Hospitalization For New-onset Heart Failure Research Articles

Baseline Health Status and its Association With Subsequent Cardiovascular Events in Patients With Atrial Fibrillation

BackgroundClinical practice guidelines recommend optimizing the health status of patients with atrial fibrillation (AF) as a primary treatment goal. Whether disease-specific health status is associated with subsequent clinical events is unknown. ObjectivesThe aim of this study was to investigate the association between health status and subsequent clinical events among patients with AF. MethodsUsing a prospective cohort study of patients with new-onset AF referred to 11 hospitals (n = 3,313, 68.4% men, mean age 67.8 ± 11.6 years), data were extracted from 3,296 patients (99.4%) who completed the disease-specific Atrial Fibrillation Effects on Quality-of-Life (AFEQT) questionnaire between 2012 and 2018. Factors associated with baseline AFEQT overall summary (OS) score and associations between major adverse cardiovascular or neurologic events (MACNE; a composite of all-cause death, stroke, or new-onset heart failure hospitalization) over 2 years were investigated. ResultsOverall, 517 participants (15.6%) had poor to fair health status (AFEQT OS <60), and 1,035 (31.2%) had fair to good health status (AFEQT OS 60 to <80) at baseline. Female sex, younger age, family history of AF, higher baseline heart rate, paroxysmal AF, initial visit to the emergency department, and history of heart failure were associated with lower AFEQT OS scores. Of those, 226 participants (6.8%) experienced MACNE; restricted cubic spline analysis with adjustment for factors associated with baseline AFEQT score showed a nonlinear increase in the risk for MACNE with AFEQT OS score <80. The strongest associations were observed for baseline AFEQT daily activity scores (for AFEQT daily activity score of <80 vs ≥80, HR: 1.65; 95% CI: 1.21-2.25). ConclusionsDiminished health status in patients with AF is common and is independently associated with subsequent adverse cardiovascular events.

Abstract 10112: Association of Coronary Artery Disease Testing During Index Hospitalization for New-Onset Heart Failure With Thirty-Day Readmission Rates and Mortality

Introduction: Testing for coronary artery disease (CAD) is recommended for patients with new-onset heart failure (HF). There are limited data on the association between testing for CAD during index hospitalization for patients with the new-onset HF and early readmission rates and readmission mortality. Hypothesis: CAD testing for new-onset HF during index hospitalization may reduce 30-day readmission rates and readmission-related mortality. Methods: Patients hospitalized for new-onset HF were identified from the Nationwide Readmission Database of the United States. Clinical characteristics, 30-day readmission rates, readmission-related mortality were compared in patients with or without testing for CAD during index hospitalization. CAD testing includes coronary angiography, coronary CT angiography, cardiac MRI, nuclear imaging or cardiac stress test. Results: Between January 2016 and November 2019, of 151,172 patients hospitalized for new-onset HF, 30,444 (20.1%) patients underwent testing for CAD during index hospitalization. Younger patients, males, and patients with HF with reduced ejection fraction (HFrEF) had more frequent testing for CAD. Only 9.5% of CAD-tested patients received percutaneous coronary intervention during the index hospitalization. Patients with CAD testing had lower 30-day readmission rates than those without testing (11.4% vs 14.3%, P&lt;0.001; adjusted odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76 to 0.87). Patients with CAD testing had lower 30-day readmission-related mortality rates than those without testing (0.5% vs 0.9%, P&lt;0.001; adjusted OR 0.82, 95% CI 0.65 to 1.04). Readmission rate for HF at 30 days was 2.3% for patients with CAD testing vs 3.5% for those without testing (P&lt;0.001; adjusted OR 0.67, 95% CI 0.59 to 0.76). There was a significant interaction between HF type (HFrEF vs HF with preserved EF) and CAD testing on 30-day readmission rates (P for interaction &lt;0.001). Conclusions: Testing for CAD during index hospitalization for patients with new-onset HF was associated with reduced 30-day readmission rates. There was substantial decrease in readmission for HF and readmission-related mortality in patients who underwent CAD testing during index hospitalization.

