HF Mortality Research Articles

Abstract 4128250: Healthier Lifestyle is Associated with Better Arterial Health in People without Prevalent Cardiovascular Disease

Background: Higher arterial stiffness contributes to atherogenesis and arterial calcification, resulting in cardiovascular morbidity and mortality. Research Question: The relations of lifestyle, measured by the AHA Life’s Essential 8 (LE8), with arterial health (AH) and CVD outcomes are incompletely understood. Aims: To examine the association of LE8 with AH and extent to which carotid-femoral pulse wave velocity (PWV) mediates the association of LE8 with outcomes in a sample free of CVD. Methods: In 3 Framingham Heart Study cohorts, we studied the relations of LE8 (total score and components) with AH, assessed by arterial stiffness (PWV, by tonometry) and coronary calcification score (CAC, by computed tomography) using multivariable-adjusted linear regression (p<0.01 considered significant after Bonferroni correction). We evaluated the extent to which PWV mediates the association of LE8 with outcomes using Cox proportional hazards regression models (p<0.05 considered significant). Results: We studied 5222 participants, aged 50±15 years, 56% women. Characteristics of the sample are presented in Table . Higher LE8 score (better cardiovascular health) was associated with more favorable AH measures (PWV inverse transformed, standardized; CAC log(CAC+1); all β±SE, x10 -3 ): β PWV =-14.4±0.7, β CAC= -51.9±7.8, both p<0.01). Of the LE8 components, BMI (β PWV =-1.53±0.31), BP (β PWV =-9.74±0.36), fasting glucose (β PWV =2.03±0.45), lipids (β PWV =-1.54±0.31, β CAC =-16.14±3.30) and smoking (β CAC =-17.9±2.8) were the greater contributors to AH (all p<0.01). PWV mediated modest degrees of the associations between LE8 and CHD, HF, CVD, and CVD mortality [ Figure ]. Conclusions: In people without prevalent CVD, healthier lifestyle was associated with better AH. Arterial stiffness mediates the association between lifestyle measures and CHD, HF, CVD, and CVD-mortality. Our results support studying lifestyle interventions to improve arterial health and their benefits for CVD outcomes.

Comparison of the Effectiveness of Body Surface Area Estimation Formulas in Predicting the Risk of Death in Patients with Heart Failure.

Background/Objectives: Body surface area is one of the most important anthropometric parameters in medicine. The study's primary objective is to compare the consistency of the BSA estimation results through applying available formulas. Other objectives include determining the ability of these formulas to discriminate between death and survival in patients, comparing the formulas' diagnostic features, and investigating whether the risk associated with a low BSA is independent of BMI. Methods: This study included 1029 patients (median age, 54 years; female, 13.7%; NYHA I/II/III/IV, 6.3%/36.5%/47.7%/9.5%) diagnosed with heart failure. For each patient, BSA was calculated using 25 formulas. Over the 3-year observation period, 31.2% of the patients died. Results: The average BSA value of the optimal discrimination thresholds was 1.79 m2 ± 0.084 m2 and the BSA difference between the estimators with the lowest (BSAMeeh1879) and the highest (BSANwoye1989) optimal discrimination thresholds was 0.42 m2. The lowest mortality rate was 35.2% and occurred in the subgroup of individuals with BSA values below the optimal discrimination threshold using the BSASchlich2010 estimator. The highest mortality was predicted when the estimator BSAMeeh1879 or BSALivingston&Lee2001 was used. Conclusions: Our study showed a relatively good concordance of 25 BSA estimators in BSA assessment in patients, without extremes of weight or height being known to disrupt it. All BSA estimators presented a significant, although weak, ability to discriminate death from survival at 3-year follow-up; however, BSA is not a very good predictor of HF mortality at 3 years. The higher risk of death in smaller patients, as shown by BSA, was independent of BMI in all but two BSA estimators.

Low levels of apolipoprotein M are associated with increased risk of ventricular arrhythmias

