Prior History Of Heart Failure Research Articles

Left Atrial Peak Systolic Strain as an Indicator Pathway of Diastolic Dysfunction of the Left Ventricle.

Left atrial peak systolic strain (LA-PSS) imaging is an emerging index of left atrial function, and it was shown to be decreased in heart failure with preserved ejection fraction (EF). We aimed to determine whether LA-PSS could be used as an additional diagnostic parameter to current existing guidelines for the presence of left ventricle diastolic dysfunction (LVDD). A total of 190 consecutive adult patients with cardiovascular risk factors and normal left ventricle EF with no prior history of heart failure were included in the study. Speckle tracking software was used to study ventricular parietal deformity, left ventricle global longitudinal systolic strain, and LA-PSS. The median left ventricle global longitudinal systolic strain was -19%, with a significant difference ( P < 0.001) between patients with normal diastolic function versus those with LVDD. The median LA-PSS was 33% (30% to 38%) ( P < 0.001). Most patients (61%) had grade 1 atrial dysfunction based on PSS (range 24%-35%). The analysis of the area under the receiver operating characteristic curve of the LA-PSS as a potential indicator pathway of LVDD was 67% [95% confidence interval (CI), 62-72], and 75% (95% CI, 70-80), when the indeterminate pattern was included. The decreased LA-PSS made it possible to reclassify patients with an indeterminate pattern of diastolic function in 96% of cases. These results support the potential role of LA-PSS as an additional parameter for the diagnosis of LVDD in patients with normal EF, and may be integrated into the guidelines for routine evaluation of patients.

Clinical significance and prognostic value of right bundle branch block in permanent pacemaker patients.

In patients undergoing pacemaker implantation with no prior history of heart failure (HF), the presence of left bundle branch block (LBBB) has been identified as an independent predictor of HF-related death or hospitalization, while the prognostic significance of right bundle branch block (RBBB) remains uncertain. We aimed to assess the long-term risk of all-cause mortality in patients with a standard indication for permanent pacing and normal or moderately depressed left ventricular function when RBBB is detected at the time of implantation. We retrospectively enrolled 1348 consecutive patients who had undergone single- or dual-chamber pacemaker implantation at the study center, from January 1990 to December 2022. Patients with a left ventricular ejection fraction ≤35% or a prior diagnosis of HF were excluded. The baseline 12-lead electrocardiogram revealed an RBBB in 241 (18%) and an LBBB in 98 (7%) patients. During a median follow-up of 65 [25th-75th percentile: 32-117] months, 704 (52%) patients died. The combined endpoint of cardiovascular death or HF hospitalization was reached by 173 (13%) patients. On multivariate analysis, RBBB was confirmed as an independent predictor of death [hazard ratio, 1.33; 95% confidence interval (CI), 1.09-1.63; P = 0.005]. However, when considering the combined endpoint of cardiovascular death and HF hospitalization, this endpoint was independently associated with LBBB (hazard ratio, 2.13; 95% CI, 1.38-3.29; P < 0.001), but not with RBBB. In patients with standard pacemaker indications and normal or moderately depressed left ventricular function, the presence of basal RBBB was an independent predictor of mortality. However, it was not associated with the combined endpoint of cardiovascular death and HF hospitalization.

Clinical significance and prognostic value of right bundle branch block in permanent pacemaker patients

Abstract Aim In patients undergoing pacemaker implantation with no prior history of heart failure (HF), the presence of left bundle branch block (LBBB) has been identified as an independent predictor of HF-related death or hospitalization, while the prognostic significance of right bundle branch block (RBBB) remains uncertain. We aimed to assess the long-term risk of all-cause mortality in patients with a standard indication for permanent pacing and normal or moderately depressed left ventricular function when RBBB is detected at the time of implantation. Methods We retrospectively enrolled 1348 consecutive patients who had undergone single- or dual-chamber pacemaker implantation at the study center, from January 1990 to December 2022. Patients with a left ventricular ejection fraction ≤35% or a prior diagnosis of HF were excluded. Results The baseline 12-lead electrocardiogram revealed an RBBB in 241 (18%) and an LBBB in 98 (7%) patients. During a median follow-up of 65 [25th-75th percentile: 32-117] months, 704 (52%) patients died. The combined endpoint of cardiovascular death or HF hospitalization was reached by 173 (13%) patients. On multivariate analysis, RBBB was confirmed as independent predictor of death (Hazard Ratio, 1.33; 95% CI, 1.09–1.63; P=0.005). However, when considering the combined endpoint of cardiovascular death and HF hospitalization, this endpoint was independently associated with LBBB (Hazard Ratio, 2.13; 95% CI, 1.38–3.29; P&amp;lt;0.001), but not with RBBB. Conclusions In patients with standard pacemaker indications and normal or moderately depressed LV function the presence of basal RBBB was an independent predictor of mortality. However, it was not associated with the combined endpoint of cardiovascular death and HF hospitalization.Time to event

