Lower Rates Of Heart Failure Research Articles

Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) Ameliorate Heart Failure through Reductions in Oxidative Stress: A Systematic Review and Meta-Analysis.

The objectives of this study were to explore the role that eicosapentaenoic acid (EPA) and/or docosahexaenoic acid (DHA) plays in heart failure (HF), highlighting the potential connection to oxidative stress pathways. Following PRISMA guidelines, we conducted electronic searches of the literature in MEDLINE and EMBASE focusing on serum EPA and/or DHA and EPA and/or DHA supplementation in adult patients with heart failure or who had heart failure as an outcome of this study. We screened 254 studies, encompassing RCTs, observational studies, and cohort studies that examined HF outcomes in relation to either serum concentrations or dietary supplementation of EPA and/or DHA. The exclusion criteria were pediatric patients, non-HF studies, abstracts, editorials, case reports, and reviews. Eleven studies met our criteria. In meta-analyses, high serum concentrations of DHA were associated with a lower rate of heart failure with a hazard ratio of 0.74 (CI = 0.59-0.94). High serum concentrations of EPA also were associated with an overall reduction in major adverse cardiovascular events with a hazard ratio of 0.60 (CI = 0.46-0.77). EPA and DHA, or n3-PUFA administration, were associated with an increased LVEF with a mean difference of 1.55 (CI = 0.07-3.03)%. A potential explanation for these findings is the ability of EPA and DHA to inhibit pathways by which oxidative stress damages the heart or impairs cardiac systolic or diastolic function producing heart failure. Specifically, EPA may lower oxidative stress within the heart by reducing the concentration of reactive oxygen species (ROS) within cardiac tissue by (i) upregulating nuclear factor erythroid 2-related factor 2 (Nrf2), which increases the expression of antioxidant enzyme activity, including heme oxygenase-1, thioredoxin reductase 1, ferritin light chain, ferritin heavy chain, and manganese superoxide dismutase (SOD), (ii) increasing the expression of copper-zinc superoxide dismutase (MnSOD) and glutathione peroxidase, (iii) targeting Free Fatty Acid Receptor 4 (Ffar4), (iv) upregulating expression of heme-oxygenase-1, (v) lowering arachidonic acid levels, and (vi) inhibiting the RhoA/ROCK signaling pathway. DHA may lower oxidative stress within the heart by (i) reducing levels of mitochondrial-fission-related protein DRP-1(ser-63), (ii) promoting the incorporation of cardiolipin within the mitochondrial membrane, (iii) reducing myocardial fibrosis, which leads to diastolic heart failure, (iv) reducing the expression of genes such as Appa, Myh7, and Agtr1α, and (v) reducing inflammatory cytokines such as IL-6, TNF-α. In conclusion, EPA and/or DHA have the potential to improve heart failure, perhaps mediated by their ability to modulate oxidative stress.

The impact of gender differences on the clinical characteristics of critically ill patients with venous thromboembolism: A retrospective, observational study.

The aim of this study is to describe the general information, disease and treatment of venous thromboembolism (VTE) in critically ill patients, to explore the characteristics of severe patients with deep venous VTE and provide clinical reference data for the prevention and treatment of VTE in critically ill patients. This study carried out a retrospective study on the medical records of patients who were treated in the intensive care unit of Affiliated Hospital of Jining Medical College from 2020 to 2022. The general data, general conditions, drug use, past history, VTE prevention measures, post-VTE conditions, and Padua risk score of 297 patients with VTE during the period of hospitalization in intensive care unit (ICU) were classified and statistically analyzed. A total of 297 including 171 male and 126 male patient medical records were included in the analysis, we compared multiple clinical indicators between male and female patients. Compared to women, male patients have a higher acute physiology and chronic health evaluation II score(APACHE-II score) (P = .027), a higher state of consciousness (P = .003), a higher rate of smoking and drinking history (P < .001), a lower rate of heart failure (P = .003) and chronic depression (P = .013), and a higher rate of recommended operations for male patients after VTE (P = .031). The prothrombin time (PT) (P = .041) and activated partial thromboplastin time (APTT) (P = .040) of male patients were significantly higher than those of female patients, while triglyceride (P = .009) and total cholesterol (TC) (P = .001) were significantly lower than those of female patients. The difference in D-dimer (P = .739) was not significant. This study shows that male and female patients with VTE in the ICU have significant differences in general characteristics, general clinical conditions, history of past illness, thrombosis character, and examination items, this may be the reason for the different rates of VTE between male and female patients in the ICU.