Abstract Background Ventricular arrhythmia (VA) is a frequent cause of sudden cardiac death (SCD). Treatment to prevent SCD includes device therapy with implantable cardioverter defibrillator (ICD). Although the electrophysiology underlying VA have been described, the molecular understanding of VA risk remains unclear. Purpose To identify proteins that are associated with higher and lower risk of VA. Methods SMASH 1 Study was a prospective observational study of 490 patients treated with ICD. The plasma proteome was analyzed with the Olink Explore 384 Cardiometabolic platform at study inclusion, and patients were followed for mean 3.1± 0.7 years. VA events were defined as adjudicated ventricular fibrillation or sustained ventricular tachycardia registered from ICD recordings and clinical events were recorded from electronic health records. Protein concentrations were quantified relatively as normalized protein expression on a log2-transformed concentrations where a large number represents higher protein level in the sample. Results The mean age was 66±12 years, 83% were male and 51% had a primary prevention ICD-indication. Episode(s) of VA occurred in 137 patients (28%) during follow-up. In total, 353 distinct proteins were successfully analyzed in all patients. Among these, high B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) levels were associated with a higher risk of VA, while Apolipoprotein M (APOM) was the only protein significantly associated with a lower risk of VA after multiple testing using Benjamini-Hochberg correction (Figure, Panel A). After adjusting for age, sex, body mass index, coronary artery disease, heart failure, renal function, left ventricular ejection fraction and antiarrhythmic medication, only low APOM levels remained significantly associated with VA: HR 0.51 (95%CI 0.32-0.79] per log unit increase, p=0.003. Patients in the lowest quartile of APOM had a particularly high risk of incident VA: HR 2.26 (95%CI 1.60-3.19), p=3.61x10-6, compared to quartile 2-4 (Figure, Panel B). High APOM levels were also associated with a lower risk of HF hospitalizations (HR 0.25 [95%CI 0.16-0.40], p<0.001) and all-cause mortality (HR 0.36 [95%CI 0.22-0.60], p<0.001), and these associations remained significant in adjusted models. Conclusions Low levels of APOM are associated with a greater risk of incident VA, independently of established risk factors. Low APOM also predicted risk of HF hospitalizations and mortality in our cohort, which suggest protective cardiovascular effects of APOM. Figure: Association of individual proteomic measures with risk of ventricular arrhythmias (VA).A:Volcano plots of the associations of individual plasma proteins with incident VA. The dotted line represents the significance level at false discovery rate <0.05 and the red dots are significant proteins after multiple testing using Benjamini-Hochberg correction.B: Risk of VA by quartile of Apolipoprotein M.

Intermittent levosimendan infusions for advanced heart failure: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Intermittent intravenous infusions of levosimendan have been shown to provide benefits in patients with advanced heart failure (AHF), preventing HF rehospitalization and mortality. Purpose We aim to investigate the efficacy of intermittent intravenous levosimendan infusion in patients with AHF. Methods A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and WOS until September 2023. We used the random-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI). Finally, we implemented a trial sequential analysis (TSA) to improve the reliability of our results. Results We included 15 RCTs with 1,181 patients. Intermittent levosimendan was significantly associated with an improved left ventricular ejection fraction (LVEF) compared to placebo (MD: 6,39, 95% CI [3.04, 9.73], P= 0.002; I2=75, P=0.0005), with cumulative Z-score of change after ≤ 1 week passing the monitoring boundaries favors the levosimendan but did not cross the required information size. Additionally, there was a significant improvement in the all-cause mortality rate favoring levosimendan (RR: 0.60, 95% CI [0.40, 0.90], P= 0.01; I2=9, P=0.36). However, There was no difference between intermittent levosimendan and placebo in all-cause rehospitalization rate (RR: 0.75, 95% CI [0.46, 1.22], P= 0.25; I2=70, P=0.04) or event-free survival rate (RR: 0.97, 95% CI [0.72, 1.30], P= 0.84; I2=63, P=0.03). Conclusion In patients with AHF, intermittent levosimendan significantly improved LVEF and all-cause mortality rate. However, there was no effect on rehospitalization or event-free survival.Figure 1.LVEF and TSAFigure 2.Mortality, Rehospital, Surviva

Digital literacy of patients with chronic heart failure using telemedicine in france: a national observational cohort study

Abstract Introduction Remote patient monitoring (RPM) is increasingly considered for chronic care management. However, several challenges exist for its implementation such as funding resources, lack of standardizations and gaps in digital literacy. Objective The aim of this study was to describe patients using RPM to manage chronic heart failure (CHF) according to their digital literacy at a national scale in France. Methods A national retrospective study was conducted using a remote monitoring system for the management and therapeutic guidance of patients with CHF. Patients were categorized according to their digital literacy (digitally literate vs poor digital literacy). The latter were identified as requiring nurse assistance in medical data entry. Data collection included baseline characteristics, comorbidities, RPM status, heart failure-related hospitalizations and mortality. Results Of the 12,072 patients with CHF enrolled for RPM follow-ups (male: 65.4%, mean age: 74.2±13.1 years), 43.3% had poor digital literacy. These patients were older (79.4±10.2 vs 70.2±13.6 years) and were less among males (39.7% vs 60.3%). Overall, digitally literate patients had more comorbidities, including diabetes (61.8%) and obesity (69.4%). Over a third of all patients withdrew from RPM (37.0%). Continued use of RPM was higher in digitally literate patients (60.1% vs 39.9%, p<0.001). Mortality was higher in patients with poor digital literacy (OR: 0.71, 95%CI: 0.66 to 0.78, p<0.0001). Poor digital literacy was linked to increased occurrences of HF episodes in contrast to digitally literate patients (34.1% vs 25.8%) who had an uHR of 0.66 (95%CI: 0.62 to 0.71, p<0.0001), and an aHR of 0.68 (95%CI: 0.64 to 0.73, p<0.0001). Conclusion Patients with poor digital literacy form a sizable subgroup in heart failure management and may require specialized tools tailored to their needs. Prevalence of poor digital literacy may increase the risk of HF hospitalization and mortality and reduce RPM adherence.