Immune Activation Mediates the Association of Advanced Hepatic Fibrosis With Adverse Outcomes in Patients With Coronary Artery Disease.

Literature suggests a bidirectional association between advanced hepatic fibrosis (AHF) and coronary artery disease (CAD). We evaluated the association of AHF with immune activation, systemic inflammation, and adverse outcomes in patients with CAD. A fibrosis-4 index cutoff value ≥2.67 was used to define AHF. Circulating levels of soluble urokinase plasminogen activator receptor and hsCRP (high-sensitivity C-reactive protein) were measured as markers for immune activation and systemic inflammation, respectively. The relationship of AHF with soluble urokinase plasminogen activator receptor, hsCRP, and adverse cardiovascular outcomes was evaluated. Among 3406 participants with CAD, 479 had AHF. Participants with AHF were older; were less likely to be Black individuals; and had a lower body mass index, worse renal function, and a prior history of heart failure. In multivariable linear regression models adjusted for clinical and demographic confounders, participants with AHF had 15.6% higher soluble urokinase plasminogen activator receptor and 24.0% higher hsCRP levels. They were more likely to experience the following adverse outcomes: all-cause death (adjusted hazard ratio [HR], 1.57 ([95% CI, 1.29-1.92]; P<0.001) and cardiovascular death: (subdistribution HR, 1.50 [95% CI, 1.14-1.95]; P=0.003). Mediation analysis showed that 47.0% (95% CI, 13.6%-81.2%]; P=0.006) of the indirect effect of AHF on cardiovascular death was mediated by circulating soluble urokinase plasminogen activator receptor levels. AHF is independently associated with immune activation, systemic inflammation, and adverse cardiovascular outcomes in patients with CAD. The association of AHF with adverse outcomes is partly mediated by immune activation, and targeting this pathway may help reduce the residual risk in patients with CAD.

Heart failure after left atrial appendage occlusion: insights from the LAAOS-III randomized trial

Abstract Background Left atrial appendage removal or occlusion (LAAO) might increase the risk for heart failure (HF) due to the loss of the LAA`s reservoir function, active contraction and neuroendocrine function. Purpose To investigate the incidence of HF hospitalizations and/or HF related death after LAAO in the Left Atrial Appendage Occlusion Study (LAAOS III). Methods In LAAOS III, 4811 patients with atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2 were randomized to undergo or not undergo surgical LAAO during cardiac surgery for another indication. We compared the incidence of a composite endpoint of HF hospitalizations and HF related death between the two randomized groups (LAAO vs no-LAAO). We also pre-specified subgroups including: sex, age, BMI, surgery type, concomitant AF ablation, prior history of HF, history of hypertension, diabetes, prior myocardial infarction, left ventricular ejection fraction, sinus rhythm and occlusion method. Results We included 2379 patients in the LAAO and 2391 patients in the no-LAAO group. Overall, mean age was 71 years, 67% were male and 57% had prior HF. Baseline characteristics including drug treatment were balanced between the groups. Over a mean follow-up of 3.8 years, 395 (8.3%) patients met the primary HF endpoint: 209 (8.8%) in the LAAO group and 186 (7.8%) in the no-LAAO group. We did not find a significant difference for the primary endpoint between the randomized groups (Hazard ratio [95% confidence intervals] 1.13 [0.93-1.37], p=0.233) (Figure). The only significant subgroup interaction was for concomitant AF ablation (p for interaction = 0.004). Patients in the LAAO group without concomitant AF ablation had a higher risk for the primary endpoint (HR [95% CI] 1.37 [1.08-1.74], p=0.009) than patients with ablation (HR [95% CI] 0.74 [0.51-1.06], p=0.097). Conclusion LAAO did not increase the risk for a combined endpoint of HF hospitalizations and HF related death in patients with AF. Patients with concomitant AF ablation might have lower risk for the combined endpoint.Figure

