modified HF risk scores (the Health Aging and Body Composition HF risk score, the Framingham HF risk score, the Pooled Cohort equations to Prevent HF risk score, and NORRISK 2). Among 36511 participants (mean±SD age of 57.9±13.3years, 55.4% female), with a mean follow-up of 10.2±1.3years, 1366 developed HF (incidence rate of 3.66 per 1000 participant years). Out of the 38 relevant clinical variables assessed, we identified 12 (atrial fibrillation being the strongest) that independently predicted an HF event. The final model demonstrated good discrimination (C statistics=0.904) and calibration, was stable in internal validation, and performed well compared with existing risk scores. The model identified that, at enrolment, 31391 (86%), 2386 (7%), 1246 (3%), and 1488 (4%) had low, low-intermediate, high-intermediate, and high 10-year HF risk, respectively. Twelve clinical variables independently predicted 10-year HF risk. The model may serve well as the foundation of a practical, online risk score for HF in general practice. ClinicalTrials.gov Identifier: NCT04648852.

Abstract P176: The Association of Blood Urea Nitrogen With Incident Heart Failure in the Community: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Blood urea nitrogen (BUN) has been shown as a potent predictor of morbidity and mortality in patients with heart failure (HF). Whether BUN levels are associated with incident HF in the general population is unknown. Methods: Among 14,263 ARIC participants without a history of HF at baseline (1987-1989) (mean age 54 [SD 5.7] years, Female 54.4%, Black 25.4%), we assessed the association of BUN with incident HF. BUN levels (mg/dL) were divided by quartiles in the primary analysis, and the highest quartile was further divided into tertiles in the secondary analysis (Q1&lt;13, Q2 13-15, Q3 15-17, Q4a 17-19, Q4b 19-21, Q4c &gt;21). We defined HF as hospitalization or death with HF diagnosis and estimated hazard ratios (HRs) using multivariable Cox regression models. Results: During a median follow-up of 26.2 years, 3,506 participants developed incident HF (incidence rate 10.7 per 1,000 person-year). When we adjusted for demographic variables, using the lowest quartile (Q1) as the reference, the top quartile (Q4) showed an HR of 1.18 (95% CI 1.08, 1.10) (Model 1 in Table ). When we subdivided Q4, Q4c showed the highest HR (1.40 [95% CI 1.21, 1.61]). The association was similar after further adjusting for lifestyle and other clinical factors (Model 2 in Table ). Further adjustment for estimated glomerular filtration rate modestly attenuated the association (Model 3 in Table ), but HRs remained significant for Q4 as a whole (1.11 [1.01, 1.22]) and Q4c (1.27 [1.09, 1.47]). In subgroup analysis, the association was stronger in Black participants than in White participants (p-for-interaction &lt;0.05). Conclusion: In this community-based cohort, higher BUN levels were significantly associated with incident HF. BUN levels are often measured as part of routine clinical care and thus may inform clinicians to identify individuals at risk of HF, particularly in resource-constrained settings with limited availability of measuring HF-specific markers such as natriuretic peptides.

Clinical Characteristics and Prognosis of MINOCA Caused by Atherosclerotic and Nonatherosclerotic Mechanisms Assessed by OCT

BackgroundMyocardial infarction with nonobstructive coronary artery (MINOCA) is a heterogeneous syndrome caused by different pathophysiologic mechanisms. There is limited evidence regarding prognosis of patients with MINOCA caused by different mechanisms. ObjectivesThe present study aimed to assess the underlying mechanisms of MINOCA by optical coherence tomography (OCT) and to correlate with clinical outcomes. MethodsPatients with MINOCA were divided into 2 groups based on OCT findings: atherosclerotic MINOCA (Ath-MINOCA) and nonatherosclerotic MINOCA (non-Ath-MINOCA). Major adverse cardiac events (MACE) were defined as cardiac death, nonfatal MI, target lesion revascularization, stroke, and rehospitalization for unstable or progressive angina. ResultsAmong 7,423 patients with a clinical diagnosis of MI who underwent angiography, 190 of 294 MINOCA were studied using OCT. The causes of Ath-MINOCA (n = 99, 52.1%) were plaque erosion (n = 64, 33.7%), plaque rupture (n = 33, 17.4%), and calcified nodule (n = 2, 1.1%) whereas the causes of non-Ath-MINOCA (n = 91, 47.9%) were spontaneous coronary artery dissection (n = 8, 4.2%), coronary spasm (n = 9, 4.7%), and unclassified cause (n = 74, 38.9%). The 1-year MACE was 15.3% for Ath-MINOCA vs 4.5% for non-Ath-MINOCA (P = 0.015). An atherosclerotic cause was an independent predictor of MACE (HR: 5.36 [95% CI: 1.08-26.55]; P = 0.040), mainly driven by target lesion revascularization and rehospitalization, despite the composite endpoint including cardiac death and MI showing no difference. ConclusionsOCT identified a cause in 61.1% of MINOCA, in which Ath-MINOCA represents an important and distinct MINOCA subset. Ath-MINOCA were more common and associated with worse outcomes. (Incidence Rate of Heart Failure After Acute Myocardial Infarction With Optimal Treatment; NCT03297164; Paradigm Shift in the Treatment of Patients With ACS; NCT02041650)