Time-varying exposure to food retailers and cardiovascular disease hospitalization and mortality in the netherlands: a nationwide prospective cohort study.

Very few studies to date investigated the prospective association of changes in exposure to the food environment with cardiovascular disease (CVD) risk. We aim to explore if time-varying exposure to the food environment was associated with hospitalization and mortality due to total and specific types of CVD in The Netherlands. In this prospective cohort study, 4,641,435 Dutch adults aged 35 + years who did not change residence in 2002-2018 were identified through registry data. Exposure to the food environment was defined as time-varying Food Environment Healthiness Index (FEHI) scores (range: - 5 to 5) and time-varying kernel density of specific food retailers (e.g., fast food outlets, supermarkets) around the home location between 2004 and 2018. The main outcome measures were hospitalization and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020, based on hospital and death registries. In Cox regression models, each unit increase in the FEHI was associated with a lower hospitalization and mortality of CVD (hospitalization hazard ratio (HRh) = 0.90 (0.89 to 0.91), mortality hazard ratio (HRm) = 0.85 (0.82 to 0.89)), CHD (HRh = 0.88 (0.85 to 0.91), HRm = 0.80 (0.75 to 0.86)), stroke (HRh = 0.89 (0.84 to 0.93)), HRm = 0.89 (0.82 to 0.98)), and HF (HRh = 0.90 (0.84-0.96), HRm = 0.84 (0.76 to 0.92)). Increased density of local food shops, fast food outlets, supermarkets, and convenience stores and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke, and HF hospitalization and mortality. In this observational longitudinal study, changes in exposure to a healthier food environment over 14years were associated with a risk reduction in CVD hospitalization and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.

Prognostic roles of neutrophil–lymphocyte, monocyte-lymphocyte and platelet-lymphocyte ratios for long-term all-cause mortality in heart failure

BackgroundHeart failure (HF) and inflammation have a bidirectional relation leading to activation and adaptation of multiple cellular lines, including leucocyte subtypes and platelets. We aimed to assess and compare the predictive value of the neutrophil–lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratios for all-cause long-term mortality in HF. MethodsThis is an observational retrospective cohort study that included patients from the HI-HF cohort that survived the initial hospitalization. Vital status and survival time were assessed in June 2020. ResultsWe analyzed 1018 HF patients with a mean age of 72.32 ± 10.29 years and 53.54 % women. All-cause long-term mortality was 38.21 % after a median follow-up time of 68 [38 – 82] months. NLR (AUC 0.667, 95 %CI 0.637 – 0.697), MLR (AUC 0.670, 95 %CI 0.640 – 0.700) and PLR (AUC 0.606, 95 %CI 0.574 – 0.636) were predictors of all-cause mortality. In multivariable Cox proportional hazards analysis, NLR≥3.56 was the only hematological index independent predictor of fatality (HR 1.36, 95 %CI 1.05 – 1.76). ConclusionsOf the three hematological indices, NLR was the only independent predictor of all-cause long-term mortality of HF patients. We suggest NLR≥3.56 as an auxiliary prognostic biomarker for the evaluation of HF patients.

Phenogrouping heart failure with preserved or mildly reduced ejection fraction using electronic health record data

BackgroundHeart failure (HF) with preserved or mildly reduced ejection fraction includes a heterogenous group of patients. Reclassification into distinct phenogroups to enable targeted interventions is a priority. This study aimed to identify distinct phenogroups, and compare phenogroup characteristics and outcomes, from electronic health record data.Methods2,187 patients admitted to five UK hospitals with a diagnosis of HF and a left ventricular ejection fraction ≥ 40% were identified from the NIHR Health Informatics Collaborative database. Partition-based, model-based, and density-based machine learning clustering techniques were applied. Cox Proportional Hazards and Fine-Gray competing risks models were used to compare outcomes (all-cause mortality and hospitalisation for HF) across phenogroups.ResultsThree phenogroups were identified: (1) Younger, predominantly female patients with high prevalence of cardiometabolic and coronary disease; (2) More frail patients, with higher rates of lung disease and atrial fibrillation; (3) Patients characterised by systemic inflammation and high rates of diabetes and renal dysfunction. Survival profiles were distinct, with an increasing risk of all-cause mortality from phenogroups 1 to 3 (p < 0.001). Phenogroup membership significantly improved survival prediction compared to conventional factors. Phenogroups were not predictive of hospitalisation for HF.ConclusionsApplying unsupervised machine learning to routinely collected electronic health record data identified phenogroups with distinct clinical characteristics and unique survival profiles.