Association between obstructive sleep apnea and heart failure in patients with and without obesity: a population-based cohort study

Abstract Background Obstructive sleep apnea (OSA) is a prevalent disorder characterized by partial or complete airway collapse during sleep, which often leads to sleep disruption and intermittent hypoxia. Previous research has suggested that patients with heart failure (HF) are more likely to have OSA. However, not enough evidence is available for association between new-onset OSA and HF. A recent Danish cohort study found that OSA, without continuous positive airway pressure therapy, is linked to a higher risk of HF across all age groups (1). In addition, the association between OSA and HF in patients with and without obesity has not been extensively studied in a large Asian cohort. Purpose To investigate the association between obstructive sleep apnea (OSA) and heart failure (HF) in a large Asian cohort stratified by obesity, as defined by World Health Organization (WHO) criteria for the Asian population, in both patients with and without obesity. Methods Using a nationally representative cohort of Korean adults over 40 years old who underwent national health screening between 2009 and 2010 with no prior history of HF or cardiovascular disease, we identified OSA using outpatient visit records (ICD-10: G47.3). Participants were tracked from January 1, 2011 to December 31, 2019 for new HF events, death from HF or other causes, or the end of follow-up, whichever occurred first. A Cox proportional hazards model adjusted for sociodemographic factors, health status, health behavior, and family history of heart disease was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Obesity was defined as a body mass index greater than 25.0 kg/m2 based on WHO criteria for the Asian population. Results The final study population included 326,662 participants (32.7% of them were with obesity). Among obese patients, those with OSA had a higher risk of developing HF (HR=1.52; 95% CI: 1.07-2.19) than those without OSA. The association between OSA and HF was less pronounced in non-obese patients (HR=1.07; 95% CI: 0.65-1.78 for HF in patients with OSA compared to those without OSA) with a significant interaction between obesity and OSA-HF association (P-value for interaction&amp;lt;0.001). Conclusions Our findings suggest that OSA is linked to an increased risk of HF, particularly in obese patients. Further research is necessary to examine important clinical subgroups regarding prevention of HF in patients with OSA.

Sex Differences in the Development of Anthracycline-Associated Heart Failure

Female sex is frequently cited as a risk factor for anthracycline cardiotoxicity based on pediatric data, but the role of sex in the development of cardiotoxicity has not been clearly established in adults. To assess the effect of female sex on the development of incident heart failure (HF) in adult patients treated with anthracyclines. This was a retrospective cohort study of 1525 adult patients with no prior history of HF or cardiomyopathy who were treated with anthracyclines between 1992 and 2019. The primary outcome was new HF within 5 years of the first dose of anthracyclines. The effect of sex was assessed using Cox proportional hazards and competing risk models. Over a median (IQR) follow-up of 1.02 (0.30-3.01) years, 4.78% of patients developed HF (44 men and 29 women). Female sex was not associated with the primary outcome in a multivariable Cox proportional hazards model (HR 0.87; 95% CI 0.53-1.43; P = 0.58). Similar results were observed in a multivariable model accounting for the competing risk of death (HR 0.94; 95% CI 0.39-2.25; P = 0.88). Age, coronary artery disease and hematopoietic stem cell transplant were associated with the primary outcome in a multivariable Cox proportional hazards model. Age and body mass index were associated with the primary outcome in a multivariable competing risk model. In this large, single-center, retrospective cohort study, female sex was not associated with incident HF in adult patients treated with anthracyclines. Female sex is frequently cited as a risk factor for anthracycline cardiotoxicity based on pediatric data, but the role of sex in the development of cardiotoxicity has not been clearly established in adults. In this retrospective cohort study, we assessed the effect of female sex on the development of incident heart failure in adult patients treated with anthracyclines. Using Cox proportional hazards and competing risk regression models, we found that there was no association between female sex and heart failure after treatment with anthracyclines.

Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design – A population-based study

Introduction and objectivesCurrent epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. MethodsThe Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. ConclusionsThrough the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life.

