New-onset Heart Failure In Patients Research Articles

Risk factors and incidence of new-onset heart failure with conventional pacemaker implant – a nationwide study

BackgroundStudies have shown that the risk of new-onset heart failure (HF) is higher post-implant for patients receiving right ventricular pacing. ObjectiveThis study aimed to investigate incidence, risk factors and implications for long-term prognosis of new-onset HF in patients after pacemaker-implant. MethodsPatients without preexisting HF who received a pacemaker in Sweden during the period 2005-2020 were identified via the nationwide Pacemaker Registry. Data was crossmatched with the population registry and national disease registries. Primary outcome was new-onset HF within 5 years, and a risk score for this was developed and validated.. ResultsIn all, 65579 patients met the inclusion criteria (10351 single chamber ventricular and 55228 dual chamber pacemakers). 13792 (21.0%) patients were diagnosed with HF within five years post-implant. Of these, 6244 (45.3%) were hospitalized for HF. Patients with new-onset heart failure were more likely to die within five years (41.2% vs. 19.7%, p<0.0001). Risk factors for new-onset HF included increasing age, male sex, hypertension, diabetes, atrial fibrillation, chronic lung- and kidney disease, ischemic heart disease, and AV block. In a combined score using these variables, patients in the highest risk-score quartile had a hazard ratio of 5.36 [4.91-5.86] (p<0.001) and an absolute risk of 32% for developing HF. ConclusionPacemaker therapy is associated with >20% risk of new-onset HF within five years, and we identified nine risk factors associated with the diagnosis of new-onset HF. The proposed score based on these variables can be used to identify patients at high risk for new-onset heart failure.

Assessment of new-onset heart failure prediction in a diabetic population using left ventricular global strain: a prospective cohort study based on UK Biobank.

Impaired glucose utilization influences myocardial contractile function. However, the prognostic importance of left ventricular global radial strain (LV-GRS), left ventricular global circumferential strain (LV-GCS), and left ventricular global longitudinal strain (LV-GLS) in predicting new-onset heart failure (HF) in a population with diabetes is unclear. The study design is prospective cohort from the UK Biobank. Totally 37,899 participants had a complete data of cardiac magnetic resonance (CMR), of which 940 patients with diabetes were included, and all the participants completed follow-up. LV-GRS, LV-GCS, and LV-GLS were measured by completely automated CMR with tissue tagging. Cox proportional hazards regression analysis and C-index was performed to evaluate the association between the strain parameters and the new-onset HF in patients suffering from diabetes. The average age of the 940 participants was 57.67 ± 6.97 years, with males comprising 66.4% of the overall population. With an average follow-up period of 166.82 ± 15.26 months, 35 (3.72%) patients reached the endpoint (emergence of new-onset HF). Significant associations were found for the three strain parameters and the new-onset HF (LV-GRS-hazard ratio [HR]: 0.946, 95% CI: 0.916-0.976; LV-GCS-HR: 1.162, 95% CI: 1.086-1.244; LV-GCS-HR: 1.181, 95% CI: 1.082-1.289). LV-GRS, LV-GCS, and LV-GLS were closely related to the related indicators to HF, and showed a high relationship to new-onset HF in individuals with diabetes at 5 and 10 years: LV-GRS: 0.75 (95% CI, 0.41-0.94) and 0.76 (95% CI, 0.44-0.98), respectively; LV-GCS: 0.80 (95% CI, 0.50-0.96) and 0.75 (95% CI, 0.41-0.98), respectively; LV-GLS: 0.72 (95% CI, 0.40-0.93) and 0.76 (95% CI, 0.48-0.97), respectively. In addition, age, sex, body mass index (BMI), and presence of hypertension or coronary artery disease (CAD) made no impacts on the association between the global strain parameters and the incidence of HF. LV-GRS, LV-GCS, and LV-GLS is significantly related to new-onset HF in patients with diabetes at 5 and 10 years.