The Effect of Early Administration of Hypertonic Saline Solution İn Acute Decompensated Heart Failure.

There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF). This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes. In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%. The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups. HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients.

The structure of liver damage in patients with acute decompensated heart failure, the prognostic role of steatosis and liver density

Abstract Funding Acknowledgements None. Aim To study the spectrum of liver damage in patients with acute decompensated heart failure (ADHF). Materials and methods Included were 566 patients hospitalized with ADHF, NYHA class II–IV, 66% men, mean age 72,4±11,4 years. All patients underwent laboratory and instrumental examination, the degree of steatosis and liver density were determined by transient elastometry methods, with an assessment of the controlled ultrasound attenuation parameter (CAP - Controlled Attenuation Parameter, S, dB/m) using a device according to standard methods. CAP values &amp;lt;294 dB/m with steatosis degree 0 - S0, 295-309 dB/m - S1, 310-330 dB/m - S2, ≥331 dB/m - S3. Liver density was used: ≤5,8 kPa – normal liver density, ≥5,9 – stage F1, ≥7,2 kPa – F2, ≥9,5 kPa – F3, ≥12,5 kPa – F4. Laboratory manifestations of liver damage were considered to be increased aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase and alkaline phosphatase. Results The incidence of hepatic steatosis (≥S1) among patients with ADHF was 29%. Among patients with liver steatosis, minimal steatosis (S1) was detected in 19% of cases, moderate steatosis (S2) - 28,6%, severe steatosis S3 - 52,4%. In patients with steatosis, the frequency of laboratory indicators of liver damage was 53%, and in patients without steatosis - 49,2%. Liver density ≥ F1 was observed in 79,5% of patients. Stage F1 was diagnosed in 10,4% of cases, F2 - in 11%, F3 - 12,7%, F4 - 44,5%. However, no relationship was found between the severity of steatosis and liver density (p&amp;gt;0,05). Multivariate Cox regression analysis showed that extremely low CAP values (&amp;lt;234 dB/m) were associated with a worse prognosis and higher risk of HF mortality during the 3-year follow-up period (adjusted hazard ratio (aHR) 1,57 95% confidence interval (CI) 1,08–2,31, p=0,019) after adjustment for established risk factors and potential confounders. The presence of increased liver density &amp;gt;15,9 kPa was also associated with a worse prognosis of the risk of death from HF during the 3-year follow-up period by Cox multivariate analysis (aHR 1,24, 95% CI 1,01–1,52, p= 0,040). Conclusion Thus, extremely low CAP values (&amp;lt;234 dB/m) and the presence of a marked increase in liver density (&amp;gt;15,9 kPa) were associated with a worse prognosis in patients with ADHF during the 3-year follow-up period.

The significance of metabolic alkalosis on acute decompensated heart failure: the ALCALOTIC study.

To determine the prevalence and the impact on prognosis of metabolic alkalosis (MA) in patients admitted for acute heart failure (AHF). The ALCALOTIC is a multicenter, observational cohort study that prospectively included patients admitted for AHF. Patients were classified into four groups according to their acid-base status on admission: acidosis, MA, respiratory alkalosis, and normal pH (reference group for comparison). Primary endpoint was all-cause in-hospital mortality, and secondary endpoints included 30/90-day all-cause mortality, all-cause readmission, and readmission for HF. Associations between endpoints and acid-base alterations were estimated in a multivariate Cox regression model including sex, age, comorbidities, and Barthel index and expressed as hazard ratio (HR) with 95% confidence interval (95% CI). Six hundred sixty-five patients were included (84years and 57% women), and 40% had acid-base alterations on admission: 188 (28%) acidosis and 78 (12%) alkalosis. The prevalence (95% CI) of MA was 9% (6.8-11.2%). Patients with MA were more women; had fewer comorbidities, better renal function, and higher left ventricle ejection fraction values; and received more treatment with oral acetazolamide during hospitalization and at discharge. MA was not associated with a higher risk of in-hospital mortality and 30/90-day all-cause mortality or readmissions but was associated with a significant increase in readmissions for HF at 30 and 90days (adjusted HR [95% CI] 3.294 [1.397-7.767], p = 0.006 and 2.314 [1.075-4.978], p = 0.032). The prevalence of MA in patients admitted for AHF was 9%, and its presence was associated with more readmissions for HF but not with all-cause mortality.

