Chronic Heart Failure Hospitalization Research Articles

Level of education and risk of heart failure: a prospective cohort study with echocardiography evaluation

With increasing socioeconomic disparity in cardiovascular risk factors, there is a need to assess the role of socioeconomic factors in chronic heart failure (CHF) and to what extent this is caused by modifiable risk factors. In a prospective cohort of 18 616 men and women without known myocardial infarction or CHF examined in 1976-78, 1981-83, 1991-94, and 2001-03 in the Copenhagen City Heart Study, we studied the effect of education on CHF incidence. During a median follow-up of 21 years (range 0-31), 2190 participants were admitted to hospital for CHF. Age-adjusted hazard ratio (HR) for intermediary (8-10 years) and high level of education (>10 years) with low (< 8 years) as reference was 0.69 (0.62-0.78) and 0.52 (0.43-0.63), respectively, with similar associations in men and women. After adjusting for updated cardiovascular risk factors, corresponding HRs were 0.75 (0.67-0.85) and 0.61 (0.50-0.73). In a random subset of the population examined with echocardiography in 2001-03 (n = 3589), education was associated with left ventricular (LV) hypertrophy, LV dilatation, reduced LV ejection fraction, and severe diastolic dysfunction (P for trend, all <0.05), whereas no association was found for mild diastolic dysfunction (P for trend, 0.61). With the exception of LV hypertrophy, significant associations persisted after adjustment for potential mediating factors. In this cohort study, the level of education was associated with cardiac dysfunction and predicted future hospital admission for CHF. Only a minor part of the excess risk was mediated through traditional cardiovascular risk factors. Strategies to reduce this inequality should be strengthened.

Effects of Telmisartan Added to Angiotensin-Converting Enzyme Inhibitors on Mortality and Morbidity in Hemodialysis Patients With Chronic Heart Failure: A Double-Blind, Placebo-Controlled Trial

the aim of this study was to determine whether telmisartan decreases all-cause and cardiovascular mortality and morbidity in hemodialysis patients with chronic heart failure (CHF) and impaired left ventricular ejection fraction (LVEF) when added to standard therapies with angiotensin-converting enzyme inhibitors. in hemodialysis patients, CHF is responsible for a high mortality rate, but presently very few data are available with regard to this population. A 3-year randomized, double-blind, placebo-controlled, multicenter trial was performed involving 30 Italian clinics. Hemodialysis patients with CHF (New York Heart Association functional class II to III; LVEF ≤ 40%) were randomized to telmisartan or placebo in addition to angiotensin-converting enzyme inhibitor therapy. A total of 332 patients were enrolled (165 telmisartan, 167 placebo). Drug dosage was titrated to a target dose of telmisartan of 80 mg or placebo. Mean follow-up period was 35.5 ± 8.5 months (median: 36 months; range: 2 to 40 months). Primary outcomes were: 1) all-cause mortality; 2) cardiovascular mortality; and 3) CHF hospital stay. at 3 years, telmisartan significantly reduced all-cause mortality (35.1% vs. 54.4%; p < 0.001), cardiovascular death (30.3% vs. 43.7%; p < 0.001), and hospital admission for CHF (33.9% vs. 55.1%; p < 0.0001). With Cox proportional hazards analysis, telmisartan was an independent determinant of all-cause mortality (hazard ratio [HR]: 0.51; 95% confidence interval [CI]: 0.32 to 0.82; p < 0.01), cardiovascular mortality (HR: 0.42; 95% CI: 0.38 to 0.61; p < 0.0001), and hospital stay for deterioration of heart failure (HR: 0.38; 95% CI: 0.19 to 0.51; p < 0.0001). Adverse effects, mainly hypotension, occurred in 16.3% of the telmisartan group versus 10.7% in the placebo group. addition of telmisartan to standard therapies significantly reduces all-cause mortality, cardiovascular death, and heart failure hospital stays in hemodialysis patients with CHF and LVEF ≤ 40%. (Effects Of Telmisartan Added To Angiotensin Converting Enzyme Inhibitors On Mortality And Morbidity In Haemodialysed Patients With Chronic Heart Failure: A Double-Blind Placebo-Controlled Trial; NCT00490958).

Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: A systematic review

Objective This review examined the effectiveness of self-management interventions compared to usual care on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure. Methods A systematic review was performed. MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched between 1996 and 2009. Randomized controlled trials were selected evaluating self-management interventions designed for patients with chronic heart failure. Outcomes of interest are mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life. Results Nineteen randomized controlled trials were identified. The effectiveness of heart failure management programs initiating self-management interventions in patients with chronic heart failure indicate a positive effect, although not always significant, on reduction of numbers of all-cause hospital readmitted patients and due to chronic heart failure, decrease in mortality and increasing quality of life. Conclusion This systematic review found that current available published studies show methodological shortcomings impairing validation of the effectiveness of self-management interventions on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure. Practice implications Further research should determine independent effects of self-management interventions and different combinations of interventions on clinical and patient reported outcomes.