Risk factors and prognostic implications for new-onset heart failure with ventricular pacing - a nationwide study

Abstract Background Studies have shown that the incidence of new-onset heart failure (HF) is higher for patients receiving pacemaker therapy with traditional right ventricular pacing, compared to age matched controls. Conduction system pacing may overcome this, but is more expensive and technically challenging. Objectives To investigate risk factors and implications for long-term prognosis of new-onset HF in patients after pacemaker-implant, with the aim of identifying patients at high risk already prior to device implant. Methods All patients without preexisting HF, who received a pacemaker with a right ventricular lead in Sweden during the period 2005-2020, were identified via the nationwide Pacemaker Registry. Data was crossmatched with the population registry and national disease registries. Outcome was new-onset HF within 5 years post-implant, HF hospitalization and all-cause mortality. Results In all, 65579 patients met the inclusion criteria (10351 single chamber ventricular and 55228 dual chamber pacemakers). 13792 (21.0%) patients were diagnosed with HF within five years post-implant. Of these, 6244 (45.3%) were hospitalized for HF (see Figure 1). Patients with heart failure were older (80.6 vs. 76.7 years, p&amp;lt;0.001), had a higher burden of comorbidities, and were more likely to die within five years compared to those without HF (41.2% vs. 19.7%, p&amp;lt;0.001). Independent risk factors with more than 25% increased odds ratio for developing heart failure within 5 years included increasing age, diabetes, atrial fibrillation, chronic lung- and kidney disease, ischemic heart disease, and AV block. A combined score using these variables was strongly associated with increased risk of both HF-hospitalization (OR 1.48 [1.46-1.51], p&amp;lt;0.0001) and 5-year mortality (OR 1.81[1.77-1.98], p&amp;lt;0.0001). There was a progressively increasing risk proportional to the summed score. Patients with at least five points on the score had &amp;gt;25% risk of new-onset heart failure within five years, and patients with at least seven points had &amp;gt;25% risk of new-onset heart failure within two years. In figure 2 we present a suggested score model, based on the results. Conclusions Pacemaker therapy with a lead in the right ventricle was associated with &amp;gt;20% risk of new-onset HF within five years. This in turn was associated with higher risk of death. Based on clinical risk factors, our proposed score can be used to identify patients at high risk for new-onset heart failure. These patients may be eligible for conduction system pacing or resynchronisation therapy. Randomized trials are needed to determine if a score-based pacing strategy (right ventricular or conduction system pacing) approach results in better clinical outcome, and if it is cost-effective.Included patients and risk of HF hosp.Decision algorithm based on results

Risk Assessment for Heart Failure in Patients with Type 2 Diabetes Mellitus Treated with Dipeptidyl Peptidase 4 Inhibitor Using a Large Claims Dataset.

Heart failure is a prevalent comorbidity in patients with diabetes mellitus (DM). However, it is unclear whether the risk factors for heart failure in DM patients treated with dipeptidyl peptidase-4 (DPP-4) inhibitors are the same as those for the general population. In this study, we evaluated the factors of new-onset heart failure in working-age patients with diabetes who started DPP-4 inhibitor therapy. This study included 7938 working-age patients. The primary endpoint of the study was the proportion of patients developing heart failure within 12 months of starting DPP-4 inhibitor therapy, which was found to be 1.89% (n = 150). In these patients, risk factors of new-onset heart failure were aging, history of atrial fibrillation, and hypertension but not sex, smoking, high body mass index, weight gain of over 10 kg from 20 years of age, levels of low-density lipoprotein or glycated hemoglobin A1c (HbA1c), history of angina pectoris, myocardial infarction, and chronic kidney disease. We confirmed that cardiovascular comorbidities are risk factors for new-onset heart failure in patients with DM, while general risk factors are not. In conclusion, physicians and pharmacists need to carefully monitor working-age patients with cardiovascular history who start DPP-4 inhibitor therapy even if they do not exhibit general risk factors for heart failure.

Clinical and Pharmacological Implications of Time to Treatment with Interleukin-1 Blockade in ST-Segment Elevation Myocardial Infarction.

Interleukin-1 (IL-1) blockade with anakinra given within 12 hours from reperfusion has been shown to reduce the inflammatory response as well as prevent heart failure (HF) events in patients with STEMI.We sought to determine whether time-to-treatment influences the efficacy of anakinra on systemic inflammation and incidence of HF events in patients with STEMI. We divided the cohort in two groups based on the median time from percutaneous coronary intervention (PCI) to investigational drug, and analyzed the effects of anakinra on the area-under-the-curve for C reactive protein (AUC-CRP) and on incidence of the composite endpoint of death or new onset HF. We analyzed data from 139 patients: 84 (60%) treated with anakinra and 55 (40%) with placebo. The median time from PCI to investigational treatment was 271(182-391) minutes. The AUC-CRP was significantly higher in patients receiving placebo versus anakinra both in those with time from PCI to treatment <271 min (222.6[103.9-325.2] vs 78.4[44.3-131.2], p<0.001) and those with time from PCI to treatment {greater than or equal to}271 min (235.2[131.4-603.4] vs 75.5[38.9-171.9], p<0.001) (p>0.05 for interaction). Anakinra significantly reduced the combined endpoint of death or new onset HF in patients with time from PCI to treatment <271 min (5[11%] vs 9[36%], log-rank Chi-square 5.985, p=0.014) as well as in patients with time from PCI to drug {greater than or equal to}271 min (2[5%] vs 7[23%], log-rank Chi-square 3.995, p=0.046) (p>0.05 for interaction). IL-1 blockade with anakinra blunts the acute systemic inflammatory response and prevents HF events independent of time-to-treatment. Significance Statement In patients with ST segment elevation presenting within 12 hours of pain onset and treated within 12 hours of reperfusion, IL-1 blockade with anakinra blunts the acute systemic inflammatory response, a surrogate of IL-1 activity, and prevents HF events independent of time-to-treatment.

