Heart Failure Mortality Research Articles

Uric Acid and SGLT2 Inhibition With Empagliflozin in HeartFailure With Preserved Ejection Fraction: The EMPEROR-Preserved Trial.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcome in patients with heart failure (HF) and reduce serum uric acid (SUA). The relevance of this metabolic effect in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. The authors investigated the effect of empagliflozin on SUA levels in relation to the therapeutic efficacy in patients with HFpEF. This post hoc analysis of the EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction; NCT03057951) trial assessed the clinical effect of SUA reduction in relation to the outcome endpoints of the trial (composite primary outcome of cardiovascular mortality or hospitalization for HF, its individual components, and all-cause mortality in patients with HFpEF). Hyperuricemia (SUA >5.7mg/dL for women, >7.0mg/dL for men) was prevalent in 49% of patients. Elevated SUA (highest tertile SUA 8.8 ± 1.4 g/dL) was associated with advanced HF severity and with higher risk of adverse outcome (primary endpoint HR: 1.23 [95%CI: 0.98-1.53]; P = 0.07; HF hospitalization HR: 1.42 [95%CI: 1.08-1.86]; P= 0.01). SUA was reduced early (after 4weeks vs placebo-0.99 ± 0.03mg/dL; P< 0.0001) and throughout follow-up, with reduction in all prespecified subgroups. Empagliflozin reduced clinical events of hyperuricemia (acute gout, gouty arthritis, or initiation of antigout therapy) by 38% (HR: 0.62 [95%CI: 0.51-0.76]; P< 0.0001). The treatment benefit on the primary endpoint was not influenced by baseline SUA (HR: 0.79 [95%CI: 0.69-0.90]; P = 0.0004). The change in SUA was an independent correlate of the treatment benefit on the primary endpoint (P = 0.07). Hyperuricemia is a common complication in HFpEF and is related to advanced disease severity and adverse outcome. Empagliflozin induced a rapid and sustained reduction of SUA levels and of clinical events related to hyperuricemia.

Nonalcoholic fatty liver disease is associated with ventricular arrhythmias and major cardiovascular events in patients with implantable cardioverter-defibrillators

BackgroundPatients with nonalcoholic fatty liver disease (NAFLD) are at risk for cardiovascular diseases. Less is known about the relationship between NAFLD, ventricular arrhythmias (VAs), and cardiovascular events. ObjectiveWe sought to evaluate the association between NAFLD and VAs and major cardiovascular events in patients with implantable cardioverter-defibrillators (ICDs). MethodsA total of 921 patients at high risk of sudden cardiac death who received ICDs were retrospectively analyzed. NAFLD is diagnosed by the presence of hepatic steatosis and lack of secondary causes of hepatic fat accumulation. The primary end points were VAs, defined as sustained ventricular tachycardia and ventricular fibrillation documented by the device. The secondary end points were cardiac mortality, heart transplantation, and rehospitalization for heart failure. ResultsThe prevalence of NAFLD in patients with ICDs was 24.2% (223/921). The mean age was 58.5 ± 12.7 years, and 25.7% were female. During the mean follow-up of 34.8 months, 272 (29.5%) patients achieved primary end points and 171 (18.6%) achieved secondary end points. Kaplan-Meier analysis revealed that NAFLD was associated with an increased risk of VAs (hazard ratio [HR], 3.90; 95% confidence interval [CI], 2.87–5.29; log-rank P < .0001) and secondary end points (HR, 2.04; 95% CI, 1.72–2.94; log-rank P < .0001). In adjusted Cox regression models, NAFLD was an independent risk factor for VAs (HR, 3.84; CI, 2.87–5.12; P < .001) and secondary end points (HR, 2.26; CI, 1.55–3.28; P < .001). ConclusionIn our retrospective cohort, NAFLD is significantly associated with VAs and major cardiovascular events in patients with ICDs.

Catheter ablation vs antiarrhythmic therapy for atrial fibrillation in heart failure with preserved ejection fraction