Cardiac power output is associated with adverse outcomes in patients with preserved ejection fraction after transcatheter aortic valve implantation.

Cardiac power output (CPO) measures cardiac performance, and its prognostic significance in heart failure with preserved ejection fraction (EF) has been previously reported. However, the effectiveness of CPO in risk stratification of patients with valvular heart disease and post-operative valvular disease has not been reported. We aimed to determine the association between CPO and clinical outcomes in patients with preserved left ventricular (LV) EF after transcatheter aortic valve implantation (TAVI). This retrospective observational study included 1047 consecutive patients with severe aortic stenosis after TAVI. All patients were followed up for all-cause mortality and hospitalization for HF. CPO was calculated as 0.222 × cardiac output × mean blood pressure (BP)/LV mass, where 0.222 was the conversion constant to W/100 g of the LV myocardium. CPO was assessed using transthoracic echocardiography at discharge after TAVI. Of the 1047 patients, 253 were excluded following the exclusion criteria, including those with low LVEF, and 794 patients (84.0 [80.0-88.0] years; 35.8% male) were included in this study. During a median follow-up period of 684 (237-1114) days, the composite endpoint occurred in 196 patients. A dose-dependent association was observed between the CPO levels and all-cause mortality. Patients in the lowest CPO tertile had significantly lower event-free survival rates (log-rank test, P = 0.043). Multivariate Cox regression analysis showed that CPO was independently associated with adverse outcomes (hazard ratio = 0.561, P = 0.020). CPO provided an incremental prognostic effect in the model based on clinical and echocardiographic markers (P = 0.034). CPO is independently and incrementally associated with adverse outcomes in patients with preserved LVEF following TAVI.

Cognitive function and related factors in patients with heart failure

Background: Impaired cognitive function is associated with poor outcomes, frequent hospitalization, and high mortality in HF. Purpose: To determine the prevalence of cognitive function in HF and what factors contribute. Method: This study was an observational analysis with cross-sectional. Study subjects: HF patients at the Cardiac Polyclinic of Dr. M. Haulussy Hospital, Ambon, Indonesia from August to September 2023, with Inclusion criteria: aged 40-65 years; able to communicate well; not having a stroke or other neurological disorders (Parkinson's disease, Alzeimer's disease, Multiple Sclerosis) or other cognitive function disorders (such as due to injury or substance abuse); can read and write. Exclusion criteria: worsening of physical condition such as loss of consciousness and worsening of symptoms such as severe shortness of breath, inability to communicate, inability to complete the questionnaire, and worsening of symptoms that do not improve after being rested when data collection is carried out. Results: HF patients were male (56.2%), had ≥ 12 years of education (72.4%), were not actively working (56.9%), suffered from HF with NYHA class II functional status (49.1%), had Coronary Artery Disease (CAD) comorbid only (49.2%), had experienced hospitalization (64.6%), and were obese (51.54%). Respondents had an average age of 57.08 ± 6.78 years, a duration of HF of 3.96 ± 4.35 years, an average body mass index of 25.65 ± 4.5 Kg/m2, normal blood pressure with an average systole of 122.73 ± 17.21 mmHg, and an average diastole of 77.44 ± 10.11 mmHg. HF patients who experienced impaired cognitive function were 87.69% with mild cognitive impairment 73.1%, moderate cognitive impairment 13.1%, and severe cognitive impairment 1.5%. The maximum score of MoCA sub-domains of executive function was 46.2%; visuospatial 35.4%; attention 37.7%, naming and language 20%; abstraction 33.8%, delayed memory 3.8% and orientation 86.9%. There was a significant correlation between cognitive function and age (ρ = 0.000; r = -0.324), education level (ρ = 0.000; r = 0.327), and New York Heart Association functional status (ρ = 0.021; r = -202). Conclusion: There is a high prevalence of impaired cognitive function in chronic HF patients accompanied by a global decline in cognitive function subdomains. Factors that may contribute to HF cognitive function include age, education level, not actively working, New York Heart Association functional status, comorbidities, and obesity.