Insuficiencia cardiaca en octogenarios con fibrilación auricular: incidencia y factores de riesgo

Introduction and objectivesAtrial fibrillation (AF) is linked to heart failure (HF). However, little has been published on the factors that may precipitate the onset of HF in AF patients. We aimed to determine the incidence, predictors, and prognosis of incident HF in older patients with AF with no prior history of HF. MethodsPatients with AF older than 80 years and without prior HF were identified between 2014 and 2018. ResultsA total of 5794 patients (mean age, 85.2±3.8 years; 63.2% women) were followed up for 3.7 years. Incident HF, predominantly with preserved left ventricular ejection fraction, developed in 33.3% (incidence rate, 11.5-100 people-year). Multivariate analysis identified 11 clinical risk factors for incident HF, irrespective of HF subtype: significant valvular heart disease (HR, 1.99; 95%CI, 1.73-2.28), reduced baseline left ventricular ejection fraction (HR, 1.92; 95%CI, 1.68-2.19), chronic pulmonary obstructive disease (HR, 1.59; 95%CI, 1.40-1.82), enlarged left atrium (HR 1.47, 95%CI 1.33-1.62), renal dysfunction (HR 1.36, 95%CI 1.24-1.49), malnutrition (HR, 1.33; 95%CI, 1.21-1.46), anemia (HR, 1.30; 95%CI, 1.17-1.44), permanent AF (HR, 1.15; 95%CI, 1.03-1.28), diabetes mellitus (HR, 1.13; 95%CI, 1.01-1.27), age per year (HR, 1.04; 95%CI, 1.02-1.05), and high body mass index for each kg/m2 (HR, 1.03; 95%CI, 1.02-1.04). The presence of incident HF nearly doubled the mortality risk (HR, 1.67; 95%CI, 1.53-1.81). ConclusionsThe presence of HF in this cohort was relatively frequent and nearly doubled the mortality risk. Eleven risk factors for HF were identified, expanding the scope for primary prevention among elderly patients with AF.

Declining risk of heart failure hospitalization following first acute myocardial infarction in Scotland between 1991-2016.

Mortality from acute myocardial infarction (AMI) has declined, increasing the pool of survivors at risk of later development of heart failure (HF). However, coronary reperfusion limits infarct size and secondary prevention therapies have improved. In light of these competing influences, we examined long-term trends in the risk of HF hospitalization (HFH) following a first AMI occurring in Scotland over 25 years. All patients in Scotland discharged alive after a first AMI between 1991 and 2015 were followed until a first HFH or death until the end of 2016 (minimum follow-up 1 year, maximum 26 years). A total of 175 672 people with no prior history of HF were discharged alive after a first AMI during the period of study. A total of 21 445 (12.2%) patients had a first HFH during a median follow-up of 6.7 years. Incidence of HFH (per 1000 person-years) at 1 year following discharge from a first AMI decreased from 59.3 (95% confidence interval [CI] 54.2-64.7) in 1991 to 31.3 (95% CI 27.3-35.8) in 2015, with consistent trends seen for HF occurring within 5 and 10 years. Accounting for the competing risk of death, the adjusted risk of HFH at 1 year after discharge decreased by 53% (95% CI 45-60%), with similar decreases at 5 and 10 years. The incidence of HFH following AMI in Scotland has decreased since 1991. These trends suggest that better treatment of AMI and secondary prevention are having an impact on the risk of HF at a population level.

Heart failure in older patients with atrial fibrillation: incidence and risk factors

Introduction and objectivesAtrial fibrillation (AF) is linked to heart failure (HF). However, little has been published on the factors that may precipitate the onset of HF in AF patients. We aimed to determine the incidence, predictors, and prognosis of incident HF in older patients with AF with no prior history of HF. MethodsPatients with AF older than 80 years and without prior HF were identified between 2014 and 2018. ResultsA total of 5794 patients (mean age, 85.2±3.8 years; 63.2% women) were followed up for 3.7 years. Incident HF, predominantly with preserved left ventricular ejection fraction, developed in 33.3% (incidence rate, 11.5-100 people-year). Multivariate analysis identified 11 clinical risk factors for incident HF, irrespective of HF subtype: significant valvular heart disease (HR, 1.99; 95%CI, 1.73-2.28), reduced baseline left ventricular ejection fraction (HR, 1.92; 95%CI, 1.68-2.19), chronic pulmonary obstructive disease (HR, 1.59; 95%CI, 1.40-1.82), enlarged left atrium (HR 1.47, 95%CI 1.33-1.62), renal dysfunction (HR 1.36, 95%CI 1.24-1.49), malnutrition (HR, 1.33; 95%CI, 1.21-1.46), anemia (HR, 1.30; 95%CI, 1.17-1.44), permanent AF (HR, 1.15; 95%CI, 1.03-1.28), diabetes mellitus (HR, 1.13; 95%CI, 1.01-1.27), age per year (HR, 1.04; 95%CI, 1.02-1.05), and high body mass index for each kg/m2 (HR, 1.03; 95%CI, 1.02-1.04). The presence of incident HF nearly doubled the mortality risk (HR, 1.67; 95%CI, 1.53-1.81). ConclusionsThe presence of HF in this cohort was relatively frequent and nearly doubled the mortality risk. Eleven risk factors for HF were identified, expanding the scope for primary prevention among elderly patients with AF.