Elevated urine albumin-to-creatinine ratio increases the risk of new-onset heart failure in patients with type 2 diabetes

BackgroundAlthough albuminuria has been linked to heart failure in the general population, the relationship between urine albumin-to-creatinine ratio (uACR) and heart failure in type 2 diabetes patients is not well understood. We aimed to investigate the relationship between uACR and new-onset heart failure (HF) in type 2 diabetics.MethodsWe included 9287 Chinese participants with type 2 diabetes (T2D) but no heart failure (HF) who were assessed with uACR between 2014 and 2016. The participants were divided into three groups based on their baseline uACR: normal (< 3 mg/mmol), microalbuminuria (3–30 mg/mmol), and macroalbuminuria (≥ 30 mg/mmol). The relationship between uACR and new-onset HF was studied using Cox proportional hazard models and restricted cubic spline. The area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to see if incorporating uACR into existing models could improve performance.Results216 new-onset HF cases (2.33%) were recorded after a median follow-up of 4.05 years. When compared to normal uACR, elevated uACR was associated with a progressively increased risk of new-onset HF, ranging from microalbuminuria (adjusted HR, 2.21; 95% CI 1.59–3.06) to macroalbuminuria (adjusted HR, 6.02; 95% CI 4.11–8.80), and 1 standard deviation (SD) in ln (uACR) (adjusted HR, 1.89; 95% CI 1.68–2.13). The results were consistent across sex, estimated glomerular filtration rate, systolic blood pressure, and glycosylated hemoglobin subgroups. The addition of uACR to established HF risk models improved the HF risk prediction efficacy.ConclusionsIncreasing uACR, even below the normal range, is an independent risk factor for new-onset HF in a type 2 diabetic population. Furthermore, uACR may improve HF risk prediction in community-based T2D patients.

Abstract 13994: Time to Treatment and Efficacy of IL-1 Blockade With Anakinra in ST-Segment Elevation Myocardial Infarction

Introduction: Interleukin-1 (IL-1) blockade with anakinra given within 12 hours from reperfusion has recently showed to reduce the inflammatory response as well as prevent heart failure (HF) events in patients with STEMI. Hypothesis: The aim of this study was to determine whether time to anakinra treatment influences the efficacy on systemic inflammation and HF events in patients with STEMI. Methods: This is a secondary analysis of the data from the three VCUART clinical trials, including adult patients with STEMI presenting within 12 hours of pain onset, enrolled within 12 hours of reperfusion and randomly assigned to anakinra or placebo for 14 days. We divided the cohort in two groups based on the median time from percutaneous coronary intervention (PCI) to investigational drug, and analyzed the effects of anakinra on the area-under-the-curve for C reactive protein (AUC-CRP) and on incidence of the composite endpoint of death or new onset HF. Results: We analyzed data from 139 patients: 84 (60%) treated with anakinra and 55 (40%) with placebo. The median time from PCI to investigational treatment was 271 [182-391] minutes. The AUC-CRP was significantly higher in patients receiving placebo versus anakinra both in those with from PCI to treatment &lt;271 min (222.6 [103.9-325.2] vs 78.4 [44.3-131.2], p&lt;0.001) and those with time from PCI to drug ≥271 min (235.2 [131.4-603.4] vs 75.5 [38.9-171.9, p&lt;0.001]. Anakinra significantly reduced the combined endpoint of death or new onset HF in patients with time from PCI to treatment &lt;271 min (5 [11%] vs 9 [36%], log-rank p value=0.014) as well as in patients with time from PCI to drug ≥271 min (2 [5%] vs 7 [23%], log-rank p value= 0.046). Conclusions: In patients with STEMI treated with anakinra within 12 hours of reperfusion, the therapeutic window of IL-1 blockade on the systemic inflammatory response and on HF events in reperfused STEMI appears to be stable for several hours.