Comparative evaluation of postoperative outcomes and expenditure between robotic and conventional single-level lumbar fusion surgery: a comprehensive analysis of nationwide inpatient sample data

IntroductionIn this study, we investigate the evolution of lumbar fusion surgery with robotic assistance, specifically focusing on the impact of robotic technology on pedicle screw placement and fixation. Utilizing data from the Nationwide Inpatient Sample (NIS) covering 2016 to 2019, we conduct a comprehensive analysis of postoperative outcomes and costs for single-level lumbar fusion surgery. Traditionally, freehand techniques for pedicle screw placement posed risks, leading to the development of robotic-assisted techniques with advantages such as reduced misplacement, increased precision, smaller incisions, and decreased surgeon fatigue. However, conflicting study results regarding the efficacy of robotic assistance in comparison to conventional techniques have prompted the need for a thorough evaluation. With a dataset of 461,965 patients, our aim is to provide insights into the impact of robotic assistance on patient care and healthcare resource utilization. Our primary goal is to contribute to the ongoing discourse on the efficacy of robotic technology in lumbar fusion procedures, offering meaningful insights for optimizing patient-centered care and healthcare resource allocation.MethodsThis study employed data from the Nationwide Inpatient Sample (NIS) spanning the years 2016 to 2019 from USA, 461,965 patients underwent one-level lumbar fusion surgery, with 5770 of them having the surgery with the assistance of robotic technology. The study focused primarily on one-level lumbar fusion surgery and excluded non-elective cases and those with prior surgeries. The analysis encompassed the identification of comorbidities, surgical etiologies, and complications using specific ICD-10 codes. Throughout the study, a constant comparison was made between robotic and non-robotic lumbar fusion procedures. Various statistical methods were applied, with a p value threshold of < 0.05, to determine statistical significance.ResultsRobotic-assisted lumbar fusion surgeries demonstrated a significant increase from 2016 to 2019, comprising 1.25% of cases. Both groups exhibited similar patient demographics, with minor differences in payment methods, favoring Medicare in non-robotic surgery and more private payer usage in robotic surgery. A comparison of comorbid conditions revealed differences in the prevalence of hypertension, dyslipidemia, and sleep apnea diagnoses—In terms of hospitalization outcomes and costs, there was a slight shorter hospital stay of 3.06 days, compared to 3.13 days in non-robotic surgery, showcasing a statistically significant difference (p = 0.042). Robotic surgery has higher charges, with a mean charge of $154,673, whereas non-robotic surgery had a mean charge of $125,467 (p < 0.0001). Robotic surgery demonstrated lower rates of heart failure, acute coronary artery disease, pulmonary edema, venous thromboembolism, and traumatic spinal injury compared to non-robotic surgery, with statistically significant differences (p < 0.05). Conversely, robotic surgery demonstrated increased post-surgery anemia and blood transfusion requirements compared to non-robotic patients (p < 0.0001). Renal disease prevalence was similar before surgery, but acute kidney injury was slightly higher in the robotic group post-surgery (p = 0.038).ConclusionThis is the first big data study on this matter, our study showed that Robotic-assisted lumbar fusion surgery has fewer post-operative complications such as heart failure, acute coronary artery disease, pulmonary edema, venous thromboembolism, and traumatic spinal injury in comparison to conventional methods. Conversely, robotic surgery demonstrated increased post-surgery anemia, blood transfusion and acute kidney injury. Robotic surgery has higher charges compared to non-robotic surgery.

The Effectiveness of the Smartphone-Based WeChat Platform on Reducing Time to Diagnosis and Treatment of ST-segment Elevation Myocardial Infarction.

This study evaluated the effectiveness of the smartphone-based WeChat platform in reducing the ischemia time of ST-segment elevation myocardial infarction (STEMI). A total of 198 STEMI patients who underwent primary percutaneous coronary intervention (PCI) from January 2022 to August 2022 in our hospital were enrolled in this retrospective cohort study. Patients were divided into two groups according to whether their electrocardiograms (ECGs) were posted on the WeChat platform. The two groups were compared for the following: diagnosis time of first ECG, time from first medical contact (FMC) to catheterization laboratory (CL) activity, bypass emergency department (ED) or critical care unit (CCU), time of door to wire, time of door to balloon, time of FMC to wire, heart failure during hospitalization, cardiogenic shock during hospitalization, malignant arrhythmia during hospitalization, death during hospitalization, total hospital cost, and length of stay. The diagnosis time for the first ECG was 10.05 3.30 mins in the control group and 2.50 0.82 mins in the WeChat group (p 0.05). The time from FMC to CL activity was significantly shorter in the WeChat group compared to the control group (p 0.05). None of the control group patients bypassed the ED, compared to 80 (80%) of patients in the WeChat group (p 0.05). The time from door to wire was 60.22 12.73 mins in the WeChat group and 92.56 20.23 mins in the control group (p 0.05). The time of FMC to wire was also significantly shorter in the WeChat group than in the control group (p 0.05). The WeChat group had a significantly lower rate of heart failure during hospitalization than the control group (p 0.05). However, the two groups showed no significant differences for cardiogenic shock during hospitalization, malignant arrhythmia during hospitalization, death during hospitalization, total hospital cost, and length of stay. The smartphone-based WeChat platform demonstrated high efficacy and accessibility in reducing the ischemia time for STEMI patients. Our results indicate that social media platforms such as WeChat could be a useful approach for improving the prognosis of cardiovascular disease.

