New Diagnosis Of Heart Failure Research Articles

Prognostic impact of fibrinogen in patients with resistant hypertension.

In this study, we investigated the long-term prognostic effects of fibrinogen levels in patients with resistant hypertension. A total of 266 patients with resistant hypertension who had serum fibrinogen measurements and 5 years of follow-up information were retrospectively included in the study. The patients were stratified according to their fibrinogen levels, which were then divided into tertiles. Clinical outcomes for major adverse cardiovascular events (MACE) were assessed at 5 years. MACE was defined as all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction (MI), non-fatal stroke, a new diagnosis of heart failure, or hospitalization for heart failure and peripheral arterial disease. The incidence of MACE at 5 years in patients with resistant hypertension was higher in the highest tertile of fibrinogen. Multivariate analysis identified fibrinogen as an independent predictor of MACE in patients with resistant hypertension (odds ratio = 1.002; 95% CI: 1.001-1.004; p = 0.009). Compared to the lowest tertile, MACE was approximately 2.5 times higher in tertile 2 and approximately 6.9 times higher in the highest tertile. Fibrinogen was able to predict MACE in patients with resistant hypertension (AUC for MACE 0.662 (95% CI 0.596-0.727; p < 0.001) based on receiver operating characteristic curve analysis. In the Kaplan-Meier curve showing follow-up without MACE (MACE-free) according to the fibrinogen cut-off value, the 5-year incidence of MACE was significantly higher in the high fibrinogen group (p < 0.001). Fibrinogen is a risk marker for MACE in patients with resistant hypertension. Antihypertensive therapy aimed at lowering fibrinogen levels may improve prognosis.

Prevalence and incidence of heart failure in type 2 diabetes patients: results from a nationwide prospective cohort—the DIABET-IC study

BackgroundType 2 diabetes (T2D) patients have an increased risk of heart failure (HF). There are limited data on the association between HF and T2D in specific healthcare settings. This study sought to analyse the prevalence and incidence of HF in a contemporary cohort of T2D patients attending cardiology and endocrinology outpatient clinics.MethodsWe conducted an observational multicentre prospective study (DIABET-IC) that enrolled patients with a T2D diagnosis attending cardiology and endocrinology outpatient clinics in 30 centres in Spain between 2018 and 2019. The prevalence at the start of the study and the incidence of HF after a 3 year follow-up were calculated. HF was defined as the presence of typical symptoms and either: a) LVEF < 40%; or b) LVEF ≥ 40% with elevated natriuretic peptides and echocardiographic abnormalities.ResultsA total of 1249 T2D patients were included in the present analysis (67.6 ± 10.1 years, 31.7% female). HF was present in 490 participants at baseline (prevalence 39.2%), 150 (30.6%) of whom had a preserved ejection fraction. The presence of adverse social determinants and chronic conditions such as chronic kidney disease and atherosclerotic cardiovascular disease were more frequent in HF patients. During the study period, there were 58 new diagnoses of HF (incidence 7.6%) among those without baseline HF. The incidence rate was 3.0 per 100 person-years. Independent predictors of incident HF were smoking, left ventricular ejection fraction, NT-ProBNP, history of tachyarrhythmia and treatment with pioglitazone, oral anticoagulants, or diuretics. Despite an average suboptimal glycaemic control, the use of antidiabetic drugs with cardiovascular benefits was low (30.4% for sodium-glucose cotransporter-2 inhibitors and 12.5% for glucagon-like peptide-1 receptor agonists).ConclusionsIn this contemporary cohort of T2D patients attending cardiology and endocrinology outpatient clinics, the prevalence and incidence of HF were high, comorbidities were frequent, and the use of antidiabetic agents with cardiovascular benefit was low. Outpatient care seems to be a unique opportunity for a comprehensive T2D approach that encompasses HF prevention, diagnosis, and treatment.Graphical

The Relationship Between Living with Family and Clinical, Demographic, and Laboratory Characteristics in Patients with Heart Failure