Sex-related differences in long-term outcome of heart failure in low-risk patients with atrial fibrillation. A Swedish registry case-control study

Abstract Background Knowledge about sex-related differences regarding long-term risk of heart failure (HF) among patients with atrial fibrillation (AF) is limited. Aim To evaluate the impact of sex on risks for new onset HF in patients with AF. Methods All patients from the Swedish National Patient Register, with a first-time diagnosis of AF between 1987 and 2018 were identified and compared with two matched controls without AF from the Total Population Register. Patients &amp;lt;18 years, or any previous cardiovascular disease, diabetes mellitus and renal failure at the baseline were excluded. Results In total 227,811 patients and 452,712 controls were included; 44.5% were women. The mean age (SD) for men was 65.5 (15) vs. 72.7 (13) in women (p&amp;lt;0.0001). The incidence rate for HF onset per 1000 person-years within one and five years after AF diagnosis was 77.3 (75.5–79.1) and 45.0 (44.3–45.7) in women vs. 66.5 (65.0–68.0) and 35.3 (34.8–35.9) in men, respectively. The incidence rate for HF onset increased with age in both patients with AF and controls, but was generally more pronounced in women. Women had 26% and 34% higher risk for HF onset, within five and thirty years, respectively. The highest risk for HF onset was found in women 18–34 years and 35–49 years of age, HR 24.64 (95%, confidence interval (CI) 7.59–80.0) and 8.09 (95%, CI 6.34–10.33) vs. 9.86 (95%, CI 6.81–14.27) and 6.52 (95%, CI 5.87–7.25) in equally old men. The mortality rate after HF was 42.3% and 33.1% in women and men with AF (p&amp;lt;0.0001). Conclusion In this nationwide, register-based cohort study, when compared to matched controls we found that the risk for HF onset was higher in women with AF, particularly in reproductive age, highlighting great importance of further research for prevention of HF in young women with AF but without any other cardiovascular risk factors. Funding Acknowledgement Type of funding sources: None.

Association Between Cholinesterase Inhibitors and New-Onset Heart Failure in Patients With Alzheimer's Disease: A Nationwide Propensity Score Matching Study

BackgroundAutonomic nervous dysfunction is a shared clinical feature in Alzheimer's disease (AD) and heart failure (HF). Cholinesterase inhibitors (ChEIs) are widely used autonomic modulators in patients with AD, but their primary preventive benefit on new-onset HF is still uncertain.ObjectiveThis study examined whether ChEIs have a primary preventive effect on new-onset HF in patients with AD.MethodsThis propensity score matching (PSM) study was conducted using data from the National Health Insurance Research Database of Taiwan for 1995 to 2017. Certificated patients with AD and without a history of HF were divided into ChEI (donepezil, rivastigmine, or galantamine) users or nonusers. The primary endpoint was new-onset HF, and the secondary endpoints were myocardial infarction and cardiovascular death after 10-year follow-up.ResultsAfter screening 16,042 patients, 7,411 patients were enrolled, of whom 668 were ChEI users and 1,336 were nonusers after 1:2 PSM. Compared with nonusers, ChEI users exhibited a significantly lower incidence of new-onset HF (HR 0.48; 95% CI 0.34–0.68, p < 0.001) and cardiovascular death (HR 0.55; 95% CI 0.37–0.82, p = 0.003) but not of myocardial infarction (HR 1.09; 95% CI 0.52–1.62, p = 0.821) after 10-year follow-up. The preventive benefit of ChEI use compared with Non-use (controls) was consistent across all exploratory subgroups without statistically significant treatment-by-subgroup interactions.ConclusionsPrescription of ChEIs may provide a preventive benefit associated with lower incidence of new-onset HF in patients with AD after 10-year follow-up.

Effect of IL-1 Blockade With Anakinra on Heart Failure Outcomes in Patients With Anterior Versus Nonanterior ST Elevation Myocardial Infarction.