Metformin versus sodium glucose co-transporters inhibitors as first-line for atherosclerotic cardiovascular disease: A meta-analysis.

There is growing evidence of prescribing sodium glucose co-transporters-2 inhibitor (SGLT-2) to patients with/at high risk of atherosclerotic cardiovascular disease as first-line (instead of metformin). This is the first meta-analysis to compare SGLT-2 inhibitors regarding the same. We aimed to compare SGLT-2 inhibitors and metformin regarding heart failure, acute coronary syndrome, and ischemic stroke. We systematically searched PubMed and Cochrane Library for relevant articles from the first article up to August 2022. The following keywords were used: Metformin, Salt glucose co-transporters inhibitors, SGLT-2 inhibitors, empagliflozin, dapagliflozin, canagliflozin, and first-line. The retrieved data were exported to an excel sheet detailing the author's names, the country of origin of the study, the number of patients and control subjects, the study duration, and the total number of events in the interventional and exercise groups. Out of 108 articles screened, only three studies fulfilled the inclusion criteria, a databased study, and two cohorts with 10309 events and 86487 patients. The present meta-analysis showed that SGLT-2 inhibitors had lower rates of heart failure (odd ratio, 1.51, 95% CI, 1.10-2.08) and myocardial infarction (odd ratio, 1.45, 95% CI, 1.08-1.96) than metformin with a similar rate of stroke (odd ratio, 1.03, 95% CI, 0.66-1.61). Significant heterogeneity was observed. Sodium-glucose co-transporter inhibitors-2 as first-line therapy showed a lower heart failure and myocardial infarction compared to metformin. No significant difference was found between the two drugs regarding ischemic stroke. Further larger studies comparing the adverse event are needed.

Effect of Early Coronary Collateral Circulation in Patients with ST Elevation Myocardial Infarction

Background and Aims: Coronary collateral circulation can develop early after STEMI and patients having these coronary collaterals have favorable outcomes. The aim of this study was to evaluate the prognostic impact of coronary collateral circulation in STEMI.&#x0D; Methods: This is an observational prospective study of 106 consecutive STEMI patients undergoing Primary PCI admitted and treated at a tertiary cardiac centre from May 2019 to April 2020. Clinical profile, complications at index admission and atone month follow up were analyzed.&#x0D; Results: Out of 106 consecutive patients, 50(47%) had early coronary collateral supplying the infarct related artery. The baseline characteristics of the patients in the two groups, with collateral and without collateral, were similar. Among patients with collateral circulation, only 5% had very well developed (Rentrop3) collaterals. The presence of collateral was strongly associated with presence of preexisting angina (p=0.007) and delayed presentation to hospital (p= 0.04). Coronary collateral was more common in non-diabetics, non-anterior wall STEMI and those with mutivessel disease. Compared with the patients without collateral supply, those who had collateral had fewer incidence of in-hospital heart failure (p=0.03) and post MI pericarditis (p=0.04).&#x0D; Conclusion: In STEMI, development or recruitment of early collateral supply to the infarct related artery was associated with lower rates of heart failure, post MI pericarditis, cardiogenic shock, hospital stay and in-hospital deaths. At 1 month, patients with collateral supply had fewer angina recurrence, reinfarcton and stent thrombosis.

Long-term outcomes in acute coronary syndrome patients without standard modifiable risk factors: a multi-ethnic retrospective cohort study Of 5400 asian patients.