BackgroundClinical outcomes of patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) treated with catheter ablation (CA) vs antiarrhythmic therapy (AAT) are not well known. ObjectiveThis study compared morbidity and mortality of patients with AF and HFpEF treated with CA vs AAT. MethodsAF and HFpEF patients from January 2017 to June 2023 were identified in TriNetX, a large global population-based database. Patients with prior diagnosis of heart failure with reduced ejection fraction (HFrEF) or crossover between AAT and CA were excluded. Baseline characteristics including age, sex, body mass index, type of AF, comorbidities, and cardiovascular medications were compared. The 2 groups were 1:1 propensity score matched for outcomes analysis. All-cause mortality, cerebrovascular accident/transient ischemic attack, and acute heart failure were compared with Kaplan-Meier curves. ResultsPatients treated with CA (n = 1959) and AAT (n = 7689) were 1:1 propensity score matched, yielding 3632 patients with no significant differences in baseline characteristics. Compared with AAT, CA was associated with decreased mortality (9.2% vs 20.5%; hazard ratio [HR], 0.431; 95% confidence interval [CI], 0.359–0.518; P < .001). In addition, CA was associated with reduced HFpEF (HR, 0.638; 95% CI, 0.550–0.741; P < .001) and acute HFrEF (HR, 0.645; 95% CI, 0.452–0.920; P = .015). There was no difference in composite of cerebrovascular accident/transient ischemic attack (HR, 0.935; 95% CI, 0.725–1.207; P = .607). ConclusionIn this retrospective study of patients with AF and HFpEF, CA was associated with lower mortality and risk of acute heart failure compared with AAT.

Predicting Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction by Using Machine Learning

Predicting Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction by Using Machine Learning

Secondary mitral regurgitation surgical management: a narrative review.

The most common valvular heart disease in the US is moderate to severe mitral regurgitation (MR). Function MR or secondary MR comprises many of these cases. Moderate and severe secondary MR are independently associated with increased all-cause mortality and rehospitalization for heart failure. Both ischemic and nonischemic cardiomyopathy can cause secondary MR via similar pathophysiology that leads to inadequate valve leaflets coaptation. The management of secondary MR is complex. The optimal treatment strategy for secondary MR remains controversial, reflected in the vast array of treatment options and the complexity of therapeutic decision-making. Several surgical mitral valve repair techniques have been described in the literature. Many of these aims to facilitate adequate valve leaflet coaptation. In this review, the pathophysiology of MR is described with a focus on evaluating and managing secondary MR. A literature review was performed using PubMed and Google Scholar. Clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews were considered from January 1, 1995 through December 31, 2022. Articles published in languages other than English with limited text availability were excluded. Optimal therapeutic approach in severe secondary MR is complex and several patient factor should be considered. We provide a framework for the surgical management of secondary MR based on echocardiographic parameters, the presence of ischemia, and myocardial viability. Further study is needed to guide the selection of patients most likely to benefit from mitral valve repair or replacement in the setting of secondary MR.

The Impact of Hormone Replacement Therapy on the Riskof Heart Failure in Postmenopausal Women: A Meta-Analysis of Clinical and Observational Studies.

The relationship between heart failure (HF) and hormone replacement therapy (HRT) in postmenopausal women remains unclear. This paper aimed to elucidate the association between HRT and HF outcomes in postmenopausal women by scrutinizing evidence from clinical trials and observational studies. The meta-analysis was systematically executed following the PRISMA guidelines to include studies identified from the electronic databases, including PubMed, EMBASE, EBSCO, ICTRP, and NIH clinical trials. The primary endpoint of the effect comprised risk ratios (RR) for HF incidence and mortality, attended by 95% confidence intervals (CIs). The risk of bias was assessed employing the Cochrane Risk of Bias 2 (RoB2) tool for clinical trials and the Newcastle-Ottawa Scale (NOS) for observational studies. The search yielded a total of eight reports, originating from six individual studies, for inclusion in the current study, and 25 047 participants were included. The meta-analysis demonstrated no remarkable association between HRT and the incidence of HF in postmenopausal women (RR: 1.07, 95% CI: 0.91-1.25, p = 0.37). However, a significant reduction in all-cause mortality was observed among post-menopausal HF patients who received HRT (RR: 0.65, 95% CI: 0.49-0.87, p = 0.003). In age-related subgroup analyses, no significant change in the risk of HF was noticed among participants on HRT. The findings of this paper demonstrate that HRT use is not associated with a significant increase in the risk of incident HF. This meta-analysis also suggests a benefit in all-cause mortality when HRT is administered to postmenopausal women with HF.

“A hot topic”: TTR amyloidosis gets its moment to shine at ESC 2024

n transthyretin amyloidosis (ATTR), the liver produces an abnormal transthyretin (TTR) protein, which aggregates into amyloid fibrils that accumulate in peripheral nerves and the heart. Over time, this can lead to progressive cardiomyopathy (ATTR-CM), heart failure (HF), and premature mortality. At the recent meeting of the ESC there was much excitement and enthusiasm about ATTR-CM, largely inspired by the HELIOS-B trial of vutrisiran, an RNA interference (RNAi) agent that, if approved, would become only the second medication indicated for ATTR-CM. This report reviews the most relevant insights from the meeting into the diagnosis and management of ATTR-CM, with expert commentary on their relevance and implications for Canadian clinicians.