Patients with ST elevation myocardial infarction (STEMI) are at risk of future heart failure (HF), particularly those with anterior STEMI. Interleukin-1 (IL-1) is a key mediator of the inflammatory response, and its blockade has emerged as a potential therapeutic strategy to prevent HF events. The aim of this analysis was to explore the effects of anakinra, an IL-1 receptor antagonist, on HF outcomes based on anterior versus nonanterior location STEMI and to explore whether this effect is mediated through the amelioration of left ventricular systolic function and cardiac remodeling. We pooled data from 3 early phase randomized clinical trials. The primary end point was a composite of all-cause death and new-onset HF at 1-year follow-up. The left anterior descending coronary artery as culprit vessel was used to identify anterior STEMI. We included 139 patients, 47 (34%) with anterior STEMI and 92 (66%) with nonanterior STEMI. Anakinra significantly reduced the combined end point of death or new-onset HF in patients with anterior STEMI [4 (13%) vs. 7 (42%), log-rank P value = 0.049] and in patients with nonanterior STEMI [3 (6%) vs. 9 (24%), log-rank P value = 0.014]. We found no significant differences comparing anakinra versus placebo in interval changes in left ventricular ejection fraction and volumes in anterior and nonanterior STEMI. In conclusion, anakinra is associated with a reduction of HF events in patients with STEMI, irrespective of anterior or nonanterior location, or of changes in left ventricular ejection fraction or cardiac remodeling.

Sex differences on new-onset heart failure in patients with known or suspected chronic coronary syndrome

Abstract Background The impact of sex in patients with chronic coronary syndrome (CCS) has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with CCS. Objectives We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected CCS undergoing vasodilator stress cardiac magnetic resonance (CMR). Methods We prospectively evaluated 5,899 consecutive HF-free patients submitted to stress CMR for known or suspected CCS. Ischemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional-hazards regression model adjusted for competing events (death, myocardial infarction, and non-CMR-related revascularization). Results A total of 2,289 (38.8%) patients were women, and 539 (9.1%) underwent CMR-related revascularization. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered a myocardial infarction, 420 (7.1%) underwent CMR-non-related revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs 0.83 per 100 person/years, p=0.002) (Figure 1). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (HR=1.61, 95% CI: 1.21–2.13, p=0.001). Compared with men, the risk of new-onset HF was higher in women with LVEF &amp;gt;53%. Conclusions Compared with men, women with CCS are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER) Figure 1

Cardiovascular risk factors as predictors of heart failure during hospitalization for Acute Coronary Syndromes

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Cardiovascular risk factors (CVRF) are a growing health problem in developed countries. These patients have a higher prevalence of acute coronary syndromes (ACS) and as a consequence ACS complication, like heart failure (HF). HF after an ACS is a common complication and CVFR can influence its manifestation. Objective Evaluate the impact of the CVRF in HF during the hospitalization for ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of HF during the hospitalization for ACS and B – with new onset of HF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, coronary artery disease, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset HF in these patients. Results 14717 patients were included, 2287 in group B (15.5%). Both groups were similar regarding body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p = 0.254). Curiously the group A exhibited higher prevalence of smoking status (29.8 vs 16.6%, p &amp;lt; 0.001). On the other hand, group B presented more females (25.0 vs 35.7%, p &amp;lt; 0.001), arterial hypertension (68.7 vs 78.2%, p &amp;lt; 0.001), diabetes mellitus (28.5 vs 43.1%, p &amp;lt; 0.001), dyslipidemia (62.2 vs 64.3%, p = 0.023), coronary artery disease (19.6 vs 25.6%, p &amp;lt; 0.001), neoplasia (4.4 vs 7.0%, p &amp;lt; 0.001), peripheral arterial disease (5.2 vs 15.8%, p &amp;lt; 0.001) and chronic kidney disease (4.6 vs 10.0%, p &amp;lt; 0.001). Logistic regression revealed that body mass index, diabetes, arterial hypertension, neoplasia and dyslipidemia were not predictors of HF during the hospitalization for ACS. Nevertheless, female gender (odds ratio (OR) 1.37, p &amp;lt; 0.001, confidence interval (CI) 1.22-1.54), chronic kidney disease (OR 1.59, p &amp;lt; 0.001, CI 1.33-1.90) and peripheral arterial disease (OR 1.54, p &amp;lt; 0.001, CI 1.27-1.86) were predictors of new onset of HF during hospitalization for ACS. Curiously, smoking seems to have a protective effect (OR 0.68, p &amp;lt; 0.001, CI 0.59-0.78) in new onset HF in ACS patients. Conclusions Chronic kidney disease and peripheral arterial disease were predictors of new onset of HF in during hospitalization for ACS.

Sex differences on new-onset heart failure in patients with known or suspected coronary artery disease.