A sizeable number of patients without standard modifiable cardiovascular risk factors (SMuRFs), such as hypertension, diabetes, hypercholesterolemia and smoking, suffer from acute coronary syndrome (ACS). These SMuRF-less patients have high short-term morbidity and mortality. We compared both short- and long-term outcomes of SMuRF-less and SMuRF ACS patients in a multi-ethnic Asian cohort.This was a retrospective study of patients with first ACS from 2011 to 2017. The primary outcome was long-term all-cause mortality. Secondary outcomes were 30-day all-cause mortality, cardiac-mortality, unplanned cardiac readmission, cardiogenic shock, heart failure, and stroke. Subgroup analysis was carried out by sex and ACS type.Of 5400 patients, 8.6% were SMuRF-less. The median follow-up time was 6.3years (interquartile range [IQR] 4.2-8.2 years). SMuRF-less patients were younger and tended to present with ST-segment elevation myocardial infarction (STEMI). They were more likely to require inotropic support, intubation, and have cardiac arrest. At 30days, SMuRF-less patients had higher rates of all-cause mortality, cardiac-related mortality and cardiogenic shock, but lower rates of heart failure. At 6years, all-cause mortality was similar in both groups (18.0% versus 17.1% respectively, p = 0.631). Kaplan-Meier curves showed increased early mortality in the SMuRF-less group, but the divergence in survival curves was no longer present in the long-term. The absence of SMuRF was an independent predictor of mortality, regardless of sex or ACS type.In a multi-ethnic cohort of patients with ACS, SMuRF-less patients were observed to have higher mortality than SMuRF patients during the early stages which was attenuated over time.

In-Hospital Outcomes of Coronary Artery Stenting in Patients With ST-Elevation Myocardial Infarction (STEMI) and Metabolic Syndrome: Insights From the National Inpatient Sample.

BackgroundMetabolic syndrome (MetS) has been recognized as a global health problem. Concurrent MetS diagnosis in patients with ST-elevation myocardial infarction (STEMI) is becoming increasingly common. Given the paucity of studies on the impact of MetS on treatment outcomes in STEMI patients, the purpose of this study was to evaluate in-hospital mortality in STEMI patients with a concurrent MetS diagnosis undergoing a stenting procedure to treat their underlying coronary artery disease.MethodPatients with or without MetS who underwent coronary stenting following STEMI between 2005 and 2014 were identified from the National Inpatient Sample database. Patients' demographics, comorbidities, and outcomes were compared using a t-test and Pearson's Chi-square test. In addition, 1:1 propensity score matching was performed for age, gender, and race.ResultsOut of 1,938,097 STEMI patients, 5,817 patients with MetS underwent coronary stenting following STEMI and were matched with 5,817 patients with no Mets. MetS group had significantly higher rates of diabetes, hypertension, hyperlipidemia, chronic kidney disease, and obstructive sleep apnea than the no MetS group but lower rates of heart failure and chronic obstructive pulmonary disease. In-hospital mortality following STEMI was significantly lower in patients with MetS (2.5% vs. 7.1%, p<0.001) and remained significant after adjusting for potential confounders (odds ratio (OR) 0.34, 95% confidence interval (95% CI) 0.28-0.42, p<0.0001).ConclusionConcurrent diagnosis of MetS among patients undergoing coronary stenting is associated with a decreased in-hospital mortality risk. The impact of specific MetS components on the observed reduction in mortality remains unclear and warrants evaluation in future studies.

Abstract P202: Optimism Moderates The Effects Of Neighborhood Disadvantage On Incident Heart Failure Among African-Americans In The Jackson Heart Study (JHS) And Atherosclerosis Risk In Communities (ARIC) Study

Background: African-Americans experience a disproportionate burden of heart failure. Although previous research has identified neighborhoods as an important contributor to these disparities, less is understood about how psychosocial resilience factors, such as optimism, may provide protection from the effects of neighborhood disadvantage on heart failure risk. We tested the hypothesis that higher levels of optimism will attenuate the associations between greater neighborhood disadvantage and higher incidence of heart failure. Methods: Among 1,448 African-Americans dually enrolled in two community-based cohorts in Jackson, Mississippi—JHS and the ARIC study—who were free of heart failure as of January 1, 2000, 459 failure events classified by reviewer panel accrued through December 31, 2019. Multi-level age- and sex-adjusted Cox regression models with interaction terms were used to examine whether individual-level optimism moderated the associations of four measures of census tract-level neighborhood socioeconomic and social environment characteristics (the national Area Deprivation Index (ADI), a JHS neighborhood disadvantage score, racial residential segregation, and perceived physical disorder) on individual-level incident hospitalized heart failure. Results: Optimism moderated the associations of some neighborhood disadvantage measures (ADI and JHS neighborhood disadvantage score) on hospitalized heart failure risk (Table). Compared to participants reporting the lowest level of optimism, those in the highest tertile had 12%, 6%, 16%, and 9% lower rates of heart failure associated with increasing neighborhood disadvantage, respectively for each exposure. Interaction estimates for racial residential segregation and perceived physical disorder did not reach statistical significance. Conclusions: Optimism may provide resilience to the detrimental effects of neighborhood disadvantage on risk for heart failure.