Proteomics for heart failure risk stratification: a systematic review

BackgroundHeart failure (HF) is a complex clinical syndrome with persistently high mortality. High-throughput proteomic technologies offer new opportunities to improve HF risk stratification, but their contribution remains to be clearly defined. We aimed to systematically review prognostic studies using high-throughput proteomics to identify protein signatures associated with HF mortality.MethodsWe searched four databases and two clinical trial registries for articles published from 2012 to 2023. HF proteomics studies measuring high numbers of proteins using aptamer or antibody-based affinity platforms on human plasma or serum with outcomes of all-cause or cardiovascular death were included. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. A third reviewer resolved conflicts. We assessed the risk of bias using the Risk Of Bias In Non-randomized Studies—of Exposure tool.ResultsOut of 5131 unique articles identified, nine articles were included in the review. The nine studies were observational; three used the aptamer platform, and six used the antibody platform. We found considerable heterogeneity across studies in measurement panels, HF definitions, ejection fraction categorization, follow-up duration, and outcome definitions, and a lack of risk estimates for most protein associations. Hence, we proceeded with a systematic review rather than a meta-analysis. In two comparable aptamer studies in patients with HF with reduced ejection fraction, 21 proteins were identified in common for the association with all-cause death. Among these, one protein, WAP four-disulfide core domain protein 2 was also reported in an antibody study on HFrEF and for the association with CV death. We proposed standardized reporting criteria to facilitate the interpretation of future studies.ConclusionsIn this systematic review of nine studies evaluating the association of proteomics with mortality in HF, we identified a limited number of proteins common across several studies. Heterogeneity across studies compromised drawing broad inferences, underscoring the importance of standardized approaches to reporting.

O Efeito da Administração Precoce de Solução Salina Hipertônica na Insuficiência Cardíaca Descompensada Aguda

Abstract Background There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF). Objectives This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes. Methods In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%. Results The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups. Conclusion HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients.

Remote myocardial fibrosis predicts adverse outcome in patients with myocardial infarction on clinical cardiovascular magnetic resonance imaging

BackgroundHeart failure (HF) most commonly occurs in patients who have had a myocardial infarction (MI), but factors other than MI size may be deterministic. Fibrosis of myocardium remote from the MI is associated with adverse remodelling. We aimed to i) Investigate the association between remote myocardial fibrosis, measured using cardiovascular magnetic resonance (CMR) extracellular volume (ECV), and HF and death following MI, ii) Identify predictors of remote myocardial fibrosis in patients with evidence of MI, and determine the relationship with infarct size. MethodsMulticentre prospective cohort study of 1,199 consecutive patients undergoing CMR with evidence of MI on late gadolinium enhancement. Median follow-up 1,133 (895-1,442) days. Cox proportional hazards modelling was used to identify factors predictive of the primary outcome, a composite of first hospitalisation for HF (HHF) or all-cause mortality, post-CMR. Linear regression modelling was used to identify determinants of remote ECV. ResultsRemote myocardial fibrosis was a strong predictor of primary outcome (χ2: 15.6, HR: 1.07 per 1% increase in ECV, 95% CI: 1.04-1.11, p<0.001), and was separately predictive of both HHF and death. The strongest predictors of remote ECV were diabetes, sex, natriuretic peptides, and body mass index, but, despite extensive phenotyping, the adjusted model R2 was only 0.283. The relationship between infarct size and remote fibrosis was very weak. ConclusionsMyocardial fibrosis, measured using CMR ECV, is a strong predictor of HHF and death in patients with evidence of MI. The mechanisms underlying remote myocardial fibrosis formation post-MI remain poorly understood, but factors other than infarct size appear to be important.

Ten year evolution of clinical characteristics and short-term outcome of patients admitted with heart failure