Heart failure (HF) is a progressive clinical syndrome associated with significant morbidity and mortality. It is known that during the course of this syndrome, social factors can impact clinical outcomes alongside medical interventions. Studies have demonstrated that social support provides favorable developments in mortality rates, event-free survival, and readmission rates in HF patients. In our study, we aimed to elucidate the effects of the concept of family, the most significant social support, on clinical characteristics, exercise capacity, echocardiographic, and laboratory features in HF cases.&#x0D; A multicenter cohort study was conducted, including 303 patients previously diagnosed with HF, following current guidelines and presenting for outpatient follow-up. Patients with a new diagnosis of HF, those with acute decompensated HF, and those with a history of malignancy were excluded from the study. Demographic data (age, gender), comorbidities (hypertension, diabetes mellitus, atrial fibrillation, etc.), HF treatments, laboratory tests, and detailed transthoracic echocardiography results were recorded.&#x0D; Patients were divided into two groups based on whether they lived with a spouse, parent, child, or without any of them, defining the presence or absence of family support. In the study, 303 patients with an average age of 62.1±13.0, of which 94 (31%) were female, were included. The mean left ventricular ejection fraction was 28.7±8.1. When the groups were compared in terms of comorbidities, there was no statistically significant difference in the presence of hypertension, diabetes mellitus, hyperlipidemia, chronic obstructive pulmonary disease, stroke, or atrial fibrillation (all p&gt;0.005). Coronary artery disease was more frequently observed in the group with family support, while chronic kidney disease was more common in the group without family support (p=0.008 and p=0.012, respectively). Smoking prevalence was significantly higher in the group without family support, while alcohol use showed no significant difference (p=0.046 and p=0.602, respectively). Analyzing the results, it was observed that patients with family support were more regularly monitored for HF reasons (71% vs. 59%, p=0.054).&#x0D; It has been observed that the social support provided by family members in individuals with HF can have positive effects on the clinical course of the disease and the patient's lifestyle.

An evaluation of a service expansion to include patients with heart failure with preserved ejection fraction

Background/Aims The Central London Community Healthcare Trust West Hertfordshire heart failure service expanded in 2020 to include patients with heart failure with preserved ejection fraction, in addition to the patients with heart failure with reduced ejection fraction. The patient population was predicted to double, requiring staff and service adjustments; this warranted an evaluation to determine if care targets were maintained. This study aimed to evaluate the impact of service expansion on service referral rates, length of stay in the service and clinical workload. Methods A retrospective quantitative evaluation of the service data from October 2020 to April 2021 was undertaken to compare referral rates, length of stay in the service and key workload metrics between patients with heart failure with reduced ejection fraction and those with heart failure with preserved ejection fraction. All referrals to the service with a new diagnosis of heart failure (confirmed by echocardiogram or magnetic resonance imaging) were considered for evaluation. Of 250 eligible referrals, 81 were selected for inclusion using a random sampling method. Data were analysed using Chi square test, Fisher’s exact test or the Wilcoxon signed rank test; a P value of &lt;0.05 indicated statistical significance. Results The participants with heart failure with preserved ejection fraction had a median length of stay in the service of 17 weeks. The participants with heart failure with reduced ejection fraction had a significantly longer stay of 35.57 weeks (P&lt;0.001) compared to a pre-expansion length of stay of approximately 17 weeks. Workload was proportional between the two cohorts. Patients with heart failure with preserved ejection fraction were more likely to be reviewed in multidisciplinary teams or by the consultant community clinic. This group was less likely to attend clinic, with 96.4% of face-to-face reviews taking place at home. Telephone reviews occurred at a similar frequency for both cohorts, comprising 50% of follow ups. The heart failure with reduced ejection fraction cohort required more alterations in medication and medication titration, generating additional follow ups. Conclusions The service expansion to include patients with heart failure with preserved ejection fraction has had a significant impact on workload, leading to a reduction in the quality of care for those with heart failure with reduced ejection fraction.

Diagnostic yield of a proactive strategy for early detection of cardiovascular disease versus usual care in adults with type 2 diabetes or chronic obstructive pulmonary disease in primary care in the Netherlands (RED-CVD): a multicentre, pragmatic, cluster-randomised, controlled trial