Abstract 11987: Bariatric Surgery Reduces the Incidence of Heart Failure in Patients With Obesity

Introduction: Obesity, and the related metabolic syndrome, is one of the largest public health challenges facing medical systems across the globe. A growing body of evidence supports using bariatric surgery in patients with obesity for weight loss and prevention of cardiovascular disease. However, relatively little research has considered whether bariatric surgery reduces the risk of heart failure. This propensity-score matched UK-wide retrospective study aims to answer that question. Hypothesis: We hypothesised that bariatric surgery would reduce the incidence of heart failure in patients with obesity, as compared to non-surgical management. Methods: Using the Clinical Practice Research Datalink, a study cohort containing 3,052 patients who had received bariatric surgery were matched by propensity score to 3,052 controls. The primary endpoint was development of any heart failure. The secondary endpoints were all-cause mortality, development of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) specifically, and hospitalisations due to heart failure. These endpoints were assessed using a Cox proportional hazards model. Results: The mean follow-up duration was 7.50 years. Patients who received bariatric surgery had a significantly lower incidence of new heart failure (hazard ratio 0.45, 95% confidence interval 0.28-0.73, p=0.0011) and all-cause mortality (hazard ratio 0.56, 95% confidence interval 0.38-0.83, p=0.0036). There was no significant difference in the rates of HFrEF or HFpEF individually, though these analyses were notably underpowered. Conclusions: In conclusion, this UK retrospective study provides evidence of lower rates of heart failure and all-cause mortality in patients who have bariatric surgery when compared to propensity-score matched controls. Future efforts to understand the mechanism behind this reduction and explore the lifetime benefits in high risk cohorts are paramount.

Cancer and atrial fibrillation/flutter: an analysis of patients referred to electrical cardioversion

Abstract Introduction Cancer is associated with an increased risk of atrial fibrillation (AF) development. Both an active tumour and AF are related to increased thromboembolic risk. Purpose To determine the clinical characteristics, management and prognosis of cancer patients with AF or atrial flutter (AFL) referred to electrical cardioversion (EC). Methods We conducted a retrospective study encompassing patients referred to EC due to AF/ AFL in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics, echocardiographic studies and follow-up data were analysed. We considered patients with a recent (up to 5 years) diagnosis of cancer. Primary endpoints were the occurrence of stroke, bleeding complications and all-cause mortality. Results A total of 691 patients were included, with a median age of 67 years-old and 70,8% male predominance. AFL was identified in 21,1% of patients and 57,4% had arterial hypertension. Persistent AF/AFL was diagnosed in 60,7%, 20,4% presented with first diagnosed AF/AFL and 17,9% had paroxysmal episodes. 89,5% of patients had indication for anticoagulation therapy and, of these, 75,4% were medicated with non-vitamin K antagonist oral anticoagulants (NOAC). 58 patients (8,4%) had a recent diagnosis of cancer, who were older (69,7 vs 67,9 years-old; p&amp;lt;0,001) and more frequently cardioverted in an outpatient setting (63,8%). They had a lower rate of heart failure (1,9% vs 16,7%; p=0,004), but a higher prevalence of sleep apnea (13% vs 5,4%; p=0,025) and chronic kidney disease (10,9% vs 4,2%; p=0,027). HAS-BLED score was applied, and higher values were obtained in cancer patients (1,0 vs 0,7; p=0,002). CHA2DS2-VASc score was not significantly different between both groups. NOAC were preferred in cancer patients (86,8% vs 74,2%; p=0,043), instead of vitamin K antagonists. These patients were less referred to AF/AFL ablation procedures (1,9% vs 11,6%; p=0,027). During a median follow-up of 1342 days, no significant differences were found regarding the occurrence of ischemic stroke and bleeding complications. All-cause mortality was significantly higher in cancer patients (31,5% vs 15,5%; p=0,003), but none died from cardiovascular causes. Conclusion Cancer is frequent in patients with AF/AFL referred to EC, who are older and had a higher bleeding risk. Stroke rate was not significantly different than other patients, and NOAC seem to be a safe medication in this population. All-cause mortality is high in cancer patients, but we did not find any association with cardiovascular causes. Funding Acknowledgement Type of funding sources: None.