Carpal Tunnel Syndrome in Patients Who Underwent Pacemaker Implantation and Relation to Amyloidosis, Heart Failure, and Mortality

Advances in treatment warrant earlier diagnosis of cardiac amyloidosis (CA). Common cardiac and extracardiac manifestations of CA, such as pacemaker implantation and carpal tunnel syndrome (CTS), might provide screening opportunities for CA. However the association between CTS and CA in patients undergoing pacemaker implantation has not been well studied. This study examined the association between previous CTS surgery and adverse cardiovascular outcomes in patients who underwent pacemaker implantation. Using Danish nationwide registries, we identified all patients ≥50 years who underwent first-time pacemaker implantation during 2000 to 2018, examining the association between previous CTS surgery and adverse cardiovascular outcomes 5 years after pacemaker implantation. Cumulative incidence functions and Cox proportional hazard models were used to assess the differences. Among 57,315 patients who underwent pacemaker implantation, 2.2% (n=1,266) had previous CTS surgery. Patients in the CTS cohort were older, more often female, and had more co-morbidities than patients without CTS. The cumulative 5-year mortality was higher among patients with CTS (44.6% [41.1% to 47.9%] versus 40.2% [39.7% to 40.6%], p=0.04). In the adjusted models, previous CTS surgery was not associated with increased 5-year mortality, but it was associated with an increased rate of hospitalization for new-onset heart failure, (hazard ratio 1.32 [1.11 to 1.57], p=0.002) and a higher risk of amyloidosis diagnosis after pacemaker implantation (hazard ratio 7.72 [2.96 to 20.10], p <0.0001), compared with no previous CTS surgery. In patients who underwent pacemaker implantation, adjusted models showed that previous CTS surgery was associated with a higher incidence of hospitalization for new-onset heart failure and amyloidosis diagnosis after pacemaker implantation. Screening for CA may be considered in patients undergoing pacemaker implantation.

Abstract 9716: Association Between Baseline Health-Related Quality of Life and Subsequent Clinical Outcomes in Patients with Atrial Fibrillation

Introduction: Recent clinical practice guidelines emphasized the need to quantify patients’ symptoms, and health-related quality of life (HR-QoL) for patients with atrial fibrillation (AF). However, little is known about the associations between patients’ HR-QoL and subsequent clinical outcomes. Methods: We extracted data from a registry-based cohort study (KiCS-AF) designed to enroll consecutive AF patients referred to tertiary hospitals in Japan. Patients completed the Atrial Fibrillation Effects on QualiTy-of-Life (AFEQT) at referral. We investigated the association between the AFEQT-overall summary (AFEQT-OS; range 0-100, higher score indicates better HR-QoL) score and cumulative incidence of the composite of all-cause death, stroke, new-onset heart failure hospitalization, and acute coronary syndrome after 2 years of follow-up. Results: Among 3,313 AF patients (men 68.4%; age 67.8±11.6 years; 60.1% diagnosed ≤1 year before enrollment to the registry), 3,296 patients (99.4%) completed the AFEQT questionnaire at the time of registration. The mean AFEQT-OS score was 77.1±17.6, and 46.8% had AFEQT-OS &lt;80, which indicated impaired HR-QoL. Female sex, education level, higher heart rate, paroxysmal AF, history of congestive heart failure were independently associated with impaired HR-QoL at registration. After a 2-year follow-up (mean 675±143 days), the patients with impaired HR-QoL were more likely to experience the composite outcomes than those without (8.5% vs 5.8%, adjusted OR 1.32 [95%CI 1.01-1.74] P=0.040), and the differences were mainly driven by the incidence of new-onset heart failure hospitalization. Conclusion: In a Japanese, contemporary clinical practice cohort of unselected AF patients with newly diagnosis, almost half of the patients had impaired HR-QoL with worse clinical outcomes after 2-year. Factors associated with patients’ HR-QoL were multifocal and further investigations were needed to clarify the underlying mechanism.

New onset atrial fibrillation and heart failure among patients with multiple myeloma: analysis from a nationwide french medical information database