Progressive cardiovascular diseases (eg, heart failure, atrial fibrillation, and coronary artery disease) are often diagnosed late in high-risk individuals with common comorbidities that might mimic or mask symptoms, such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes. We aimed to assess whether a proactive diagnostic strategy consisting of a symptom and risk factor questionnaire and low-cost and accessible tests could increase diagnosis of progressive cardiovascular diseases in patients with COPD or type 2 diabetes in primary care. In this multicentre, pragmatic, cluster-randomised, controlled trial (RED-CVD), 25 primary care practices in the Netherlands were randomly assigned to usual care or a proactive diagnostic strategy conducted during routine consultations and consisting of a validated symptom questionnaire, followed by physical examination, N-terminal-pro-B-type natriuretic peptide measurement, and electrocardiography. We included adults (≥18 years) with type 2 diabetes, COPD, or both, who participated in a disease management programme. Patients with an established triple diagnosis of heart failure, atrial fibrillation, and coronary artery disease were excluded. In the case of abnormal findings, further work-up or treatment was done at the discretion of the general practitioner. The primary endpoint was the number of newly diagnosed cases of heart failure, atrial fibrillation, and coronary artery disease, adjudicated by an expert clinical outcome committee using international guidelines, at 1-year follow-up, in the intention-to-treat population. Between Jan 31, 2019, and Oct 7, 2021, we randomly assigned 25 primary care centres: 11 to usual care and 14 to the intervention. We included patients between June 21, 2019, and Jan 31, 2022. Following exclusion of ineligible patients and those who did not give informed consent, 1216 participants were included: 624 (51%) in the intervention group and 592 (49%) in the usual care group. The mean age of participants was 68·4 years (SD 9·4), 482 (40%) participants were female, and 734 (60%) were male. During 1 year of follow-up, 50 (8%) of 624 participants in the intervention group and 18 (3%) of 592 in the control group were newly diagnosed with heart failure, atrial fibrillation, or coronary artery disease (adjusted odds ratio 2·97 [95% CI 1·66-5·33]). This trial is registered with the Netherlands Trial Registry, NTR7360, and was completed on Jan 31, 2023. An easy-to-use, proactive, diagnostic strategy more than doubled the number of new diagnoses of heart failure, atrial fibrillation, and coronary artery disease in patients with type 2 diabetes or COPD in primary care compared with usual care. Although the effect on patient outcomes remains to be studied, our diagnostic strategy might contribute to improved early detection and timely initiation of treatment in individuals with cardiovascular disease. Dutch Heart Foundation.

Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality

ObjectivesTo determine the association between symptoms and signs reported in primary care consultations following a new diagnosis of heart failure (HF), and 3-month hospitalisation and mortality.DesignNested case–control study with density-based...

Abstract 16586: Differences in Medical Care Across the Left Ventricular Ejection Fraction Spectrum Following New Heart Failure Diagnosis in a US Healthcare System

Introduction: Heart failure (HF) is a major public health concern with increasing prevalence and burden on healthcare systems. HF is aggravated by type 2 diabetes (T2D) and chronic kidney disease (CKD). Research Question: Understanding how HF is treated after new diagnosis could improve care. Aim: Describe treatment of patients with newly diagnosed HF. Methods: Observational, longitudinal study using electronic medical record data from 24,340 adults (≥18 years) in the US between 2005-2019 with new diagnosis of HF, defined as no HF identified at least 12 months prior to index diagnosis. Outcomes were stratified by HF type (reduced ejection fraction [HFrEF; LVEF ≤40%], preserved ejection fraction [HFpEF; LVEF ≥50%]) and presence of CKD and T2D. Results: For the 24,340 incident HF cases, mean age was 72.1±13.4 years. 51.1% had HFpEF and 10.0% HFrEF; 38.6% also had CKD, 39.7% had T2D and 40.3% had neither. Most patients were diagnosed in hospital (41.7%), Emergency Department (23.3%) or Primary Care (16.9%). First visit after HF diagnosis was most commonly with Primary Care (34.0%) or other specialties (39.6%), with only 10.7% with a cardiologist, regardless of comorbid CKD or T2D. Within the first year, those with HFpEF vs HFrEF were less likely to be seen by a cardiologist (51.7% vs 79.6%). Hospitalization rates within the first year were higher in patients with HF and both comorbidities (49.6%). All-cause mortality was slightly higher in HFpEF (15.3%) compared to HFrEF (13.9%), particularly in those with HFpEF and CKD (19.2%). At time of diagnosis, patients were likely to use any HF medication. Patients with HFpEF were more likely than those with HFrEF to be treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB; 46.1% vs 40.7%), β-blockers (BB; 53.2% vs 41.3%) and diuretics (41.0% vs 26.5%). Within 90 days of diagnosis, fewer patients with HFpEF vs HFrEF initiated ACEi/ARB (42.8% vs 70.4%), BB (35.4% vs 56.2%) and diuretics (47.8% vs 65.2%). Conclusion: Primary care plays a major role in early HF care. Comorbid CKD and T2D increased hospitalization and mortality rates but not cardiology care. However, patients with HFpEF were less likely to be seen by a cardiologist or initiate medication following diagnosis vs those with HFrEF.