Utilisation and safety of catheter ablation of atrial fibrillation in public and private sector hospitals

BackgroundLittle is known about the utilisation and safety of catheter ablation of atrial fibrillation (AF) among public and private sector hospitals.AimsTo examine the uptake of AF ablations and compare procedural safety between the sectors.Method:Hospitalisation data from all public and private hospitals in four large Australian states (NSW, QLD, VIC and WA) were used to identify patients undergoing AF ablation from 2012 to 17. The primary endpoint was any procedure-related complications up to 30-days post-discharge. Logistic regression was used to evaluate the association between treatment at a public hospital and risk of complications adjusting for covariates.ResultsPrivate hospitals performed most of the 21,654 AF ablations identified (n = 16,992, 78.5 %), on patients who were older (63.5 vs. 59.9y) but had lower rates of heart failure (7.9 % vs. 10.4 %), diabetes (10.2 % vs. 14.1 %), and chronic kidney diseases (2.4 % vs. 5.2 %) (all p < 0.001) than those treated in public hospitals. When compared with private hospitals, public hospitals had a higher crude rate of complications (7.25 % vs. 4.70 %, p < 0.001). This difference remained significant after adjustment (OR 1.74 [95 % CI 1.54–2.04]) and it occurred with both in-hospital (OR 1.83 [1.57–2.14]) and post-discharge (OR 1.39 [1.06–1.83]) complications, with certain complications including acute kidney injury (OR 5.31 [3.02–9.36]), cardiac surgery (OR 5.18 [2.19–12.27]), and pericardial effusion (OR 2.18 [1.50–3.16]).ConclusionsPrivate hospitals performed most of AF ablations in Australia with a lower rate of complications when compared with public hospitals. Further investigations are needed to identify the precise mechanisms of this observed difference.

Time to Think Differently About Sarcomere-Negative Hypertrophic Cardiomyopathy.

Time to Think Differently About Sarcomere-Negative Hypertrophic Cardiomyopathy.

Lower Rates of Heart Failure and All-Cause Hospitalizations During Pulmonary Artery Pressure-Guided Therapy for Ambulatory Heart Failure: One-Year Outcomes From the CardioMEMS Post-Approval Study.

Ambulatory hemodynamic monitoring with an implantable pulmonary artery (PA) sensor is approved for patients with New York Heart Association Class III heart failure (HF) and a prior HF hospitalization (HFH) within 12 months. The objective of this study was to assess the efficacy and safety of PA pressure-guided therapy in routine clinical practice with special focus on subgroups defined by sex, race, and ejection fraction. This multi-center, prospective, open-label, observational, single-arm trial of 1200 patients across 104 centers within the United States with New York Heart Association class III HF and a prior HFH within 12 months evaluated patients undergoing PA pressure sensor implantation between September 1, 2014, and October 11, 2017. The primary efficacy outcome was the difference between rates of adjudicated HFH 1 year after compared with the 1 year before sensor implantation. Safety end points were freedom from device- or system-related complications at 2 years and freedom from pressure sensor failure at 2 years. Mean age for the population was 69 years, 37.7% were women, 17.2% were non-White, and 46.8% had preserved ejection fraction. During the year after sensor implantation, the mean rate of daily pressure transmission was 76±24% and PA pressures declined significantly. The rate of HFH was significantly lower at 1 year compared with the year before implantation (0.54 versus 1.25 events/patient-years, hazard ratio 0.43 [95% CI, 0.39-0.47], P<0.0001). The rate of all-cause hospitalization was also lower following sensor implantation (1.67 versus 2.28 events/patient-years, hazard ratio 0.73 [95% CI, 0.68-0.78], P<0.0001). Results were consistent across subgroups defined by ejection fraction, sex, race, cause of cardiomyopathy, presence/absence of implantable cardiac defibrillator or cardiac resynchronization therapy and ejection fraction. Freedom from device- or system-related complications was 99.6%, and freedom from pressure sensor failure was 99.9% at 1 year. In routine clinical practice as in clinical trials, PA pressure-guided therapy for HF was associated with lower PA pressures, lower rates of HFH and all-cause hospitalization, and low rates of adverse events across a broad range of patients with symptomatic HF and prior HFH. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02279888.

Association between the ST segment resolution after primary angioplasty and short term outcomes in patients with acute myocardial infarction

Background The aim of this study was to evaluate the relationship between the early/late complete ST-resolution and short-term cardiovascular outcomes in patients undergoing primary angioplasty. Methods This was a prospective cross-sectional study of patients with acute myocardial infarction who candidate for primary percutaneous coronary intervention (PCI) during 1 year. An ECG obtained at the time of admission, 90 minutes and 24 hour after PCI. Patients were followed up for in hospital and 1-year outcomes and then data assessed according to the ST segment resolution (STR) (complete ≥70% and incomplete Results Totally 124 patients included in the study. The rates of complete STR were 44.4% after 90 minutes and 82.3% after 24 hours. Patients with early complete STR had significant lower rates of heart failure after 1 year follow up (32% versus 46%, OR: 1.88, 95%CI: 1.42-2.50, P=0.005) but not like patients with late STR. No significant relationship observed between early/late complete STR and Re-Infarction, Stroke, Re-hospitalization and Death during 1 year follow-up (P>0.05). Moderate correlations were found between percentage of ST resolution after 90 minutes and EF before discharge and final EF (correlation coefficient: 0.395 and 0.488, respectively, P Conclusions Based on the results of this study, early complete STR can be an indicator for development of heart failure after 1 year follow up.