Effect of atorvastatin in patients with chronic heart failure - insights from randomized clinical trials.

IntroductionRecent large clinical trials have yielded disappointing results of rosuvastatin in the chronic heart failure (CHF) population. The question that remains is whether these results of rosuvastatin studies could be extended to other statins. Therefore, we performed a meta-analysis based on all currently available randomized controlled trials (RCTs) to evaluate the clinical efficacy of atorvastatin in CHF patients.Material and methodsThe published literature was scanned by formal searches of electronic databases up to January 2010. RCTs were eligible for inclusion if they compared atorvastatin versus placebo treatment in patients with CHF and reported the clinical outcomes.ResultsPre-specified criteria were met by 7 trials involving 540 patients. The primary endpoint, all-cause mortality, was significantly reduced with atorvastatin therapy compared with placebo in CHF patients (odds ratio [OR] 0.39, P = 0.002), with similar results in cardiovascular mortality (OR 0.28, P = 0.002) and sudden cardiac death (OR 0.24, P = 0.01). There was also a significant decrease in hospitalization for worsening CHF with atorvastatin therapy compared with placebo (OR 0.30, P < 0.001).ConclusionsThis meta-analysis suggests the effectiveness of atorvastatin treatment in reducing the risks of all-cause mortality and worsening CHF hospitalization in patients with CHF. Further large, well-conducted randomized trials are needed to confirm the benefits of atorvastatin or other statins for CHF relative to placebo or rosuvastatin.

Utility of Highly Sensitive Cardiac Troponin T Assay on Discharge in Patients With Chronic Heart Failure

Troponin T (TnT) predicts adverse outcome in chronic heart failure (CHF) patients but is detectable in only a small fraction of those with stable CHF. We evaluated the utility of a new highly sensitive TnT (hsTnT) assay (lower detection limit of 0.002ng/mL) on discharge in 77 CHF patients without detectable TnT with traditional assay (lower detection limit of 0.01ng/mL). Results: 1) HsTnT was detectable in 95% patients. 2) During a mean follow-up period of 23 months, there were 25 cardiac events defined as cardiac death or hospitalization for CHF.

A Propensity-Matched Study of Elevated Jugular Venous Pressure and Outcomes in Chronic Heart Failure

The independence of association between elevated jugular venous pressure (JVP) and outcomes in heart failure (HF) has not been well studied. The objective of propensity-matched study was to determine if an elevated JVP had intrinsic associations with outcomes in chronic systolic and diastolic HF. Of the 7,788 participants in the Digitalis Investigation Group trial, 1,020 (13%) had elevated JVP at baseline. Propensity scores for elevated JVP were estimated for all patients based on 32 baseline characteristics and were used to match 827 pairs of patients with normal and elevated JVP. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated to compare outcomes associated with elevated versus normal JVP during 34 months of median follow-up. Before matching, all-cause mortality occurred in 31% and 47% (unadjusted HR 1.70, 95% CI 1.54 to 1.88, p <0.0001), and all-cause hospitalization occurred in 60% and 71% (unadjusted HR 1.35, 95% CI 1.25 to 1.47, p <0.0001) of patients with normal and elevated JVP, respectively. After matching, all-cause mortality occurred in 48% and 45% (matched HR 0.95, 95% CI 0.80 to 1.12, p = 0.521), and all-cause hospitalization occurred in 70% and 70% (matched HR 0.97, 95% CI 0.87 to 1.09, p = 0.613) of patients with normal and elevated JVP, respectively. Elevated JVP had no intrinsic associations with cardiovascular mortality (matched HR 0.93, 95% CI 0.77 to 1.12, p = 0.440) or hospitalization for HF (matched HR 0.94, 95% CI 0.78 to 1.14, p = 0.532). In conclusion, an elevated JVP is a marker of higher burden of sickness and poor outcomes. However, elevated JVP had no intrinsic association with mortality or hospitalization in chronic HF.

Insulin Resistance: A Potential New Target for Therapy in Patients with Heart Failure

There is increasing evidence to suggest that chronic heart failure (CHF) is an insulin resistant (IR) state and that the degree of IR correlates with the severity and mortality of CHF. The pathophysiology of IR in CHF has yet to be fully defined. Additionally, it remains to be determined if IR is merely a marker reflecting the severity of CHF or whether it contributes to the disease in CHF. If IR is truly a culprit that worsens CHF, it will potentially be a new target for therapy as strategies that can reverse IR in CHF may potentially result in an improvement in symptoms and even mortality in these patients. However, there are concerns regarding the use of certain insulin sensitizers, most notably, the thiazolidinediones (TZDs) which have been associated with increased risk of hospitalizations for CHF. Despite previous concerns of lactic acidosis (LA), there is now evidence that metformin may not only be safe but could potentially be useful in the setting of CHF. There are now ongoing prospective studies, including the TAYSIDE study, to determine if reversing IR with metformin will have beneficial effects in patients with CHF.