Cardiac safety of pegylated liposomal doxorubicin after conventional doxorubicin exposure in patients with sarcoma and breast cancer.

388 Background: Lifetime cumulative doses of conventional doxorubicin (&gt;450 mg/m2) are associated with dose-dependent cardiotoxicity. In soft tissue sarcoma (STS) and breast cancer, conventional doxorubicin is often utilized in earlier lines of therapy, whereas pegylated liposomal doxorubicin (PLD) is typically reserved for recurrent and metastatic disease. PLD is associated with less cardiotoxicity than conventional doxorubicin and high doses of PLD can be administered without increased risk of cardiotoxicity in patients without prior exposure to conventional doxorubicin. Limited data exists evaluating cardiotoxicity associated with PLD treatment after conventional doxorubicin, especially when doxorubicin lifetime doses approach the established cumulative total lifetime dose of 450-550 mg/m2. This study aims to evaluate the cardiac safety of PLD use in patients who had prior exposure to conventional doxorubicin. Methods: This was a single-center, observational, retrospective cohort study conducted in patients ≥18 years with STS or breast cancer, who were exposed to conventional doxorubicin from an earlier line of treatment prior to PLD between January 2010 – May 2022. Patients participating in clinical trials were excluded. The primary outcome of the study was cardiac safety. Cardiac toxicity was defined as ≥ 10% decrease in left ventricle ejection fraction (LVEF) or new diagnosis of heart failure within 6 months after PLD cessation. Results: 494 patients were screened and 50 patients met inclusion criteria, 8 STS and 42 breast cancer patients. Median lifetime cumulative conventional doxorubicin dose in patients with STS was 450 mg/m2 with a max dose of 825 mg/m2, and 240 mg/m2 with a max dose of 300 mg/m2 in breast cancer patients. Median lifetime cumulative PLD dose was 105 mg/m2 (range: 35-150 mg/m2) in the STS group and 105 mg/m2 (range: 35-510 mg/m2) in the breast cancer group. A decrease of ≥ 10% in LVEF was not observed in the STS group. 22 breast cancer patients had available LVEF data on PLD; 3 of these patients experienced ≥ 10% in LVEF drop and one of three patients was diagnosed heart failure. The average cumulative dose of PLD administered in patients with &gt; 10% decrease in LVEF was 177 mg/m2 and had an average of 3.5 cycles. Most of STS patients initiated PLD treatment within 2 years after conventional doxorubicin while most breast patients initiated PLD treatment at least 10 years following conventional doxorubicin exposure. Conclusions: PLD administration in patients with prior exposure to conventional doxorubicin appears to be safe with limited cardiotoxicity in patients with STS and breast cancer. Future research is needed to determine if and how often routine cardiac monitoring is needed for patients on PLD without existing cardiac risk.

Cardiac Safety of Pegylated Liposomal Doxorubicin After Conventional Doxorubicin Exposure in Patients With Sarcoma and Breast Cancer.

Lifetime cumulative doses of conventional doxorubicin (>450 mg/m2) are associated with dose-dependent cardiotoxicity. In sarcoma and breast cancer, conventional doxorubicin is often utilized in the adjuvant setting, whereas pegylated liposomal doxorubicin (PLD) is typically reserved for recurrent and metastatic disease. PLD is believed to be associated with reduced cardiotoxicity compared to conventional doxorubicin.Limited data exists evaluating the cardiotoxicity associated with PLD treatment after conventional doxorubicin, especially when doxorubicin lifetime doses approach the established cumulative total lifetime dose of 450-550 mg/m2. This study aims to further qualify the cardiac safety of PLD use in patients who have had prior exposure to conventional doxorubicin. This was a single-center, observational, retrospective cohort study conducted in patients ≥18 years with sarcoma or breast cancer who were exposed to conventional doxorubicin from an earlier line of treatment before PLD between January 2010 to May 2022. Patients were evaluated for the presence of cardiac toxicity at any point in their treatment course. Cardiac toxicity was defined as ≥ 10% decrease in left ventricle ejection fraction (LVEF) or a new diagnosis of heart failure within six months after PLD cessation. The time interval between the last conventional doxorubicin exposure and PLD initiation and the time interval between PLD initiation and LVEF monitoring were also analyzed. 494 patients were screened, and 50 met inclusion criteria: eight with sarcoma and 42 with breast cancer. The median lifetime cumulative conventional doxorubicin dose in patients with sarcoma was 450 mg/m2 with a maximum dose of 825 mg/m2and 240 mg/m2 with a maximum dose of 300 mg/m2in breast cancer patients. The median lifetime cumulative PLD dose was 105 mg/m2(range: 35-150 mg/m2) in the sarcoma group and 105 mg/m2(range: 35-510 mg/m2) in the breast cancer group. A decrease of ≥ 10% in LVEF was not observed in the sarcoma group. Patients with breast cancer had available LVEF data on PLD, and three of these patients experienced ≥ 10% in LVEF drop, with one of these patients diagnosed with heart failure. The average cumulative dose of PLD administered in patients with > 10% decrease in LVEF was 177 mg/m2 and had an average of 3.5 cycles. Five sarcoma patients initiated PLD treatment within two years after conventional doxorubicin exposure, while most breast patients initiated PLD treatment at least 10 years following conventional doxorubicin exposure. The average time from PLD initiation to first and second available LVEF monitoring was one and five months in the sarcoma group and three and eight months in the breast cancer group, respectively. PLD administration in patients with prior exposure to conventional doxorubicin appears to be safe, with limited cardiotoxicity in patients with sarcoma and breast cancer. Future research is needed to determine if and how often routine cardiac monitoring is needed for patients on PLD without existing cardiac risk.