Abstract Background Over the last decade, new therapies, screening optimization, and cardiovascular management have changed the cardiovascular prognosis of patients with multiple myeloma (MM). Older studies suggested that MM could be associated with increased risk of heart failure (HF). Based on a nationwide hospitalization database, we aimed to assess the risk of hospitalization for Heart failure (HF) and/or Atrial fibrillation (AF). Methods From 1st January 2013 to 31st December 2013, 3,381,472 adults (age ≥18 years) were hospitalized for any reason in French hospitals and then had at least 5 years of complete follow-up (or suffered death earlier). We identified 15,774 patients diagnosed with known MM at baseline. The outcome analysis on hospitalization for new onset HF or AF was performed with follow-up (FU) starting at the time of last event. For each patient with MM, a propensity score-matched patient with no MM was selected (1:1) using the one-to-one nearest neighbor method (n=15774 in each group). Findings In the propensity-score-matched population, mean±SD FU was 3.7±2.3 years, median (IQR)5.0 (1.3–5.7) years, mean age was 71±12y, and most were female (55%). When compared with patients without MM, MM patients were more likely to have history of HF (16.8% vs. 10.5%, p&amp;lt;0.0001), pulmonary edema (1.5 vs. 0.8%, p&amp;lt;0.0001), or AF (13.4% vs. 9.6%, p&amp;lt;0.0001). At FU, MM patients had a higher risk of all-death (yearly rate 20.02 vs 11.39%/year). Moreover, yearly rates of new onset HF or AF, which were the common CV causes of re-hospitalisation, were higher in the MM group, i.e. respectively for incidence rate, 7.47 vs 5.42%/year (p&amp;lt;0.0001) and 4.57 vs 3.72%/year (p&amp;lt;0.0001). Multivariate analysis showed that MM remained significantly associated with a higher rate of HF and AF (HR (95% CI): 1.343 (1.276–1.413) and 1.196 (1.128–1.269), respectively). Results were similar in sensitivity analysis limited to patients with recent MM (i.e. diagnosed within the 3 previous months). Interpretation From a large nationwide hospitalization database, we show that patients with MM had a higher risk of new onset HF and AF. Our findings highlight the key issue of cardiovascular management in patients with MM. Funding Acknowledgement Type of funding sources: None.

Mortality after hospital admission for heart failure: improvement over time, equally strong in women as in men

BackgroundTo assess the trend in age- and sex-stratified mortality after hospitalization for heart failure (HF) in the Netherlands.MethodsTwo nationwide cohorts of patients, hospitalized for new onset heart failure between 01.01.2000–31.12.2002 and between 01.01.2008–31.12.2010, were constructed by linkage of the Dutch Hospital Discharge Registry and the National Cause of Death registry. 30-day, 1-year and 5 -year overall and cause-specific mortality rates stratified by age and sex were assessed and compared over time.ResultsWe identified 40,230 men and 41,582 women. In both cohorts, men were on average younger than women (74–75 and 78–79 years, respectively) and more often had comorbid conditions (37 and 30%, respectively). In the 2008–10 cohort, mortality rates for men were 13, 32 and 64% for respectively 30-day, 1-year and 5-year mortality and 14, 33 and 66% for women. Mortality rates increased considerably with age similarly in men and women (e.g. from 10.5% in women aged 25–54 to 46.1% in those aged 85 and older after 1 year). Between the two time periods, mortality rates dropped across all ages, equally strong in women as in men. The 1-year absolute risk of death declined by 4.0% (from 36.1 to 32.1%) in men and 3.2% (from 36.2 to 33.0%) in women.ConclusionsMortality after hospitalization for new onset HF remains high, however, both short-term and long-term survival is improving over time. This improvement was similar across all ages and equally strong in women as in men.

High-sensitivity cardiac troponin I is a biomarker for occult coronary plaque burden and cardiovascular events in patients with rheumatoid arthritis.

Patients with RA display greater occult coronary atherosclerosis burden and experience higher cardiovascular morbidity and mortality compared with controls. We here explored whether pro-inflammatory cytokines and high-sensitivity cardiac troponin I (hs-cTnI), a biomarker of myocardial injury, correlated with plaque burden and cardiovascular events (CVEs) in RA. We evaluated 150 patients with 64-slice coronary CT angiography. Coronary artery calcium, number of segments with plaque (segment involvement score), stenotic severity and plaque burden were assessed. Lesions were described as non-calcified, mixed or fully calcified. Blood levels of hs-cTnI and pro-inflammatory cytokines were assessed during coronary CT angiography. Subjects were followed over 60 (s.d. 26) months for both ischaemic [cardiac death, non-fatal myocardial infarction (MI), stroke, peripheral arterial ischaemia] and non-ischaemic (new-onset heart failure hospitalization) CVEs. Plasma hs-cTnI correlated with all coronary plaque outcomes (P < 0.01). Elevated hs-cTnI (⩾1.5 pg/ml) further associated with significant calcification, extensive atherosclerosis, obstructive plaque and any advanced mixed or calcified plaques after adjustments for cardiac risk factors or Framingham D'Agostino scores (all P < 0.05). Eleven patients suffered a CVE (1.54/100 patient-years), eight ischaemic and three non-ischaemic. Elevated hs-cTnI predicted all CVE risk independent of demographics, cardiac risk factors and prednisone use (P = 0.03). Conversely, low hs-cTnI presaged a lower risk for both extensive atherosclerosis (P < 0.05) and incident CVEs (P = 0.037). Plasma hs-cTnI independently associated with occult coronary plaque burden, composition and long-term incident CVEs in patients with RA. Low hs-cTnI forecasted a lower risk for both extensive atherosclerosis as well as CVEs. hs-cTnI may therefore optimize cardiovascular risk stratification in RA.