Projecting the Population Level Burden of CKD Progression According to Urine Albumin-to-Creatinine Ratio Categories

IntroductionUrinary albumin-creatinine ratio (uACR) is an independent predictor of chronic kidney disease (CKD) progression, however there is limited evidence on the burden of CKD according to uACR categories at a population level. This study estimates future clinical and financial burden of CKD according to uACR categories using the Inside CKD microsimulation. MethodsThe Inside CKD model is an individual patient level microsimulation that emulates national populations based on demographic, epidemiological and economic data. The analysis estimates clinical and economic outcomes over time according to KDIGO uACR categories (A1–A3) at a population level for 31 countries and regions. ResultsCKD populations (diagnosed and undiagnosed individuals, stages G3-5) were projected to be predominantly within uACR categories A1 and A2 in 2022. Projected cumulative incidence of CKD stage transitions (disease progression) and cardio-renal complications (heart failure, myocardial infarction, stroke, and all-cause mortality) occurred mostly in uACR categories A1 and A2 between 2022–2027. Patients in uACR categories A1 and A2, who represent the largest proportion of patients with CKD, were projected to incur most of the healthcare costs associated with CKD management and cardio-renal complications for the diagnosed population (prevalence 2027). ConclusionThis study highlights the disproportionate population-level clinical and economic burden associated with individuals within KDIGO uACR categories A1 and A2, who represent most of the CKD population. This awareness will help healthcare decision makers to appropriately allocate resource and interventions to the CKD population, including those with mildly to moderately increased albuminuria, to reduce clinical and economic burden associated with CKD.

Assessment of the Right Ventricle Function in Patients With Significant Tricuspid Regurgitation: A Review.

Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function-a key prognostic factor in TR-remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes.

Implementation of Random Forest with Synthetic Minority Oversampling Technique and Particle Swarm Optimization for Predicting Survival of Heart Failure Patients

Abstract. Heart failure is caused by a disruption in the heart’s muscle wall, which results in the heart’s inability to pump blood in sufficient quantities to meet the body’s demand for blood. The increasing prevalence and mortality rates of heart failure can be reduced through early disease detection using data mining processes. Data mining is believed to aid in discovering and interpreting specific patterns in decision-making based on processed information. Data mining has also been applied in various fields, one of which is the healthcare sector. One of the data mining techniques used to predict a decision is the classification technique. Purpose: This research aims to apply SMOTE and PSO to the Random Forest classification algorithm in predicting the survival of heart failure patients and to determine its accuracy results. Methods/Study design/approach: To predict the survival of heart failure patients, we utilize the Random Forest classification algorithm and incorporate data imbalance handling with SMOTE and feature selection techniques with PSO on the Heart Failure Clinical Records Dataset. The data mining process consists of three distinct phases. Result/Findings: The application of SMOTE and PSO on the Heart Failure Clinical Records Dataset in the Random Forest classification process resulted in an accuracy rate of 93.9%. In contrast, the Random Forest classification process without SMOTE and PSO resulted in an accuracy rate of only 88.33%. This indicates that the proposed method combination can optimize the performance of the classification algorithm, achieving a higher accuracy compared to previous research. Novelty/Originality/Value: Data imbalance and irrelevant features in the Heart Failure Clinical Records Dataset significantly impact the classification process. Therefore, this research utilizes SMOTE as a data balancing method and PSO as a feature selection technique in the Heart Failure Clinical Records Dataset before the classification process of the Random Forest algorithm.

GENDER DIFFERENCES IN CLINICAL OUTCOMES AMONG STEMI PATIENTS UNDERGOING PRIMARY PCI

ST-elevation myocardial infarction (STEMI) is a major cause of death worldwide. Primary percutaneous coronary intervention (PCI) is the preferred treatment, restoring coronary blood flow to reduce mortality. However, women often experience worse outcomes after STEMI compared to men. Objective: This study aimed to assess gender differences in clinical outcomes, focusing on in-hospital mortality and heart failure among STEMI patients undergoing primary PCI. Methods: A prospective study was conducted at Lady Reading Hospital Peshawar from January to July 2020. The study included 298 STEMI patients aged 35-70 years who underwent primary PCI. Of these, 154 were females (51.7%) and 144 were males (48.3%). Data on demographics, clinical features, and outcomes were collected. Statistical analysis was performed using SPSS Version 25. Continuous variables were presented as mean ± standard deviation, and categorical variables as percentages. Multivariate logistic regression was applied to control for confounding factors. Results: Female patients showed a higher rate of heart failure (12.8% vs. 6.1%, p=0.011) and in-hospital mortality (7.0% vs. 3.5%, p=0.020) compared to males. The odds ratio for heart failure in females was 0.389 (95% CI 0.185-0.817), and for mortality, it was 0.310 (95% CI 0.111-0.870). Stent thrombosis rates were similar between genders (1.7% each, p=0.707). Major bleeding was more frequent in females (2.3% vs. 1.4%), though the difference was not significant (p=0.770).Conclusion: This study reveals significant gender disparities in STEMI outcomes after primary PCI, with women at greater risk for heart failure and in-hospital mortality. These findings highlight the need for tailored strategies in STEMI management to improve outcomes for women.