1245-P: Heart Failure Biomarkers in Diabetes—A National Reference Laboratory Study

Background: Recent guidelines1,2 recommend yearly biomarker screening (BNP, NT-proBNP or hs-cardiac troponin) of patients with diabetes at-risk for heart failure (HF) and team-based care with a cardiovascular specialist if elevated1-3. Methods: Using de-identified laboratory results from Labcorp® patients (2015-2022), we studied diabetes and HF ICD incidence via HbA1c and subsequent BNP/NT-proBNP (in pg/mL). Patients were classified as A1c consistent with no diabetes, prediabetes, or diabetes and newly diagnosed HF if they had no HF-associated ICD on/before date of initial HF testing and assigned one on a later date. Distribution of HF by cohort was evaluated by chi squared and likelihood by odds ratios (OR). Results: There were 805,512 unique patients with A1c and either BNP/NT-proBNP performed. Using published cutoffs1-3, new diagnosis of HF by ICD was significantly different among cohorts for all cutoffs (p&amp;lt;0.001) and more likely in patients with diabetes compared to those without (OR 1.48 by BNP ≥ 35, 1.45 by BNP ≥ 50, 1.37 by NT-proBNP). As BNP cutoff increased, patients meeting criteria decreased. NT-proBNP &amp;gt; 125 had similar proportional yield of HF diagnosis to BNP ≥ 35. Conclusion: Patients with diabetes (by A1c) were more likely to have a new diagnosis of HF on subsequent testing than patients without diabetes. The BNP cutoff utilized has meaningful implications for the number of patients referred to team-based care. Disclosure D.Alfego: Employee; LabCorp. A.Valcour: Employee; LabCorp. Z.Shajani-yi: Employee; LabCorp. R.M.Young: Employee; LabCorp. R.M.Sullivan: Employee; LabCorp.

Baseline native T1 values are associated with adverse outcome in a newly diagnosed, hospitalised heart failure patient population