Extracellular Matrix Turnover and Inflammatory Markers Independently Predict Functional Status and Outcome in Chronic Heart Failure

Background Inflammatory pathways may promote extracellular matrix (ECM) remodeling and chronic heart failure (CHF) progression. The relationship between markers of inflammation and of ECM remodeling, and their influence on functional status and outcomes has not been examined in a large cohort of CHF patients. Methods and Results We measured baseline blood serum collagen (amino-terminal propeptide of collagen III [PIIINP], metalloproteinase 1 [MMP-1], tissue inhibitor of metalloproteinase 1 [TIMP-1]), and inflammatory (high-sensitivity C-reactive protein [(hsCRP], interleukin [IL]-18, IL-10) markers in 1009 patients enrolled in the Research into Etanercept Cytokine Antagonism in Ventricular Dysfunction (RECOVER) trial. A positive correlation was detected between the 2 classes of markers (PIIINP to IL-18, MMP-1 and TIMP-1 to CRP, TIMP-1 to IL-18, MMP-1 to IL-10). In the adjusted multivariable model including all biomarkers, only PIIINP ( P = .03) and MMP-1 ( P = .048) were independent predictors of 6-minute walk test (6-MWT), whereas in another model including only inflammatory biomarkers, IL-18 was an independent predictor. PIIINP ( P = .001) was the only biomarker independently associated with death and CHF hospitalization. Conclusions The independent associations of PIIINP and MMP-1 with 6-MWT and PIIINP with CHF morbi-mortality suggest that excessive ECM turnover may be associated with functional capacity deterioration and poor outcome.

A Propensity-Matched Study of Hypertension and Increased Stroke-Related Hospitalization in Chronic Heart Failure

Hypertension is a risk factor for heart failure and stroke. However, the effect of hypertension on stroke in patients with heart failure has not been well studied. In the Digitalis Investigation Group trial, 3,674 (47%) of the 7,788 patients had a history of hypertension. Probability or propensity scores for a history of hypertension were calculated for each patient through use of a multivariable logistic regression model and were then used to match 2,386 pairs of patients with and without a history of hypertension. Kaplan-Meier and matched Cox regression analyses were used to estimate associations of a history of hypertension hospitalization for stroke during 37 months of median follow-up. After matching, patients without and with a history of hypertension had a mean systolic blood pressure of 127 mm Hg. Hospitalization for stroke occurred in 90 patients (rate, 129/10,000 person-years of follow-up) without a history of hypertension and 121 patients (rate, 178/10,000 person-years of follow-up) with a history of hypertension (hazard ratio when hypertension was compared with no hypertension=1.52; 95% confidence interval=1.11 to 2.08; p=0.010). This association was also observed among patients with baseline systolic blood pressure <140 mm Hg (hazard ratio=1.35; 95% confidence interval=1.01 to 1.81; p=0.044). In conclusion, a history of hypertension was associated with increased risk of hospitalization for stroke among patients with heart failure who were balanced in all measured baseline covariates, including blood pressure.

Inhibition of the Renin-Angiotensin System Prevents Re-Hospitalization of Heart Failure Patients With Preserved Ejection Fraction

Approximately half of the patients with chronic heart failure (CHF) show preserved systolic function, but less is known about CHF with preserved ejection fraction (EF). In a retrospective analysis, patients with CHF who had been admitted to hospital were divided into 2 groups: reduced EF (EF < or = 40%) and preserved EF (EF >40%). The rate of preserved EF was 53.5% and those with preserved EF were older, more likely to be female, and had a lower serum hemoglobin concentration than those in the reduced EF group. In the multivariate analysis, only older age was independently related to CHF with preserved EF. CHF patients with preserved EF who were successfully discharged from hospital and then followed at the outpatient clinic were reviewed and re-hospitalization for CHF was examined by Cox hazard univariate analysis, which showed that prior CHF hospitalization, absence of hypertension, and non-use of angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin-receptor blocker (ARB) were predictors. In the multivariate analysis, non-use of ACEI/ARB was the sole predictor for CHF re-hospitalization. CHF patients with preserved EF are older than those with reduced EF and use of ACEI/ARB prevents their re-hospitalization.