Abstract Background/Introduction Heart failure (HF) continues to be a leading cause of morbidity, decreased quality of life (QoL) and mortality worldwide. Contributing to decreased QoL is the high rehospitalization rate, which is often related to non-cardiac causes, highlighting the important multimorbidity of the HF population. Detailed clinical and outcome data for HF admissions in Belgium over time are only scarcely available. Purpose We aimed to evaluate and compare two groups of patients admitted with HF ten years apart, regarding clinical characteristics, comorbidities, use of HF medication and devices, as well as rehospitalization rate and all-cause mortality three months post-discharge. Methods This is a monocentric retrospective observational cohort study conducted in Belgium. Two groups of patients admitted for acute decompensated HF who were discharged alive were included and compared: 340 patients during 2011-2012 and 319 patients during 2021-2022. Results The two cohorts did not differ significantly regarding age (77.3 vs. 78.4 years), gender (47.4 vs. 44.5% women), number of patients with HF with reduced ejection fraction (47.4 vs. 48.6%) and NT-proBNP on admission (8514 vs. 7398 pg/mL). Similarly, comorbidities including diabetes, chronic obstructive pulmonary disease, peripheral artery disease, stroke and renal failure were comparable in both groups. Concerning medical therapy at discharge, mineralocorticoid receptor antagonists (MRA) were used significantly more frequently in the latest cohort. However, there was no change in administration of beta-blockers or renin angiotensin aldosterone system antagonists. As part of the implementation of new therapies for heart failure with reduced ejection fraction, 29% of patients were prescribed sodium-glucose cotransporter-2 (SGLT-2) inhibitors, while sacubitril/valsartan was given in 13% of the cases. The use of internal defibrillators (ICD) and resynchronization devices (CRT) doubled from 2011-2012 to 2021-2022 (3.9 vs. 9.6%, p = 0.002). In-hospital length of stay decreased significantly over a ten-year period across all ejection fraction subgroups from 7 to 5 days (figure 1). The combined outcome of rehospitalization for HF and all-cause mortality three months post-discharge remained constant at approximately 20% (figure 2). Conclusion Clinical characteristics and comorbidities of patients admitted with acute decompensated HF did not change significantly between 2011 and 2022. Uptake of evidence-based medicine for HF increased, especially for MRA, SGLT-2 inhibitors and sacubitril/valsartan, as did the use of ICD and CRT, but still with considerable potential for improvement. Although in-hospital length of stay decreased significantly over time, rehospitalization rates for HF and all-cause mortality within 90 days post-discharge remained high and did not improve. These sobering results illustrate the need for continuing efforts to improve the care and outcome of HF patients.

Trends in heart failure mortality in the USA 1999 to 2020

Abstract Background Heart failure (HF) is a complex clinical syndrome which is a public health challenge in the US. Despite advancements in HF treatment strategies the mortality reduction has been far from ideal. We aimed to study the trends of HF mortality stratified by race and gender from 1999 to 2020. Methods The CDC WONDER multiple cause of death dataset was used to analyze trends in mean age at death (MAD) and age adjusted mortality rate (AAMR, expressed per 100,000 persons) for patients dying from HF (underlying cause of death) and dying with HF (co-morbid HF) in the USA. Results From 1999 to 2020, the AAMR and MAD for patients dying from HF were 19.3 (Men, Women; 21.3, 17.7) and 83.2 (Men, Women; 85.3, 80.4; p &amp;lt;0.01). The AAMR and MAD for patients dying with HF were 72.4 (Men, Women; 85.8, 63.0) and 81.1 years (Men, Women; 83.2, 78.6; p &amp;lt;0.01). The AAMR and MAD remained stable in both genders between the years 1999 and 2020. The AAMR and MAD among White, Black and other race patients dying with HF were (73.3, 75.1, and 37.7; p&amp;lt;0.01) and (81.4, 74.0 and 79.8; p&amp;lt;0.01). The AAMR and MAD among White, Black and other race patients dying from HF were (20.2, 22.5, and 8; p&amp;lt;0.01) and (84, 76.1 and 85.1; p&amp;lt;0.01). While there was no statistically significant change in AAMR and MAD among persons dying from HF, there was a significant decline in AAMR among persons dying with HF with an AAPC of -0.5(-0.8 to -0.1). Black patients witnessed a statistically significant decline in MAD from 77.8 in 1999 to 74.3 in 2020, MAD remained stable in Whites and Other Races. Conclusion Despite advances in guideline directed medical therapy with proven mortality benefit for management of heart failure, the nationwide HF mortality trend has plateaued. Racial disparities with higher HF related mortality in Black patients continue to exist. Therefore, systemic efforts are needed to optimize the HF outcomes by optimizing the preventive and treatment strategies of HF.

Red cell distribution width (RDW) to serum albumin ratio (RAR) in chronic heart failure