Abstract Funding Acknowledgements Type of funding sources: None. Background Tissue characterisation by T1 mapping on Cardiac Magnetic Resonance (CMR) imaging is a non-invasive assessment of diffuse cardiac fibrosis and has been shown to predict outcome in Heart Failure (HF). Purpose There is a need for improved risk stratification that delivers more personalised care for HF patients. We conducted the first prospective study to investigate novel CMR tissue characterisation biomarkers and correlate to adverse outcome, in a cohort of patients hospitalised with a new HF diagnosis. Methods This was single centre observational study. Inclusion criteria were admission with signs and symptoms of HF, and LVEF ≤50% or elevated plasma NTproBNP and being treated with intravenous furosemide. 43 consecutive eligible participants were included and underwent comprehensive CMR to establish anatomy, function and myocardial tissue characteristics during their presentation admission. Participants were managed according to best practice HF guidelines and underwent reviews at 6, 12–18 and 24–30 months. All clinically relevant event data e.g. death and rehospitalisation were recorded. Baseline CMR volumes, function, presence of Late Gadolinium Enhancement (LGE) and T1 mapping values were compared between the adverse event group and no adverse event group. ‘Adverse event’ was defined as all-cause mortality or HF hospitalisation. Results The median follow-up of 43 participants was 24.4 months. 41 (95%) were diagnosed with HF with reduced EF and 2 (5%) with HF with preserved Ejection Fraction. Baseline clinical, biochemical characteristics and NYHA class were similar between the adverse event and no adverse event groups. There was no significant difference between baseline LVEF (37% vs. 23%; p = 0.339) or NTproBNP levels (4948 vs.5456; p = 0.929) between groups. There was high uptake of HF medical therapy in both groups. (Table 1) 9 participants (21%) experienced adverse events. There was a significantly higher proportion of Ischaemic Cardiomyopathy in the adverse event group (67% vs. 18%; p = 0.008) with lower indexed LV volumes and mass. Native septal T1 (ms) was significantly higher in the adverse event group compared with the no adverse event group (1035 vs.996 p = 0.045). (Table 1) Receiver Operating Characteristic (ROC) analysis indicated a Native T1 cut-off value of 1022ms as most sensitive and specific. Kaplan-Meier survival analysis comparing those with Native T1 &amp;lt;1022ms and those with Native T1 &amp;gt;1022ms on their baseline CMR showed an adverse event-free survival benefit favouring the lower T1 value group (HR 11.4, p = 0.003 - Figure 1). Conclusions In a cohort of all-comer hospitalised patients with a new diagnosis of HF, followed up over a 24-month period, there was a high rate of adverse events. A higher native T1 value on baseline CMR was associated with worse outcome in terms of all-cause mortality or HF hospitalisation.

Oral Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation.

Oral Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation.

Is it possible to start quadruple therapy in patients with a new diagnosis of HF and reduced ejection fraction? Real-life data from the TIDY-HF registry

Abstract Background The 2021 European heart failure (HF) guidelines recommended treatment with an inhibitor of the renin-angiotensin-aldosterone axis (RAAS), a beta-blocker (BB), a mineralocorticoid receptor antagonist (MRA), and a cotransporter sodium-glucose type 2 inhibitor (SGLT2) in patients with HF and left ventricular ejection fraction (LVEF) ≤40%. However, there is little evidence on implementing quadruple therapy in clinical practice. Purpose Study the implementation of quadruple therapy in patients with a new diagnosis of HF and reduced ejection fraction in clinical practice. Methods A prospective multicenter registry (38 centers in Spain) was carried out, including all patients newly diagnosed with HF with LVEF ≤40% in clinical practice. Their baseline and laboratory characteristics were recorded and their pharmacological treatment: at baseline (discharged from hospitalization or first outpatient visit within a maximum period of 1 month after the echocardiographic diagnosis), one month, and 3 months later. Results On 1th of March 2022, 349 patients were included, with baseline treatment data in 289. The mean age was 65.0±14.2 years, and 72.1% were men. The mean LVEF was 28.5±7.3%, with 57.6% in NYHA II and 29.1% in NYHA III–IV. The most frequent causes of cardiomyopathy were: ischemic (25.1%), tachycardiomyopathy (16.6%), and idiopathic (15.7%). 46.4% were dyslipidemic, 57.5% hypertensive and 33.3% diabetic. 65.1% of the patients were in sinus rhythm. Before HF diagnosis, 44.6% had been treated with RAASi, 22.8% with BB, 7.8% with MRA, 8.1% with iSGLT2, and 24.5% with diuretics. The drugs used at baseline and the changes during follow-up are shown in Table 1. Conclusions According to our cohort, almost 60% of newly diagnosed patients with HF and reduced LVEF start quadruple therapy during the first month after diagnosis, with sacubitril/valsartan being the preferred RAASi in most cases. The implementation of drugs with prognostic benefit is above 70% at baseline and exceeds 80% at one month of follow-up, with a progressive reduction in loop diuretics during follow-up. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Spanish Society of Cardiology

Long term changes in health-related quality of life for people with heart failure: the ECHOES study.