Association Between Pulmonary Hypertension and Its Effect on 30-Day Mortality, Readmission, and Cost After Transcatheter Aortic Valve Replacement: A Multicenter Study.

Background Pulmonary hypertension (PH) is commonly seen in patients with severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) has been shown to improve PH, however, its impact on clinical outcomes and cost remains unclear. Methods We did a multicenter, retrospective analysis of patients undergoing TAVR in our system between December 2012 to November 2020. The initial sample size was 1356. We excluded patients with prior history of heart failure, with a left ventricular ejection fraction of 40% or less, and patients who had active symptoms of heart failure within two weeks of the procedure. Patients were divided into four groups based on their pulmonary pressures, using right ventricular systolic pressure (RVSP) as a surrogate for PH. Groups included patients with normal pulmonary pressures (<35mmHg), mild (35-45mmHg) moderate (46-60mmHg), and severe PH (>60mmHg). Primary outcomes included 30-day mortality and readmission. Secondary outcomes included length of ICU stay and cost of admission. We used Chi-square and T-tests for demographic analysis of categorical continuous variables respectively. Adjusted regression was used for the reliability of correlation between variables. Multivariate analysis was used for final outcomes. Results Final sample size was 474. Average age was 78.9 years (SD: 8.2, 53% Male). Thirty-one percent (n=150) had normal pulmonary pressures, 33% (n=156) had mild PH, 25% (n=122) had moderate and 10% (n=46) had severe PH. Patients with history of hypertension (p-value<0.001), diabetes (p-value<0.001), chronic lung disease (p-value=0.006) and those on supplemental oxygen (p-value=0.046), had significantly higher proportion of patients with moderate and severe PH. We found significantly higher odds of 30-day mortality in patients with severe PH (OR: 6.77, CI: 1.09-41.98: p-value 0.04) compared with normal or mild PH. There was no significant difference in 30-day readmission (p-value=0.859) between the four groups. Cost did not change with severity of PH (Avg: $261,075: p-value=0.810). Patients with severe PH spent a significantly higher number of hours in ICU, compared with the other three groups (Mean: 18.2, p=value <0.001). Conclusions Severe pulmonary hypertension significantly increased the odds of 30-day mortality and ICU stay in TAVR patients. We did not see any significant difference in 30-day readmission and cost of admission, based on PH severity.

Post-operative atrial fibrillation and risk of heart failure hospitalization.

Post-operative atrial fibrillation (POAF) is associated with stroke and mortality. It is unknown if POAF is associated with subsequent heart failure (HF) hospitalization. This study aims to examine the association between POAF and incident HF hospitalization among patients undergoing cardiac and non-cardiac surgeries. A retrospective cohort study was conducted using all-payer administrative claims data that included all non-federal emergency department visits and acute care hospitalizations across 11 states in the USA. The study population included adults aged at least 18 years hospitalized for surgery without a prior diagnosis of HF. Cox proportional hazards regression models were used to examine the association between POAF and incident HF hospitalization after making adjustment for socio-demographics and comorbid conditions. Among 76 536 patients who underwent cardiac surgery, 14 365 (18.8%) developed incident POAF. In an adjusted Cox model, POAF was associated with incident HF hospitalization [hazard ratio (HR) 1.33; 95% confidence interval (CI) 1.25-1.41]. In a sensitivity analysis excluding HF within 1 year of surgery, POAF remained associated with incident HF hospitalization (HR 1.15; 95% CI 1.01-1.31). Among 2 929 854 patients who underwent non-cardiac surgery, 23 763 (0.8%) developed incident POAF. In an adjusted Cox model, POAF was again associated with incident HF hospitalization (HR 2.02; 95% CI 1.94-2.10), including in a sensitivity analysis excluding HF within 1 year of surgery (HR 1.49; 95% CI 1.38-1.61). Post-operative atrial fibrillation is associated with incident HF hospitalization among patients without prior history of HF undergoing both cardiac and non-cardiac surgeries. These findings reinforce the adverse prognostic impact of POAF and suggest that POAF may be a marker for identifying patients with subclinical HF and those at elevated risk for HF.