Abstract Background The RDW to albumin ratio (RAR) is a novel and simple biomarker of inflammation. The value of RAR in predicting acute HF prognosis has been suggested. However, its application in chronic HF was never investigated. Purpose To study the association of RAR with all-cause mortality in chronic HF. Methods We conducted a retrospective cohort study in patients followed in a HF clinic of a tertiary care academic hospital between January 2012 and December 2020. Consecutive adult patients with left ventricular systolic dysfunction (ejection fraction &amp;lt;50%) referred to the clinic were included. Patients with no measurement of RDW and no measurement of serum albumin were excluded from the analysis. The RAR was calculated as RDW (in %) / albumin (in g/dL). Patients were followed up to December 2022 and the endpoint under analysis was all-cause mortality. The association of RAR with mortality was assessed using a Cox-regression analysis. RAR was analysed as a continuous variable and as a categorical variable (cut-off 1st tertile). Multivariable models were built with adjustments to age, sex, arterial hypertension (AHT) history, diabetes mellitus (DM), atrial fibrillation (AF), ischaemic HF, severe left ventricular systolic dysfunction (LVSD), New York Heart Association class, systolic blood pressure (SBP), estimated glomerular filtration rate, haemoglobin, BNP, beta blocker (BB) use, angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi) or angiotensin receptor neprilysin inhibithors (ARB) use and mineralocorticoid receptor antagonist (MRA) use. Results We studied 754 patients, 63.3% male, mean age 71 (13) years, 64.1% had AHT history, 38.5% had DM, 33.3% had AF, HF was ischaemic in 44.4%, and 49.3% has severe LVSD. A total of 92.3% of the patients were on BB, 82.8% on ACEi or ARB or ARNi, and 29.7% on MRA. RAR presented a skewed right tailed distribution with a median value of 3.56, percentile 33.3 = 3.31 and percentile 66.7 = 3.85. During a median follow-up of 43 months 370 (49.1%) patients died. Mortality increased with increasing RAR: 33.2% in patients with ratio&amp;lt;3.31, 50.6% in patients with ratio 3.31 to &amp;lt;3.85 and 63.1% in patients with ratio≥3.85, p&amp;lt;0.001. The multivariate adjusted HR of all-cause death was 1.27 (95% CI: 1.12-1.43) per each unit increase in the RDW: albumin ratio. If RAR was analysed as a categorical variable, patients with RAR≥3.31 (1st tertile) presented an increased mortality risk of 1.48 (1.12-1.96); the increase in risk was independent of age, sex, comorbidities, LVSD, symptoms, SBP, haemoglobin, renal function, BNP and disease-modifying therapy. Conclusions The RAR is a strong and independent mortality predictor in chronic HF. Patients with a RAR ≥3.31 have a 48% increase in all cause-death in the long term; the increase in risk is of 27% per each unit rise in the ratio. Our results reinforce the importance of inflammation in chronic HF pathophysiology and progression.

Characterization and prognostic impact of ischemic etiology in heart failure with reduced left ventricular ejection fraction

Abstract Introduction and objectives Ischemic heart disease is the cause of 50-60% of cases of heart failure with reduced left ventricular ejection fraction (HF-rEF). The impact of ischemic etiology on left ventricular ejection fraction (LVEF) improvement and prognosis remains unclear. Our main objective was to analyze the differential clinical profile between ischemic and non-ischemic etiology, as well as its medium-to-long term prognosis. Methods Prospective study of a cohort of patients with HF-rEF in real clinical practice. A comparative analysis was performed between patients with HF-rEF of non-ischemic etiology (Group 1) and ischemic etiology (Group 2). Clinical, analytical, echocardiographic and therapeutic variables were analyzed, and the medium-to-long term impact in terms of mortality and hospital readmissions for HF was evaluated. Results 409 patients were analyzed. 276 patients (67.5%) had non-ischemic etiology and 133 patients (32.5%) had ischemic etiology. Group 2 was older (65.8±13.3vs70.8±10.3;p&amp;lt;0.001), more men (68.1%vs86.5%;p&amp;lt;0.001), higher prevalence of arterial hypertension (62.3%vs76.7%;p = 0.004), diabetes mellitus (38.8%vs67.7%; p&amp;lt;0.001), dyslipemia (52.4%vs82.7%;p&amp;lt;0.001), chronic kidney disease (34.4%vs56.4%;p&amp;lt;0.001), anemia (24.3%vs47.4%;p&amp;lt;0.001) and vascular comorbidity (25.7%vs54.9%;p&amp;lt;0.001) and lower prevalence of atrial fibrillation (56.2%vs44.4%;p = 0.025). In Group 2 there was a lower proportion of de novo HF (60.1%vs45.1%;p = 0.004) with longer HF evolution time (24.4±48.8vs61.5±89.3; p&amp;lt;0.001), a lower proportion of patients improving LVEF at follow-up (51.6%vs21.1%;p&amp;lt;0.001) and a higher baseline NTproBNP concentration [4463(IQR 1976-10431)vs5746(IQR 2336.5-13789);p = 0.039]. Regarding baseline treatment, in Group 1 there was a higher prescription of mineralocorticoid receptor antagonists (78.3%vs63.9%;p = 0.002) and less ICD implantation (6.5vs14.3%;p = 0.01), with no differences in the rest of the treatment. With a mean follow-up of 60 months, Group 2 had a higher readmission rate (39%vs50.3%;p&amp;lt;0.01) and higher HF mortality (26.8%vs41%;p&amp;lt;0.01), with differences from early stages. Conclusions Patients with HF-rEF of ischemic etiology associate a greater number of comorbidities, a lower percentage of de novo HF, longer time of HF evolution, lower percentage of LVEF improvement and higher baseline NTproBNP.