Heart failure (HF) impairs all aspects of health-related quality of life (HRQoL), but little is known about the effect of developing HF on HRQoL over time. We aimed to report changes in HRQoL over a 13-year period. HRQoL was measured in the Echocardiographic Heart of England Screening (ECHOES) study and the ECHOES-X follow-up study (N=1618) using the SF-36 questionnaire (Version 1). Mixed modelling compared changes in HRQoL across diagnostic groups, adjusting for potential predictors and design variables. Patients who had developed HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF) at rescreening had significantly greater reduction in physical functioning (PF) and role physical (RP) scores compared with those without HF; adjusted mean difference in PF: HFrEF -16.1, [95% confidence interval (CI) -22.2 to -10.1]; HFpEF -14.6, (95% CI -21.2 to -8.1); in RP: HFrEF -20.7, (95% CI -31.8 to -9.7); HFpEF -19.3, (95% CI -31.0 to -7.6). Changes in HRQoL of those with a HF diagnosis at baseline and rescreen, with exception of role emotion, were similar to those without HF but started from a much lower baseline score. People with a new diagnosis of HF at rescreening had a significant reduction in HRQoL. Conversely, for those with HF detected on initial screening, little change was observed in HRQoL scores on rescreening. Further research is required to understand the development of HF over time and to test interventions designed to prevent decline in HRQoL, potentially through earlier diagnosis and treatment optimization.

Clinical predictors of improvement in left ventricular ejection fraction in U.S. veterans with heart failure

BackgroundOur understanding of the factors associated with improvement of LVEF and a heart failure with improved EF (HFimpEF) phenotype remains incomplete. MethodsWe conducted a retrospective study using a national database of patients followed in the Veterans Affairs (VA) health system with serial assessment of left ventricular ejection fraction (LVEF) by echocardiography. We identified US veterans with a new diagnosis of heart failure with: (i) LVEF of <40 % in the 12 months prior to diagnosis, and (ii) follow-up LVEF assessment at least 6 months after their diagnosis. We defined HFimpEF as a final LVEF of ≥40 %. ResultsAmong the 106,414 US veterans with an initial LVEF of <40 % in this analysis, 39,994 (37.6 %) had a final EF of >40 % after a median follow up of 5 years. Multivariate regression analysis identified several factors that were independently associated with LVEF improvement including female sex, younger age, higher BMI, and a history of specific comorbid conditions such as hypertension, valve disease, atrial fibrillation, connective tissue disease, liver disease, and malignancy (p < 0.001). Conversely, a history of ischemic heart disease and peripheral arterial disease, as well as specific racial backgrounds (Black and Hispanic) were associated with lower rates of LVEF improvement. The model c-statistic for predicting LVEF improvement was 0.70. ConclusionsThis large, detailed dataset facilitated an analysis of a large number of variables that significantly associated with HFimpEF; however, their combined discriminatory value for LVEF improvement remained modest, underscoring the complexity of the gene-environment-treatment interactions that govern LV function.

Burden of heart failure in primary healthcare

ObjectivesTo determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource utilization. DesignRetrospective observational cohort study. SettingStudy was carried out in primary care setting. Participants and interventionsPatients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality. Main measuresInformation came from electronic medical records. ResultsA total of 64441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients’ homes. ConclusionHeart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.

IMPACT OF ATRIAL FIBRILLATION ON RENAL FUNCTION IN HEART FAILURE PATIENTS USING REAL WORLD DATA

Objective: The objective of the present study is to assess the nalysedional interaction between heart failure (HF) and atrial fibrillation (AF) in the renal function using Real World Data. Design and method: From an Electronic Health Recording with a population of 3,799,885 adult subjects, those with prevalent or incident HF were selected and followed throughout a study period of 5 years. Prevalence and incidence of AF, and their impact in worsening renal function (decrease eGFR&gt; 20%), were identified. When both eGFR and albuminuria data was available, the patients were classified on the Kidney Disease Global Outcomes (KDIGO) risk scale. Two different sets of data were nalysed in two groups of HF patients: S1) included all patients with prevalent or incident HF, 128086 patients; S2) included subjects with a new diagnosis of HF during the study period in the absence of previous AF, 57354 patients. Results: In S1, the impact of AF on a reduction of eGFR by &gt; 20% was observed in 18,513 patients, incidence 66.2/103 patients/year, Figure panel A with an increment of risk (HR 1.13, P95th CI 1.09–1.18, p &lt; 0.001) higher than the present due to diabetes, hypertension, dyslipidemia or coronary heart disease. The increment of risk was also demonstrated in S2, Figure panel B. The number of subjects with decreased eGFR values was 7,067, incidence 94.0/103 patients/year with AF increasing the risk (HR 1.22, P95th CI 1.14–1.31, p &lt; 0.001) independent of the other potential factors. In the subgroup of patients with KDIGO risk classification, 10,425 (27.8%) and 3,297 (23.2%) respectively in S1 and S2 cohorts increased by at least one category in S1 and S2, respectively. Conclusions: AF largely increases the risk of decline renal function contributing to the deterioration in the condition of these patients.