Candesartan: from left ventricular hypertrophy to heart failure, a global approach

Cardiovascular disease is a continuum, starting with risk factors resulting from physiological changes and extending to vascular pathology associated with adverse clinical outcomes. The overactivation of the renin–angiotensin–aldosterone system has been related to the development and worsening of risk factors associated with cardiovascular diseases such as hypertension and heart failure. Treatment at each stage along the continuum may prevent, or at least delay, the next one, and so it is crucial to initiate therapy as early as possible in such patients so as to provide optimal care. Candesartan, a long-acting angiotensin receptor antagonist, has been shown to be an effective, and well-tolerated therapy, in both the early and late phases of cardiovascular disease (prehypertension, hypertension, left ventricular hypertrophy and heart failure). This article reviews the data supporting the use of candesartan in cardiovascular medicine, with a focus on left ventricular hypertrophy and ultimately heart failure. Particular emphasis is given to the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) program, which has shown a positive impact of candesartan in patients with chronic heart failure in terms of reducing the incidence of cardiovascular deaths and chronic heart failure hospitalizations.

Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis

Objective To determine whether remote monitoring (structured telephone support or telemonitoring) without regular clinic or home visits improves outcomes for patients with chronic heart failure.Data sources 15 electronic databases, hand...

Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure

Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure

Incorrect Data in: Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure

Incorrect Data in: Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure

Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure—Reply

Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure—Reply

Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure

Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure

Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure

Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure

Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure

Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear. To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure. Propensity-adjusted cohort study of adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had no previous known statin use, within an integrated health care delivery system in northern California between January 1, 1996, and December 31, 2004. Statin use was estimated from filled outpatient prescriptions in pharmacy databases. All-cause death and hospitalization for heart failure during a median of 2.4 years of follow-up. We examined the independent relationships between statin therapy and risks for adverse events overall and stratified by the presence or absence of coronary heart disease after multivariable adjustment for potential confounders. Among 24,598 adults diagnosed with heart failure who had no prior statin use, those initiating statin therapy (n = 12,648; 51.4%) were more likely to be younger, male, and have known cardiovascular disease, diabetes, and hypertension. There were 8235 patients who died. Using an intent-to-treat approach, incident statin use was associated with lower risks of death (age- and sex-adjusted rate of 14.5 per 100 person-years with statin therapy vs 25.3 per 100 person-years without statin therapy; adjusted hazard ratio, 0.76 [95% confidence interval, 0.72-0.80]) and hospitalization for heart failure (age- and sex-adjusted rate of 21.9 per 100 person-years with statin therapy vs 31.1 per 100 person-years without statin therapy; adjusted hazard ratio, 0.79 [95% confidence interval, 0.74-0.85]) even after adjustment for the propensity to take statins, cholesterol level, use of other cardiovascular medications, and other potential confounders. Incident statin use was associated with lower adjusted risks of adverse outcomes in patients with or without known coronary heart disease. Among adults diagnosed with heart failure who had no prior statin use, incident statin use was independently associated with lower risks of death and hospitalization among patients with or without coronary heart disease.

Herzinsuffizienz - Auch hier haben Statine eine protektive Wirkung

Quelle: Fo AS, Lee WY, Yang J et al. Statin therapy and risks for death and hospitalization in chronic heart failure. JAMA 2006; 296: 2105-2111

Drug Copayment and Adherence in Chronic Heart Failure: Effect on Cost and Outcomes

To measure the association among prescription copayment, drug adherence, and subsequent health outcomes among patients with chronic heart failure (CHF). Retrospective cohort study. Database of a large, national health insurance plan. Patients with CHF receiving commercial and Medicare supplemental benefits. We estimated adherence to therapy with beta-blockers or angiotensin-converting enzyme (ACE) inhibitors in 2002 by using the medication possession ratio, an estimate of the proportion of days a patient was exposed to a drug while taking a drug regimen. For 2003, we measured the annualized total cost of health care and identified hospitalizations with a diagnostic code for CHF. We used a two-stage regression approach to model the association among copayment, adherence, and patient outcomes. For patients taking ACE inhibitors, a $10 increase in copayment was associated with a 2.6% decrease in the medication possession ratio (95% confidence interval [CI] 2.0-3.1%). This change in adherence was associated with a predicted 0.8% decrease in medical costs (95% CI -4.2-2.5%) but a predicted 6.1% increase in the risk of hospitalization for CHF (95% CI 0.5-12.0%). Among patients taking beta-blockers, a $10 increase in copayment was associated with a 1.8% decrease in the medication possession ratio (95% CI 1.4-2.2%). This change in adherence was associated with a predicted 2.8% decrease in medical costs (95% CI -5.9-0.1%) and a predicted 8.7% increase in the risk of hospitalization for CHF (95% CI 3.8-13.8%). Among patients with CHF, higher drug copayments were associated with poorer adherence. The change was relatively small and did not affect predicted total health care costs, but it was sufficient to increase the predicted risk of hospitalization for CHF.