Incidence of heart failure following exposure to a protein kinase inhibitor, a French population-based study.

Pharmacovigilance signals of heart failure (HF) following exposure to protein kinase inhibitors (PKIs) have been detected in recent years. Our aim was to identify the PKIs most frequently associated with the development of HF. Using the French National Healthcare Database, all patients newly exposed to a PKI between January 2011 and June 2014 were followed up for 18 months. Specific hospitalization diagnosis and long-term HF-related disease codes were used to identify HF patients. HF incidence rate ratios (IRRs) were measured and adjusted hazard ratios (aHRs) were estimated using a Cox model. Sensitivity analyses were performed to limit the potential indication and competitive risk bias. Thirteen PKIs were studied. Among the 49 714 new PKI users registered during the study period, the mean IRR of HF was 3.38 per 100 person-years, with a median time to onset of 155 days. We found a significant increase in the incidence of HF for six medicinal products: pazopanib (aHR = 2.42, 95% confidence interval [CI] 1.67-3.52), dasatinib (aHR = 2.22, 95% CI 1.42-3.44), ruxolitinib (aHR = 2.11, 95% CI 1.69-2.64), crizotinib (aHR = 1.71, 95% CI 1.07-2.72), everolimus (aHR = 1.45, 95% CI 1.26-1.67) and vemurafenib (aHR = 1.37, 95% CI 1.01-1.86). Sensitivity analyses were consistent with our primary analysis. The current study provides knowledge on HF following exposure to a PKI. Additional studies could confirm these results for dasatinib, everolimus, pazopanib and ruxolitinib, and particularly for the two medicinal products with results slightly above the significance threshold, namely, crizotinib and vemurafenib, in our sensitivity analyses.

Abstract 13088: Peak Systolic Strain Rate is Associated With Incident Heart Failure in the General Population - The Copenhagen City Heart Study

Introduction: Peak systolic strain rate (SrS) reflecting the maximal acceleration of the systolic deformation during systole derived from speckle tracking echocardiography has been demonstrated to be a significant predictor of cardiovascular outcomes in patients with myocardial infarction. However, the prognostic utility of SrS in individuals with low cardiovascular risk is unknown. Hypothesis: We hypothesized that SrS was associated with incident heart failure (HF) in the general population. Methods: The 5th Copenhagen City Heart Study is a prospective cohort study. All participants had echocardiography performed. Exclusion criteria were prevalent HF and inadequate image quality for SrS assessment. The multivariable Cox model included variables from the Atherosclerosis Risk In Communities (ARIC) HF risk score and left ventricular ejection fraction. Results: A total of 4,013 participants were included in the final study sample. The mean age was 56 years and 2,290 (57.1%) were female. The mean SrS was 1.11 s -1 . During a median follow-up of 5.4 years, 101 participants (3%) developed HF. In multivariable analysis, decreasing SrS was significantly associated with HF (HR 1.32 (95% CI: 1.12; 1.56) p= 0.001) per s -1 decrease) (Figure). The optimal cutoff value of SrS &lt; 1.028 s -1 was linked to a 4-fold risk of HF (HR 4.38 (95% CI: 2.92; 6.56). Incidence rate of HF was 2.4 per 1000 person-years (95% CI: 1.77; 3.36) when SrS ≥ 1.028 and 10.7 per 1000 person-years (95% CI: 8.35; 13.63) when SrS &lt; 1.028. The cutoff had a sensitivity of 63.4% (95% CI: 53.2; 72.7), a specificity of 72.1% (95% CI: 70.6; 73.5), and a negative predictive value of 98.7% (95% CI: 98.2; 99.1). Finally, SrS added incremental value to the ARIC HF risk score with a net reclassification index of 0.264 (95% CI: 0.086; 0.415). Conclusions: SrS was significantly associated with the development of HF in the general population and provided incremental value to the ARIC HF risk score.