Cardiotoxicity risk factors with immune checkpoint inhibitors

BackgroundCheckpoint-inhibitor immunotherapies have had a profound effect in the treatment of cancer by inhibiting down-regulation of T-cell response to malignancy. The cardiotoxic potential of these agents was first described in murine models and, more recently, in numerous clinical case reports of pericarditis, myocarditis, pericardial effusion, cardiomyopathy, and new arrhythmias. The objective of our study was to determine the frequency of and associated risk factors for cardiotoxic events in patients treated with immune checkpoint inhibitors.MethodsMedical records of patients who underwent immunotherapy with durvalumab, ipilimumab, nivolumab, and pembrolizumab at Wake Forest Baptist Health were reviewed. We collected retrospective data regarding sex, cancer type, age, and cardiovascular disease risk factors and medications. We aimed to identify new diagnoses of heart failure, atrial fibrillation, ventricular fibrillation/tachycardia, myocarditis, and pericarditis after therapy onset. To assess the relationship between CVD risk factors and the number of cardiac events, a multivariate model was applied using generalized linear regression. Incidence rate ratios were calculated for every covariate along with the adjusted P-value. We applied a multivariate model using logistic regression to assess the relationship between CVD risk factors and mortality. Odds ratios were calculated for every covariate along with the adjusted P-value. Adjusted P-values were calculated using multivariable regression adjusting for other covariates.ResultsReview of 538 medical records revealed the following events: 3 ventricular fibrillation/tachycardia, 12 pericarditis, 11 atrial fibrillation with rapid ventricular rate, 0 myocarditis, 8 heart failure. Significant risk factors included female gender, African American race, and tobacco use with IRR 3.34 (95% CI 1.421, 7.849; P = 0.006), IRR 3.39 (95% CI 1.141, 10.055; P = 0.028), and IRR 4.21 (95% CI 1.289, 13.763; P = 0.017) respectively.ConclusionsOur study revealed 34 significant events, most frequent being pericarditis (2.2%) and atrial fibrillation (2.0%) with strongest risk factors being female gender, African American race, and tobacco use. Patients who meet this demographic, particularly those with planned pembrolizumab treatment, may benefit from early referral to a cardio-oncologist. Further investigation is warranted on the relationship between CTLA-4 and PD-L1 expression and cardiac adverse events with ICIs, particularly for these subpopulations.

Heart failure in patients with COPD exacerbations: Looking below the tip of the iceberg

BackgroundPatients surviving hospitalization for exacerbations of chronic obstructive pulmonary disease (ECOPD) are at heightened risk of cardiovascular events. Heart failure is often underdiagnosed and undertreated in COPD; better care could improve outcome. We aimed to capture contemporary investigation and management of heart failure (HF) in patients hospitalized with ECOPD. MethodsIn two UK hospitals, patients admitted with ECOPD between 2017 and 2020 were retrospectively identified. Baseline characteristics between known, newly diagnosed and no HF were compared using analysis of variance and chi-squared test. Impact of HF on mortality was assessed by Kaplan-Meier analysis and Cox proportional-hazards regression. Sensitivity and specificity of NT-proBNP for diagnosing HF at recognized thresholds were reported. ResultsOn admission, 94/476 (19.7%) patients had known HF. Among remaining patients, 89/382 (23.3%) were investigated within 100 days of admission, confirming HF in 38. Of 33 patients with heart failure with reduced ejection fraction (HFrEF), 18 (54.5%) were prescribed ACE-inhibitor and B-blocker. 77/132 patients (58.3%) with HF and 108/344 patients (31.4%) without HF died (adjusted HR 2.03, 95% CI 1.46–2.82, p < 0.001) during follow up (median 11.7 months). At ≥400 pg/mL, NPV and PPV of NT-proBNP for the diagnosis of HF were 77.8% and 82.8%. ConclusionsA new diagnosis of HF was made in over 40% investigated. In patients with coexistent HF, undertreatment was common and 1-year mortality exceeded 50%. NT-proBNP may help identify patients who need cardiovascular functional imaging. Research to improve HF diagnosis and treatment in hospitalized ECOPD is urgently needed.

Changes in heart failure management and long-term mortality over 10 years: observational study

ObjectivesTo estimate the long-term survival of two cohorts of people diagnosed with heart failure 10 years apart and to assess differences in patient characteristics, clinical guideline compliance and survival by...