In-Hospital Outcomes of Patients with Non-ST Elevation Myocardial Infarction Undergoing Early Invasive Percutaneous Coronary Intervention

Methodology: A cross-sectional study was conducted in the Adult Cardiology Department at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from August 2019 to February 2020. The study included 165 patients, both male and female, aged 40 to 75 years, who presented with NSTEMI and underwent early invasive PCI. All patients were either admitted through the emergency department or referred from outpatient services at NICVD. Comprehensive medical assessments were performed, and relevant medical history and clinical details were documented. PCI procedures were conducted under the supervision of experienced consultant cardiologists with over five years of procedural expertise. The primary outcomes evaluated were the incidence of cardiogenic shock, heart failure, and in-hospital mortality. Results: Of the 165 patients included in the study, 125 (75.8%) were male, with a mean age of 56.6±7.72 years and a mean BMI of 26.5±3.8 kg/m². Hypertension was prevalent in 100 (60.6%) patients, while 78 (47.3%) had diabetes mellitus. A history of smoking was reported in 70 (42.4%) patients. Heart failure emerged as the most common in-hospital adverse outcome, occurring in 25 (15.2%) patients, followed by cardiogenic shock in 9 (5.5%) patients, and in-hospital mortality in 20 (12.1%) patients. Conclusion: Among patients undergoing early invasive PCI following NSTEMI, heart failure was the most frequent adverse in-hospital outcome, followed by mortality and cardiogenic shock. These findings underscore the importance of vigilant monitoring and management of high-risk NSTEMI patients during the early stages of PCI intervention.

Transcatheter occlusion of venovenous collaterals in the total cavopulmonary Fontan circulation.

Venovenous collaterals are abnormal connections between the systemic and pulmonary venous systems. They are commonly seen in the Fontan circulation and may lead to significant hypoxaemia. Transcatheter closure of venovenous collaterals is a potential but controversial treatment as the long-term benefits and outcomes are not well understood. This retrospective cohort study utilised data from the Australian and New Zealand Fontan Registry. Patients who underwent transcatheter venovenous collateral occlusion for hypoxemia from the year 2000 onwards were included. Atriopulmonary and Kawashima-type Fontan circulations were excluded to reflect a more contemporary Fontan cohort. Nineteen patients (age 19.3 ± 7.8 years, 53% female) underwent transcatheter venovenous collateral occlusion. Compared to baseline, mean oxygen saturation was improved at latest follow-up (90.5% vs 87.0%; p = 0.003). Nine patients achieved a clinically significant response (defined as an increase of at least 5% to 90% or greater), and this was associated with lower baseline Fontan pressures (12.9 v 15.6 mmHg; p = 0.02). No heart failure hospitalisations, arrhythmia, transplant referrals, or mortality were observed during the median follow-up period of 4 years. Two patients experienced thromboembolic events and five patients underwent re-intervention. Transcatheter occlusion of venovenous collaterals in Fontan patients with chronic hypoxaemia resulted in a modest increase in oxygenation over a median follow-up of 4 years and longer-term prognosis did not appear to be adversely affected. Lower Fontan pressures at baseline were associated with a greater improvement in oxygenation.

Socio-economic inequalities and heart failure morbidity and mortality: A systematic review and data synthesis.

Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation.

Beneficial effects of extravascular lung water index-guided volum management in patients with cardiogenic shock

Objective: To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock. Methods: This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment. Results: A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95%CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value (AUC=0.54, 95%CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion: EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.

Selective loss of Y chromosomes in lung adenocarcinoma modulates the tumor immune environment through cancer/testis antigens.