Abstract 13238: Association of Worsening Arterial Stiffness With the Progression of Stage A/B Heart Failure

Introduction: Several studies have suggested that an enhanced and deteriorating arterial stiffness is associated with an increase in left ventricular (LV) afterload and LV diastolic dysfunction, which may contribute to heart failure (HF) progression. We sought to investigate the independent and incremental role of worsening arterial stiffness in new-onset HF in patients with preclinical HF. Methods: We retrospectively studied 456 consecutive asymptomatic patients with HF risk factors (hypertension, obesity, type 2 diabetes mellitus, atrial fibrillation, and ischemic heart disease) who underwent paired applanation tonometry examinations (median interval of 2.4 years) during 2006-2011. Brachial ankle pulse wave velocity (baPWV) was measured as a surrogate marker of arterial stiffness. Patients were followed up for admission for new-onset HF over a median duration of 4.9 years after the second examination. Results: HF was observed in 30 patients (7%). The change in baPWV (ΔbaPWV) was significantly associated with hospitalization for new-onset HF, independent of and incremental to comorbidities, renal dysfunction, left ventricular (LV) dysfunction, and baPWV at baseline (Per 10% increase, Hazard ratio, 1.23-1.42). Even in patients with an LV ejection fraction of ≥40%, ΔbaPWV was significantly associated with the primary outcome after similar adjustments. When the patients were divided into groups based on the optimal cutoff value of ≥15% ΔbaPWV and the generally accepted external cutoff value of ≥1750 cm/s for baseline baPWV, the Kaplan-Meier estimates of the time of hospitalization for new-onset HF showed that a higher rate of HF was associated with higher baPWV at baseline and higher ΔbaPWV (Figure). Conclusions: In patients with stage A/B HF, the deterioration of arterial stiffness was associated with hospitalization for new-onset HF, independent of and incremental with the clinical LV function and increased stiffness parameters at baseline.

Association of worsening arterial stiffness with incident heart failure in asymptomatic patients with cardiovascular risk factors.

We investigated the independent and incremental role of worsening arterial stiffness in new-onset heart failure (HF) in patients with preclinical HF. We retrospectively studied 456 consecutive asymptomatic patients with HF risk factors (hypertension, obesity, type 2 diabetes mellitus, atrial fibrillation and ischemic heart disease) who underwent paired applanation tonometry examinations (median interval of 2.4 years) during 2006-2011. Brachial ankle pulse wave velocity (baPWV) was measured as a surrogate marker of arterial stiffness. Patients were followed up for admission for new-onset HF over a median duration of 4.9 years after the second examination. HF was observed in 30 patients (7%). The change in baPWV (∆baPWV) was significantly associated with hospitalization for new-onset HF, independent of and incremental to comorbidities, renal dysfunction, left ventricular (LV) dysfunction and baPWV at baseline. Even in patients with an LV ejection fraction of ⩾40%, ∆baPWV was significantly associated with hospitalization for new-onset HF after similar adjustments. When the patients were divided into groups based on this cutoff value of ⩾15% ∆baPWV and the generally accepted external cutoff value of ⩾1750 cm s-1 for baseline baPWV, the Kaplan-Meier estimates of the time of hospitalization for new-onset HF showed that a higher rate of HF was associated with higher baPWV at baseline and higher ∆baPWV (P=0.00005). In asymptomatic patients with cardiovascular risk factors, the deterioration in arterial stiffness was associated with hospitalization for new-onset HF, independent of and incremental with the clinical LV function and increased stiffness parameters at baseline.