Abstract 14179: Unsupervised Machine Learning on Myocardial Deformation Curves Identifies Specific Clusters of People at Risk of Heart Failure - The Copenhagen City Heart Study

Background Peak global longitudinal strain is recognized as a powerful predictor of heart failure (HF). However, whether the entire strain curve add important prognostic information regarding risk of HF remains unknown. We aimed to investigate whether patterns of myocardial deformation identified through unsupervised machine learning (uML) entailed additional information regarding risk of HF. Methods Longitudinal strain curves from 3,710 subjects from the general population without prevalent HF were clustered by similarity using uML based on strain curves alone. The grouped clusters were then compared by incidence rate of HF and in multivariable COX models. Results Mean age was 56 years and 43% were male. During a median follow-up of 5.3 years, 92 subjects (2.5%) developed HF. The uML algorithm generated a hierarchical clustering tree (Figure 1) and 10 different clusters. Generally, with increasing incidence of HF, strain curves displayed a smaller reduction of strain from peak-GLS to the maximal curvature during the early filling relative to the size of their peak-GLS (Figure 1 and 2): We called this value early diastolic strain to peak-GLS (EDS to peak-GLS). One exception was cluster 9. In multivariable Cox regression, cluster 9 was significantly associated with increased incidence of HF when compared to cluster 3,4 and 5 [For cluster 3: HR 6.6, 95%CI: 1.5;29.0, p = 0.013] even though the subjects of cluster 9 were younger (40 years), displayed healthier clinical baseline characteristics, and only had slightly reduced Peak-GLS. The mean strain curve of the lateral basal segment of cluster 9 displayed an early systolic lengthening followed by a late and reduced contraction specifically related to the basal lateral segment (Figure 3). Conclusion uML could identify clusters with high incidence of HF based on strain curves alone. The algorithm identified unknown strain patterns beyond peak-GLS presumably related to increased risk of HF.

Abstract 12827: The Prognostic Value of Peak Mitral Annulus Systolic Velocity in Relation to Incident Heart Failure in the General Population - The Copenhagen City Heart Study

Introduction: Peak mitral annulus systolic velocity (s’) measured by color tissue Doppler echocardiography can be used to evaluate longitudinal systolic function of the left ventricle (LV). The prognostic value of s’ has previously been documented in patients with ischemic heart disease and heart failure (HF). We sought to investigate the prognostic value of s’ in association with incident HF in the general population with low cardiovascular risk. Methods: This prospective cohort consists of participants from the 5th Copenhagen City Heart Study. All participants had echocardiography performed. Exclusion criteria were prevalent HF, prevalent atrial fibrillation and inadequate image quality for s’ assessment. Multivariable Cox regression models adjusted for; sex, age, smoking-status, diabetes, ischemic heart disease, hypertension, heart rate, left atrial volume index and E/e’, were used to assess the association between s’ and HF. Results: Of 4,110 participants included (mean age 56 years ± 17.4 year, 56.8% female), 90 (2.2%) developed HF during a median follow-up of 5.4 years, [IQR: 4.4-6.3]. The mean s’ was 6.05 cm/s ± 1.2. Following multivariable adjustment, decreasing s’ remained significantly associated with HF (HR 1.60 (95% CI: 1.24; 2.07 p&lt;0.001) per 1 cm/s decrease) (Figure). An optimal cut-off value for s’ was calculated to be 5.9 cm/s. Participants with s’ below this cut-off had a 3-fold increased risk of HF (HR 3.15 (95% CI: 1.97; 5.03 p&lt;0.001). In participants with s’ ≥ 5.9 cm/s, the incidence rate of HF was 2.1 per 1000 person-years (95% CI: 1.39; 3.09) and 6.5 per 1000 person-years (95% CI: 5.13; 8.31) when s’ &lt; 5.9 cm/s. The cut-off value had a sensitivity of 73.3% (95% CI: 63; 82.1), a specificity of 54.0 (95% CI: 52.4; 55.6), and a negative predictive value of 98.9% (95% CI: 98.4; 99.3). Conclusion: In the general population, s’ is an independent prognosticator for the development of HF. Figure. The assocation between s’ and HF.