The impact of sex in patients with CAD has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with known or suspected CAD. We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected coronary artery disease (CAD) undergoing vasodilator stress cardiac magnetic resonance (CMR). We prospectively evaluated 5899 consecutive HF-free patients submitted to stress CMR for known or suspected CAD. Ischaemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional hazards regression model adjusted for competing events [death, myocardial infarction (MI), and revascularization]. A total of 2289 (38.8%) patients were women. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered an MI, 905 (15.3%) underwent revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs. 0.83 per 100 person-years, P = 0.001). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (hazard ratio 1.58, 95% confidence interval 1.18-2.10; P = 0.002). We found a sex-differential effect along the continuum of LVEF (P-value for interaction = 0.007). At lower LVEF, there was an increased risk in both sexes. However, compared with men, the risk of new-onset HF was higher in women with LVEF >55%. Women with known or suspected CAD are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.

Risk of heart failure associated with thiazide diuretics compared with calcium channel blockers in patients with type 2 diabetes: a nationwide nested case-control study

Abstract Background Thiazide diuretics and calcium channel blockers (CCB's) are two important and widely used antihypertensive drugs classes among patients with type 2 diabetes (T2D). The risk of developing heart failure (HF) is increased in patients with T2D but whether use of these two drugs are associated with changes in HF risk is unknown. Purpose To examine and compare the association of two different classes of antihypertensive drugs, thiazide diuretics and CCB's, with the development of new onset HF in patients with T2D. Methods The study cohort comprised T2D patients &amp;gt;40 years on metformin and renin-angiotensin system inhibitor (RAS-i) without a history of HF or use of loop diuretics identified in Danish health care registers (period 1995 to 2015). A nested case-control study was conducted by matching all HF cases on sex, age and duration of T2D with 10 controls from the T2D population. Exposure was defined as three redeemed prescriptions of either a thiazide diuretic or a CCB up to 365 days before index, which corresponds to one year of antihypertensive therapy. Conditional logistic regression adjusted for comorbidities (atrial fibrillation, chronic obstructive pulmonary disease and anemia) was used to estimate and compare the treatment effect of thiazide diuretics and CCB's, with patients receiving neither of the two drugs as reference. Results The study population consisted of 170,514 T2D patients using metformin and RAS-i, comprising 13,814 HF cases each matched on sex, age and duration of T2D with 10 controls. The median age was 62 years and 55% were men. T2D patients, who had received antihypertensive treatment with only thiazide diuretics one year prior to index had a significantly lower risk of HF compared to the reference group who did not receive treatment with neither thiazide diuretics or CCB's: Hazard ratio (HR) 0.79 [95% confidence interval (CI) 0.74–0.85]. Patients who had received treatment with only CCB's had a comparable risk of HF: HR 0.98 [95% CI 0.94–1.02]. Patients who had received treatment with both thiazide diuretics and CCB's were not associated with a lower risk of HF: HR 1.01 [95% CI 0.96–1.08]. Conclusion Patients with T2D who received antihypertensive therapy with thiazide diuretics for at least one year had a significantly lower risk of HF compared to those who were not treated with either thiazide diuretics or CCB's. No association between use of CCB's and HF was observed. Use of thiazide diuretics may prevent development of HF in T2D and a randomized clinical trial evaluating diuretics is patients with T2D is warranted. Risk of new onset heart failure Funding Acknowledgement Type of funding source: None

Cobalt alloy hip prostheses and new-onset heart failure in patients with and without chronic kidney disease

Cobalt alloy hip prostheses and new-onset heart failure in patients with and without chronic kidney disease

Early changes in NT-proBNP levels predict new-onset heart failure in patients with STEMI