META-ANALYSIS ASSESSING THE IMPACT OF PRIOR HEART FAILURE AND CHRONIC KIDNEY DISEASE ON THE CARDIOVASCULAR EFFICACY OF GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS

Objective: Chronic kidney disease (CKD) and heart failure (HF) represent common co-morbidities in patients with type 2 diabetes mellitus (T2DM), constituting an additional burden that boosts overall morbidity and mortality. Therefore, we sought to determine whether history of HF or CKD affects the cardiovascular efficacy of GLP-1RAs, also utilizing data from the recently published FREEDOM Cardiovascular Outcomes Trial, which evaluated the cardiovascular safety of delivering a continuous subcutaneous infusion of the GLP-1RA exenatide (ITCA 650) in T2DM. Design and method: We searched the relevant, hallmark, cardiovascular outcome trials of GLP-1RAs in T2DM. We set as primary efficacy outcome the effect of GLP-1RAs versus placebo on the risk for a major adverse cardiovascular event (MACE) according to the prior history of HF, while we also assessed as a secondary efficacy outcome the effect of GLP-1RAs on the risk for MACE according to a prior diagnosis of CKD. Results: We finally pooled data from 4 trials for a total of 26,272 enrolled participants with T2DM. Regarding the primary efficacy outcome, we demonstrated that GLP-1RAs versus placebo resulted in a significant decrease by 14% (RR = 0.86, 95% CI; 0.76 – 0.97, I2 = 50%), regardless of history of HF (p-value for subgroup differences = 0.88). Concerning the secondary efficacy outcome, we showed that GLP-1RA treatment was superior to placebo in reducing the risk for a MACE (RR = 0.87, 95% CI; 0.75 – 1.02, I2 = 70%), while prior status of CKD did not affect the generated results (p-value for subgroup differences = 1.00). Conclusions: GLP-1RAs seem to constitute a safe and efficacious treatment option in patients with T2DM and established or at high risk for atherosclerotic cardiovascular disease, while HF or CKD status at baseline do not substantially affect the observed cardio-protective effect against hard cardiovascular endpoints.

Epidemiology of atrial fibrillation in the All of Us Research Program.

The prevalence, incidence and risk factors of atrial fibrillation (AF) in a large, geographically and ethnically diverse cohort in the United States have not been fully described. We analyzed data from 173,099 participants of the All of Us Research Program recruited in the period 2017-2019, with 92,318 of them having electronic health records (EHR) data available, and 35,483 having completed a medical history survey. Presence of AF at baseline was identified from self-report and EHR records. Incident AF was obtained from EHR. Demographic, anthropometric and clinical risk factors were obtained from questionnaires, baseline physical measurements and EHR. At enrollment, mean age was 52 years old (range 18-89). Females and males accounted for 61% and 39% respectively. Non-Hispanic Whites accounted for 67% of participants, with non-Hispanic Blacks, non-Hispanic Asians and Hispanics accounting for 26%, 4% and 3% of participants, respectively. Among 92,318 participants with available EHR data, 3,885 (4.2%) had AF at the time of study enrollment, while the corresponding figure among 35,483 with medical history data was 2,084 (5.9%). During a median follow-up of 16 months, 354 new cases of AF were identified among 88,433 eligible participants. Individuals who were older, male, non-Hispanic white, had higher body mass index, or a prior history of heart failure or coronary heart disease had higher prevalence and incidence of AF. The epidemiology of AF in the All of Us Research Program is similar to that reported in smaller studies with careful phenotyping, highlighting the value of this new resource for the study of AF and, potentially, other cardiovascular diseases.