Glycemic Status and Incident Heart Failure in Elderly Without History of Diabetes Mellitus: The Health, Aging, and Body Composition Study

Background It is unclear whether measures of glycemic status beyond fasting glucose (FG) levels improve incident heart failure (HF) prediction in patients without history of diabetes mellitus (DM). Methods and Results The association of measures of glycemic status at baseline (including FG, oral glucose tolerance testing [OGTT], fasting insulin, hemoglobin A 1c [HbA 1c] levels, and homeostasis model assessment of insulin resistance [HOMA-IR] and insulin secretion [HOMA-B]) with incident HF, defined as hospitalization for new-onset HF, was evaluated in 2386 elderly participants without history of DM enrolled in the Health, Aging, and Body Composition Study (median age, 73 years; 47.6% men; 62.5% white, 37.5% black) using Cox models. After a median follow-up of 7.2 years, 185 (7.8%) participants developed HF. Incident HF rate was 10.7 cases per 1000 person-years with FG <100 mg/dL, 13.1 with FG 100–125 mg/dL, and 26.6 with FG ≥126 mg/dL ( P = .002; P = .003 for trend). In adjusted models (for body mass index, age, history of coronary artery disease and smoking, left ventricular hypertrophy, systolic blood pressure and heart rate [HR], and creatinine and albumin levels), FG was the strongest predictor of incident HF (adjusted HR per 10 mg/dL, 1.10; 95% CI, 1.02–1.18; P = .009); the addition of OGTT, fasting insulin, HbA 1c, HOMA-IR, or HOMA-B did not improve HF prediction. Results were similar across race and gender. When only HF with left ventricular ejection fraction (LVEF) ≤40% was considered (n = 69), FG showed a strong association in adjusted models (HR per 10 mg/dL, 1.15; 95% CI, 1.03–1.29; P = .01). In comparison, when only HF with LVEF >40%, was considered (n = 71), the association was weaker (HR per 10 mg/dL, 1.05; 95% CI; 0.94–1.18; P = .41). Conclusions Fasting glucose is a strong predictor of HF risk in elderly without history of DM. Other glycemic measures provide no incremental prediction information.

Abstract 5880: Serum Resistin Concentrations and Risk of New Onset Heart Failure in the Elderly

Resistin, a novel adipocytokine, is associated with inflammation and insulin resistance; both mechanisms are known to increase risk for heart failure (HF). We studied 2904 older persons without HF (age 73.3±2.8 years, 47.9% men, 58.6% whites) enrolled in the Health ABC study who underwent serum resistin measurements at baseline. Participants were divided into groups based on tertiles of resistin concentrations and rates of incident HF (defined as hospitalization for new onset HF) were compared by Cox proportional hazards models. After 7.1 year median follow-up 252 participants (8.7%) developed HF. Increasing resistin concentrations were significantly associated with increasing incident HF rates (Figure 1 ). After adjusting for baseline differences (including body mass index) and predictors of incident HF (age, coronary disease, smoking, blood pressure, heart rate, serum glucose, creatinine, and albumin concentrations, and left ventricular hypertrophy), serum resistin concentrations were independently associated with incident HF [highest vs. lowest tertile hazard ratio (HR) 1.96, 95% confidence interval (CI) 1.35–2.82). Further adjustment for markers of inflammation (Creactive protein, interleukin-6, and tumor necrosis factor α) and of insulin resistance (fasting insulin level and hemoglobin A1c) only moderately attenuated this association which remained significant (HR 1.67, 95% CI 1.13–2.60). These findings were consistent in both sexes and among whites and blacks. High serum resistin concentrations are independently associated with increasedrisk for HF. Further studies are needed to confirm these findings.

Incident Heart Failure Prediction in the Elderly

Background— Despite the rising heart failure (HF) incidence and aging United States population, there are no validated prediction models for incident HF in the elderly. We sought to develop a new prediction model for 5-year risk of incident HF among older persons. Methods and Results— Proportional hazards models were used to assess independent predictors of incident HF, defined as hospitalization for new-onset HF, in 2935 elderly participants without baseline HF enrolled in the Health ABC study (age, 73.6�2.9 years, 47.9% males, 58.6% whites). A prediction equation was developed and internally validated by bootstrapping, allowing the development of a 5-year risk score. Incident HF developed in 258 (8.8%) participants during 6.5�1.8 years of follow-up. Independent predictors of incident HF included age, history of coronary disease and smoking, baseline systolic blood pressure and heart rate, serum glucose, creatinine, and albumin levels, and left ventricular hypertrophy. The Health ABC HF model had a c -statistic of 0.73 in the derivation dataset, 0.72 by internal validation (optimism-corrected), and good calibration (goodness-of-fit χ 2 6.24, P =0.621). A simple point score was created to predict incident HF risk into 4 risk groups corresponding to &lt;5%, 5% to 10%, 10% to 20%, and &gt;20% 5-year risk. The actual 5-year incident HF rates in these groups were 2.9%, 5.7%, 13.3%, and 36.8%, respectively. Conclusion— The Health ABC HF prediction model uses common clinical variables to predict incident HF risk in the elderly, an approach that may be used to target and treat high-risk individuals.