There is increasing recognition that the sex chromosomes, X and Y, play an important role in health and disease that goes beyond the determination of biological sex. Loss of the Y chromosome (LOY) in blood, which occurs naturally in aging men, has been found to be a driver of cardiac fibrosis and heart failure mortality. LOY also occurs in most solid tumors in males and is often associated with worse survival, suggesting that LOY may give tumor cells a growth or survival advantage. We analyzed LOY in lung adenocarcinoma (LUAD) using both bulk and single-cell expression data and found evidence suggesting that LOY affects the tumor immune environment by altering cancer/testis antigen expression and consequently facilitating tumor immune evasion. Analyzing immunotherapy data, we show that LOY and changes in expression of particular cancer/testis antigens are associated with response to pembrolizumab treatment and outcome, providing a new and powerful biomarker for predicting immunotherapy response in LUAD tumors in males.

The effects of digoxin on heart failure mortality and re-admission in a single center cross-sectional study.

Mortality benefit of digoxin prescription in patients suffering from heart failure has been questioned many time. We evaluated these effects among admitted symptomatic heart failure patients. We retrospectively divided our patients into two groups: group A (n=205) were digoxin prescribed, and group B (n=96) were digoxin naïve patients. Both groups' medical records were gathered for one year, and the study endpoints were compared between the two groups. The mean age was 62.3±12.1 years and 54.8 % were male. All-cause mortality and readmission occurred in 26.7% and 31.7% of individuals, respectively, without significant differences between the two groups. However, in subgroup analysis, there was a significant relationship between in-hospital mortality and the presence of cardiovascular risk factors. Digoxin might increase in-hospital mortality in patients with underlying cardiovascular risk factors.

The Comparison of the Effectiveness of Dapagliflozin and Empagliflozin in the Prevention of Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Network Meta-Analysis.

Type 2 diabetes mellitus (T2DM) is a significant risk factor for cardiovascular diseases, prompting research into treatments that can mitigate this risk. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, particularly dapagliflozin and empagliflozin, have shown promising cardiovascular benefits in T2DM patients. This meta-analysis aimed to directly compare the cardiovascular outcomes of these two drugs. To achieve this, we conducted a comprehensive literature search across multiple databases up to August 5, 2024, including both randomized controlled trials (RCTs) and observational studies. The primary outcomes of interest were major adverse cardiovascular events (MACE), atrial fibrillation (AF), cardiovascular mortality, myocardial infarction (MI), and hospitalization for heart failure (HF). Twelve studies met the inclusion criteria for this meta-analysis. The pooled analysis revealed several key findings. Notably, dapagliflozin demonstrated superior efficacy in preventing atrial fibrillation compared to empagliflozin. However, no significant differences were observed between the two drugs in terms of MACE, cardiovascular mortality, hospitalization for heart failure (HHF), or myocardial infarction. When compared to placebo, both dapagliflozin and empagliflozin showed greater effectiveness in preventing adverse cardiovascular outcomes in T2DM patients.These results reinforce the cardiovascular benefits of both dapagliflozin and empagliflozin in patients with T2DM. The comparable efficacy in most outcomes suggests that clinicians have flexibility in prescribing either of these SGLT2 inhibitors. However, the lower risk of atrial fibrillation associated with dapagliflozin may be a crucial factor in treatment decisions, especially for patients with a history of or at high risk for atrial fibrillation.

Explainable machine learning and online calculators to predict heart failure mortality in intensive care units

Explainable machine learning and online calculators to predict heart failure mortality in intensive care units

Association of serum uric acid to all-cause and cardiovascular mortality in patients with cardiovascular disease

Serum uric acid (SUA) has been linked to mortality in heart failure, hypertension, diabetes, hyperlipidemia, obstructive sleep apnea, and metabolic dysfunction-associated fatty liver disease. However, data are lacking on how it affects the mortality risk of patients with cardiovascluar disease (CVD). This study evaluated the data of 4 308 individuals from the National Health and Nutrition Examination Survey 1999–2008 using multivariate Cox proportional hazards regression, trend, restricted cubic splines (RCS), subgroup and inflection point analyses. All-cause and cardiovascular mortality accounted for 42.8% and 17.6% of cases, respectively, over a median 80- month follow-up. Upon control for confounding variables, no linear trend was seen in the Cox proportional hazards regression analysis between SUA and all-cause (P = 0.001) or cardiovascular death (P = 0.007) mortality. On the RCS analysis, SUA showed an L-shaped connection with all-cause (non-linear P < 0.001) and cardiovascular mortality (non-linear P = 0.003) mortality. On the inflection point analysis, patients with CVD and an SUA ≥ 6.127 mg/dL had an all-cause mortality hazard ratio of 1.146 (95% confidence interval, 1.078–1.217; P < 0.001), while those with CVD and an SUA ≥ 5.938 mg/dL had a cardiovascular mortality hazard ratio of 1.123 (95% confidence interval, 1.03–1.225; P = 0.007). In patients with CVD, higher SUA was non-linearly correlated with all-cause and cardiovascular mortality.