Abstract 11261: Impact of Baseline Heart Failure on RV:LV Diameter Ratio in Patients with Acute Pulmonary Embolism

Introduction: Among patients with acute pulmonary embolism (PE), an elevated right ventricular to left ventricular diameter (RV:LV) ratio is associated with increased morbidity and mortality. RV:LV cut-offs used to identify PE patients at elevated risk for adverse events range from 0.9-1.0. It is unclear whether this cut-off should be used for PE risk stratification among patients with heart failure (HF), who may have abnormal cardiac chamber dimensions. Methods: Patients diagnosed with acute PE between 2010 and 2015 at the University of Toledo Medical Center were identified. Patients were categorized as: no HF, heart failure with reduced ejection fraction (HFrEF), and heart failure with preserved ejection fraction (HFpEF). No HF was defined as having no prior history of HF and an ejection fraction (EF) ≥ 50%. HFrEF was defined as history of HF and an EF &lt; 50%. HFpEF was defined as history of HF and an EF ≥ 50%. Results: One hundred and eighty-three patients were identified for this study. Twelve patients were excluded due to missing EF records. Among the remaining 171 patients, 142 were categorized as no HF, 13 were categorized as HFrEF, and 16 were categorized as HFpEF. There were no significant differences in mean RV diameter between HFrEF [39.1 mm, standard deviation (SD) ± 5.9], no HF [36.9 mm, SD ± 7.5], or HFpEF [38.5 mm, SD ± 6.6] (p=0.575). However, mean LV diameter among patients with HFrEF was significantly higher [52.2 mm, SD ± 7.2] compared to no HF [38.1 mm, SD ± 8.3] and HFpEF [42.1 mm, SD ± 6.6] (p&lt;0.001). Median RV:LV ratio was 0.77 [interquartile range (IQR) 0.65-0.89] for HFrEF, 0.91 [IQR 0.79-1.17] for no HF, and 0.89 [IQR 0.80-1.04] for HFpEF (p=0.024). Conclusions: Patients with HFrEF who presented to the hospital with acute PE had significantly higher mean LV diameter and lower RV:LV ratio compared to patients with HFpEF or no HF. These results suggest that risk stratification using current RV:LV ratio guidelines may underestimate PE risk among patients with HFrEF.

Abstract 11238: Impact of Baseline Heart Failure and Heart Failure Subtype on Brain Natriuretic Peptide Levels in Patients with Acute Pulmonary Embolism

Introduction: Among patients with acute pulmonary embolism (PE), elevated levels of brain natriuretic peptide (BNP) correlate with right ventricular dysfunction and increased morbidity and mortality. Suggested BNP cut-offs for PE risk stratification in the general population range from 90-100 pg/mL. It is unclear whether this BNP cut-off should be used for PE risk stratification among patients with heart failure (HF), who may have elevated BNP at baseline. Methods: Patients diagnosed with acute PE between 2010 and 2015 at the University of Toledo Medical Center were identified. Patients were categorized as: no HF, heart failure with reduced ejection fraction (HFrEF), or heart failure with preserved ejection fraction (HFpEF). No HF was defined as having no prior history of HF and an ejection fraction (EF) ≥ 50%. HFrEF was defined as history of HF and an EF &lt; 50%. HFpEF was defined as history of HF and an EF ≥ 50%. HF was defined as subjects with HFrEF or HFpEF. Results: One hundred and eighty-three patients with acute PE were identified for this study. One hundred and forty-two patients were classified as no HF (median BNP 112 [interquartile range (IQR) 49-355] pg/mL), while 41 were classified as HF (median BNP 422 [IQR 179-940] pg/mL) (p&lt;0.0001). When HF was further sub-categorized, we found significant differences in BNP levels between subjects with HFrEF (median BNP 923 [IQR 464-2296] pg/mL) vs. subjects with HFpEF (median BNP 247 [IQR 88-726] pg/mL) (p=0.002). Median BNP among patients with HFrEF was significantly higher compared to patients with no HF (p&lt;0.0001). Median BNP among patients with HFpEF was not significantly different compared to patients with no HF (p=0.416). Conclusions: Patients with HFrEF who present to the hospital with acute PE have significantly higher median BNP compared to patients with HFpEF or no HF. These results suggest that risk stratification for PE using current BNP cut-off guidelines may not be optimal for patients with HFrEF.