Previous studies suggested that N-terminal pro-brain natriuretic peptide (NT-proBNP) level is a powerful independent predictor of death or heart failure (HF) when measured at admission in patients with chest pain or acute coronary syndrome. Little is known about the role of NT-proBNP level measured during a hospitalization for ST segment elevation myocardial infarction (STEMI) in predicting clinical outcomes. We evaluated the optimal NT-proBNP timing (admission, 72 hours, or delta [Δ] NT-proBNP [72 hours minus admission]) to predict 1-year new-onset HF in STEMI patients. We measured NT-proBNP levels at admission and 72 hours in 72 patients with STEMI. HF events were adjudicated and defined as hospitalization for HF or need for new initiation of a loop diuretic at 1-year follow-up. Values are presented as medians and interquartile range or frequencies (%) as appropriate. Cox regression analysis was used to determine predictors of adverse events. A receiver-operative-curve was constructed to identify the discriminative value and optimal cut-off points for NT-proBNP. Patients (age 56 [49-64] years, males 59 [82%]) were followed for a median duration of 365 [180-365] days. HF events were recorded in 9 (12.5%) patients. NT-proBNP values at admission, 72 hours, and ΔNT-proBNP were 89 (26-268) pg/mL, 452 (223-1064) pg/mL, and 283 (68-686) pg/mL, respectively. NT-proBNP at 72 hours and ΔNT-proBNP, but not admission NT-proBNP predicted new-onset HF events at follow-up (P=0.03, P=0.002 and P=0.89, respectively). The optimal area under the curve of 0.771 (95%, CI [0.630-0.912], P= 0.009) and cut-off value of 830 pg/mL (sensitivity 79%; specificity 76%) were found for NT-proBNP at 72 hours. The Kaplan-Meier survival curves for NT-proBNP at 72 hours dichotomized above and below this cut-off value, confirmed NT-proBNP at 72 hours >830 pg/mL as predictive of HF events (log-rank statistic = 8.688, P=0.003). NT-proBNP level at 72 hours and ΔNT-proBNP (72 hours minus admission), but not at time of admission, predicted HF events in patients following STEMI.

Left ventricular contractile performance and heart failure in patients with left ventricular ejection fraction more than 40%

Heart failure (HF) with mid-range left ventricular ejection fraction (LVEF) (HFmrEF) is considered a new category of HF and LVEF < 50%, which is the upper threshold of LVEF for HFmrEF, is thought to represent a mild decrease in LV contractile performance. We aimed to consider an LVEF threshold value to be taken as a surrogate for impairment of LV contractile performance, resulting in new-onset HF. We enrolled 398 patients with LVEF ≥ 40% that underwent cardiac catheterization. Using the LV pressure recording with a catheter-tipped micromanometer, we calculated the inertia force of late systolic aortic flow (IFLSAF), which was sensitive to the slight impairment in LV contractile performance. We evaluated the utility of the IFLSAF for predicting future cardiovascular death or hospitalization for HF. We performed a receiver operating characteristic (ROC) curve analysis to determine the best LVEF threshold value for distinguishing whether the LV maintained the IFLSAF. A multivariate Cox proportional-hazards model revealed that the loss of IFLSAF was significantly associated with the future adverse events (HR: 7.798, 95%CI 2.174–27.969, p = 0.002). According to the ROC curve analysis, an LVEF ≥ 58% indicated that the LV could maintain the IFLSAF. We concluded that the loss of IFLSAF, which could reflect even slight impairment in LV contractile performance, was a reliable indicator for new-onset HF in patients with LVEF ≥ 40%. LVEF ≥ 58% could be taken as a surrogate for the IFLSAF maintenance; this threshold could be useful for risk stratification of new-onset HF in patients with preserved LVEF.

Predictive value of electrocardiography-gated myocardial perfusion imaging to new-onset heart failure in patients with chronic kidney disease: findings from the J-ACCESS 3 study

The incidence of heart failure (HF) increases in patients with chronic kidney disease (CKD). Factors that could predict patients with CKD who are at high risk for developing HF should be identified. We analysed clinical parameters and stress/rest myocardial perfusion imaging (MPI) findings derived from 499 patients with CKD by the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT 3 (J-ACCESS 3) to clarify predictors of new-onset HF. Forty-one patients with congestive HF in the J-ACCESS 3 database were followed up for three years. Multivariable Cox hazards models selected haemoglobin (hazard ratio [HR] 0.809; 95% confidence interval [CI] 0.679-0.964), summed stress score (HR 1.082; 95% CI 1.016-1.151) and left ventricular ejection fraction (HR 0.970; 95% CI 0.949-0.992) as independent predictors of new-onset HF. Haemoglobin combined with summed stress scores and ejection fraction had the greatest incremental prognostic value over any one or more combined factors (global χ2, 29.9). Anaemia, stress-induced myocardial ischaemia, and left ventricular contraction are independent predictors of risk of new-onset HF in patients with CKD. Stress/rest MPI provides additional information with which to identify patients with CKD at greater risk of new-onset HF.

The Impact of Emergency Interventions and Patient Characteristics on the Risk of Heart Failure in Patients with Nontraumatic OHCA.