Association between ST-segment resolution after primary angioplasty and short-term outcomes in patients with acute myocardial infarction

The aim of this study was to evaluate the relationship between the early/late complete ST-resolution and short-term cardiovascular outcomes in patients undergoing primary angioplasty. This was a prospective cross-sectional study of patients with acute myocardial infarction who candidate for primary percutaneous coronary intervention (PCI) during 1 year. An ECG obtained at the time of admission, 90 minutes and 24 hour after PCI. Patients were followed up for in hospital and 1-year outcomes and then data assessed according to the ST segment resolution (STR) (complete ≥70% and incomplete <70% STR). Overall, 124 patients included in the study. The rates of complete STR were 44.4% after 90 minutes and 82.3% after 24 hours. Patients with early complete STR had significant lower rates of heart failure after 1-year follow-up (32% versus 46%, OR: 1.88, 95% CI: 1.42-2.50, P=0.005) but not like patients with late STR. No significant relationship was observed between early/late complete STR and re-infarction, stroke, re-hospitalization and death during 1-year follow-up (P>0.05). Moderate correlations were found between percentage of ST resolution after 90 minutes and EF before discharge and final EF (correlation coefficient: 0.395 and 0.488, respectively, P<0.001). Early complete STR can be an indicator for development of heart failure after 1-year follow-up.

421-P: Efficacy and Safety of Sodium–Glucose Cotransporter-2 Inhibitors: A Systematic Review and Meta-analysis

Background: Several large randomized trials suggest SGLT2Is may reduce mortality in addition to lowering A1c in patients with T2D. Treatment algorithms from the ADA and EASD now recommend a SGLT2I be initiated in patients with T2D who have chronic kidney disease or heart failure, regardless of A1c level. To better quantify the efficacy and safety of SGLT2Is, we conducted a systematic review and meta-analysis of all randomized trials of this drug class. Methods: We searched PubMed and Scopus (inception to June 2019) for randomized trials of at least 52 weeks duration enrolling adults with T2D that compared SGLT2Is with placebo. Outcomes included microvascular/macrovascular complications, mortality, change in cardiovascular (CV) risk factors, and adverse events. Continuous outcomes were calculated with standardized mean differences, and binary outcomes were calculated using odds ratios. Pooled analyses were performed with fixed and random effects models. Heterogeneity was assessed with the I2 statistic. Results: See Table for results. Conclusions: Patients who received SGLT2Is when compared to placebo had significantly lower rates of heart failure and A1c. These findings support the current ADA/EASD treatment recommendations. Subsequent cost effectiveness analyses will help further inform healthcare policy decisions. Disclosure J. Alexander: None. E.M. Staab: None. W. Wan: None. M. Franco: None. A.C. Knitter: None. C.C. Thomas: None. V.G. Press: Consultant; Self; Humana, Vizient Inc. M. Zeytinoglu: None. R. Skandari: None. K.E. Gunter: None. B. Bindon: None. S. Jumani: None. S.D. Bolen: None. N.M. Maruthur: Other Relationship; Self; Johns Hopkins HealthCare Solutions. E. Huang: None. L.H. Philipson: None. N. Laiteerapong: None. Funding American Diabetes Association (1-18-JDF-037 to N.L.); National Institutes of Health (P30DK092949)

Initiation of sacubitril/valsartan shortly after hospitalisation for acutely decompensated heart failure in patients with newly diagnosed (de novo) heart failure: a subgroup analysis of the TRANSITION study.