Background Since out-of-hospital cardiac arrest- (OHCA-) related dysfunction (ischemic/reperfusion injury and inflammatory response) might result in long-term impairment, we suspect that new-onset heart failure might be common in long-term survivors. However, these relationships had not been well addressed, and we aimed to analyze the impact of emergency interventions and patient characteristics on the risk of new-onset heart failure in patients with nontraumatic OHCA. Methods The Taiwanese government healthcare database contains data for 49,101 nontraumatic OHCA adult patients from 2011-2012, which were analyzed in this study. Nontraumatic OHCA patients who survived to the intensive care unit (ICU) were included as the study group (n = 7,321). Matched patients (n = 21,963) were recruited as a comparison group. Patients with any history of heart failure or cardiac arrest were not included in either group. All patients were followed-up for 6 months for the identification of new-onset heart failure. Adjustments were made for demographics, age, emergency interventions, and comorbidities as potential risk factors. Results In all, 3.84% (n = 281) of OHCA patients suffered new-onset heart failure, while only 1.24% (n = 272) of matched patients in the comparison group suffered new-onset heart failure. Strong risk factors for heart failure were age (60–75 years, HR: 11.4; 95% CI: 9–14.4), medical history (myocardial infarction, HR: 2.47; 95% CI: 2.05–2.98 and cardiomyopathy, HR: 2.94; 95% CI: 1.45–5.94), and comorbidities during hospitalization (ischemic heart disease, HR: 4.5; 95% CI: 3.46–5.86). Only extracorporeal membrane oxygenation (ECMO) decreased the risk of heart failure. Most (53.6%) heart failure events occurred within 60 days after OHCA. Conclusion An age from 61 to 75 years, a history of myocardial infarction or cardiomyopathy, and ischemic heart disease or infection as comorbidities occurring during hospitalization were strong risk factors for new-onset heart failure in OHCA patients. However, ECMO could decrease this risk. More importantly, most heart failure events occurred within 60 days after OHCA.

3269Impact of type 2 diabetes on incidence and phenotype of heart failure in patients with atrial fibrillation

Abstract Background Type 2 diabetes (T2DM) portends adverse prognosis in patients with atrial fibrillation (AF). Whether T2DM independently increases the risk of incident heart failure (HF) in AF is uncertain. Also, HF phenotype developing in patients with vs. those without T2DM has not been characterised. Purpose In AF patients without a history of prior HF, we aimed to assess: 1) the impact of T2DM on the risk of new-onset HF; and 2) the association between T2DM and HF phenotype developing during the prospective follow-up. Methods We included diabetic and non-diabetic AF patients, without a history of HF. Baseline T2DM status was inferred from medical history, haemoglobin A1c levels and oral glucose tolerance test. Study outcome was the first hospital admission or emergency department treatment for new-onset HF during the prospective follow-up. The phenotype of new-onset HF was determined by echocardiographic exam performed following clinical stabilisation (at hospital discharge, or within a month after HF diagnosis). HF phenotype was defined as HFrEF (left ventricular ejection fraction [LVEF] &lt;40%), HFmrEF (LVEF 40–49%) or HFpEF (LVEF≥50%). Cox regression analyses adjusted for age, sex, baseline LVEF, comorbidities, smoking status, alcohol intake, AF type (paroxysmal vs. non-paroxysmal) and T2DM treatment was used to analyse the association between T2DM and incident HF. Results Among 1,288 AF patients without prior HF (mean age: 62.1±12.7 years; 61% male), T2DM was present in 16.5%. Diabetic patients had higher mean baseline LVEF compared with nondiabetic patients (50.0±6.2% vs. 57.6±9.0%; P&lt;0.001). During the median 5.5-year follow-up, new-onset HF occurred in 12.4% of patients (incidence rate, 2.9; 95% confidence interval [CI], 2.5–3.3 per 100 patient-years). Compared with non-diabetic patients, those with T2DM had a hazard ratio of 2.1 (95% CI, 1.6–2.8; P&lt;0.001) for new-onset HF, independent of baseline LVEF or other factors. In addition, diabetic patients had a significantly greater decline in covariate-adjusted mean LVEF (−10.4%; 95% CI, −9.8% to −10.8%) at follow-up, compared with nondiabetic patients (−4.0%; 95% CI, −3.8% to −4.2%), P&lt;0.001. The distribution of HF phenotypes at follow-up is presented in Figure. Among patients with T2DM, HFrEF (56.9%) was the most common phenotype of HF, whereas in patients without T2DM, HF mostly took the phenotype of HFpEF (75.0%). Conclusions T2DM is associated with an independent risk of new-onset HF in patients with AF and confers a greater decline in LVEF compared to individuals without T2DM. HFrEF was the most prevalent presenting phenotype of HF in AF patients with T2DM.