Sacubitril/valsartan has shown efficacy and tolerability in patients with heart failure (HF) and reduced ejection fraction (HFrEF) in the ambulatory setting (PARADIGM-HF), and following stabilisation of acutely decompensated HF (ADHF) (PIONEER-HF and TRANSITION). However, data are lacking for the initiation of sacubitril/valsartan in newly diagnosed (de novo) HFrEF. Here, we assess the tolerability of initiating sacubitril/valsartan following ADHF in TRANSITION subgroups of patients with a de novo vs. prior diagnosis of HFrEF. TRANSITION randomised 1002 patients to pre- and post-discharge initiation of sacubitril/valsartan (analysis set n=991, following exclusions for mis-randomisation). In this post-hoc analysis, tolerability to sacubitril/valsartan [proportion of patients achieving target dose (97/103 mg b.i.d.) at 10 weeks post-randomisation], adverse events (AEs) and serious AEs (SAEs) were compared in de novo (n=286) and prior HFrEF (n=705) subgroups. More de novo than prior HFrEF patients achieved target dose at Week 10 (56% vs. 45%; relative risk ratio 1.30, 95% confidence interval 1.12-1.52, P < 0.001), and fewer had SAEs and permanent treatment discontinuations. Initiation of sacubitril/valsartan did not prevent the concomitant initiation and up-titration of guideline-directed HF therapies. De novo patients showed faster and greater decreases in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin-T, and lower rates of HF and all-cause rehospitalisation vs. prior HFrEF. After ADHF, first-line initiation of sacubitril/valsartan in de novo HFrEF, alongside the initiation of other guideline-directed therapies, is feasible and is associated with a better risk-benefit profile than in patients with prior HFrEF. Early intervention with sacubitril/valsartan may be considered to delay disease progression in patients with de novo HFrEF. ClinicalTrials.gov, NCT02661217.

Surgical ablation of atrial fibrillation concomitant to coronary-artery bypass grafting provides cost-effective mortality reduction

BackgroundData on the longitudinal impact of surgical ablation (SA) for atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) remain limited. This study examined 2-year risk-adjusted mortality and total hospital costs in Medicare beneficiaries with AF requiring CABG with or without SA. MethodsCABG was performed in 3745 Medicare beneficiaries with AF in 2013, with concomitant SA in 17% (626 of 3745). Risk-adjusted mortality, morbidity, and cost during the first 2 postoperative years for patients with SA and those without SA were compared. A piecewise Cox proportional hazard model (0-90 days and 91-729 days) was used to risk-adjust mortality. ResultsCompared with the no SA group, the SA group had lower rates of heart failure before surgery (31% vs 36%), chronic lung disease (27% vs 33%), renal failure (4% vs 7%), and urgent or emergent presentation (34% vs 49%) (all P < .05). Risk-adjusted index admission costs were higher with SA (rate ratio [RR], 1.11; P < .01), as were readmissions for AF (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.00-1.29; P = .04) and pacemaker/defibrillator implantation (HR, 1.37; 95%, 1.08-1.74; P = .01). Risk-adjusted inpatient days and inpatient costs were similar after 2 years (RR, 0.97; P = .31 and RR = 1.04; P = .17, respectively); however, the risk-adjusted hazard for late mortality (91-729 days) was significantly lower with SA (HR, 0.71; 95% CI, 0.52-0.97; P = .03). ConclusionsIn patients with AF requiring CABG, SA was associated with a 29% lower risk-adjusted hazard for late mortality. Index hospital costs were higher with SA, but total inpatient costs were not different in the 2 groups after 2 years. SA appears to be a cost-effective intervention to enhance late 2-year survival in patients with AF undergoing CABG.

Race and Sex Differences in Diabetic Complications in a Large Health Care System

Existing studies of racial differences in diabetic complications between African Americans and whites have provided conflicting results. The objective of this study was to investigate race and sex differences in diabetic complications between African-American and white patients in Louisiana’s largest integrated health delivery system. We performed a prospective cohort study of 28,218 African Americans and 31,237 whites with diabetes. Cox proportional hazards regression was used to estimate the relative risk of each of four health outcomes between African Americans and whites. The age- and sex-adjusted incident rates per 1,000 person-years and 95% confidence intervals (CI) of coronary heart disease (CHD), heart failure, stroke, and end-stage renal disease (ESRD) for African-American patients with diabetes were 59.8 (95% CI 57.7-62.0), 43.5 (41.7-45.4), 34.0 (32.4-35.7), and 56.5 (53.8-59.3), respectively. Compared with African-American patients with diabetes, white patients with diabetes had a higher age- and sex-adjusted incident rate of CHD [63.3 (61.2-65.3)] and lower rates of heart failure [32.0 (30.6-33.4)], stroke [29.7 (28.4-31.1)] and ESRD [45.7 (44.0-47.4)]. Men with diabetes had higher age-adjusted incident rates of CHD, heart failure, and ESRD than women with diabetes. Results of the Cox proportional hazard models confirmed racial and sex differences observed in the age- and sex-adjusted incident rates. African Americans with diabetes have higher risks of heart failure, stroke and ESRD than white counterparts, whereas whites with diabetes have a higher risk of CHD than African-American counterparts. Disclosure P. Yin: None. L. Shi: None. E. Nauman: None. P.T. Katzmarzyk: None. E.G. Price-Haywood: None. A.N. Bazzano: None. Y. Shen: None. G. Hu: None.