Abstract 13174: Female Sex is Not Associated With Subsequent Heart Failure in Adult Patients Treated With Anthracyclines

Introduction and Hypothesis: Female sex has long been considered a risk factor for anthracycline-associated cardiotoxicity, based largely on data in childhood cancer survivors. However, preclinical experiments suggest that female sex hormones present in adulthood may protect against doxorubicin cardiotoxicity. We therefore hypothesized that female sex would be associated with a decreased odds of heart failure in adult patients treated with anthracyclines. Methods: We conducted a retrospective cohort study of 871 adult patients (44% women and 56% men) at our medical center with no prior history of heart failure who were treated with anthracyclines for non-hormone-dependent malignancies including lymphoma, leukemia, and sarcoma. Patients who expired during the study period were excluded. The presence or absence of heart failure within five years of initiation of anthracyclines was assessed using ICD-9/10 codes. Logistic regression models were used to assess odds ratios based on self-reported sex and other covariates, adjusting for age. Results: Baseline characteristics were similar in men and women, including age, total cumulative anthracycline dose, and prevalence of cardiovascular comorbidities such as hypertension, diabetes, and coronary artery disease. The odds of heart failure increased modestly with age (OR: 1.02; 95% CI: 1.01 to 1.03, p = 0.001). In an age-adjusted model, female sex was not associated with subsequent heart failure (OR: 1.03, 95% CI 0.72 to 1.47, p = 0.88), including after stratification by age ≤ 50 years or &gt; 50 years as a surrogate for menopausal status. Conclusions: In this retrospective cohort study, female sex was not associated with heart failure in adult patients treated with anthracyclines for non-hormone-dependent tumors. These findings diverge from prior reports suggesting an increased risk of cardiotoxicity in women. Future studies will assess the competing risks of cancer and cardiovascular disease/death in men versus women treated with anthracyclines.

Relationship between the ideal cardiovascular health behaviors and factors and newonset heart failure

Objective: To explore the relationship between the ideal cardiovascular health behaviors and factors and newonset heart failure. Methods: It was a prospective cohort study. People who attended the 2006-2007 physical examination of Kailuan Group Company and with complete data of cardiovascular behaviors and related factors were eligible for this study. A total of 95 167 participants who were free of valvular heart diseases, congenital heart diseases and a prior history of heart failure were included. Basic cardiovascular health score (CHS) of each participant was calculated. Participants were divided into 3 groups according to CHS. Group 1:CHS<8 (n=26 640), Group 2:8≤CHS<10 (n=35 230), Group3:CHS≥10 (n=33 297). The general clinical data and laboratory test results were collected. The outcome was defined as the first occurrence of heart failure at the end of followup(December 31, 2016). Cox regression model was used to determine the association between baseline CHS and the risk of newonset heart failure. Results: After a median followup of 10.3 years, the incidence of newonset heart failure in the group of CHS<8,8≤CHS<10,CHS≥10 were 2.7%(729/26 640), 1.8%(651/35 230) and 1.1%(360/33 297),respectively. After adjustment for age, sex, history of myocardial infarction, history of atrial fibrillation, income, alcohol consumption, education and the use of antihypertensive, cholesterol-lowering, glucose-lowering medications, compared with the group of CHS<8, the Cox regression model showed that HRs of the group of 8≤CHS<10 and CHS≥10 were 0.68 (95%CI 0.61-0.75), 0.49 (95%CI 0.43-0.55), respectively. Cox regression analysis after removing each single cardiovascular behavior or factor showed that the HR value range ability was as follows:systolic blood pressure(HR=0.78,95%CI 0.74-0.82), body mass index(HR=0.78,95%CI 0.74-0.82), fasting blood glucose (HR=0.77,95%CI 0.73-0.81), total cholesterol(HR=0.76,95%CI 0.72-0.80), physical exercise(HR=0.72,95%CI 0.69-0.76), smoking(HR=0.75,95%CI 0.71-0.79) and salt intake(HR=0.73,95%CI 0.69-0.77). Conclusion: CHS is negatively associated with the risk of newonset heart failure, and there is a dose-response relationship between the two indexes.

Admission NT-proBNP and outcomes in patients without history of heart failure hospitalized with COVID-19.

AimsWe examined the value of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in patients admitted for coronavirus disease 2019 (COVID‐19) without prior history of heart failure (HF) or cardiomyopathy.Methods and resultsRetrospective cohort of consecutive adults (N = 679; median age 59 years; 38.7% women; 87.5% White; 7.1% Black; 5.4% Asian; 34.3% Hispanic) admitted with documented COVID‐19 in an academic centre in Long Island, NY. Admission NT‐proBNP was categorized using the European Society of Cardiology Heart Failure Association age‐specific criteria for acute presentations. We examined (i) mortality and the composite of death or mechanical ventilation and (ii) out‐of‐hospital, intensive care unit (ICU)‐free, and ventilator‐free days at 28 days. Estimates were adjusted for confounders using a lasso selection process. Using age‐specific criteria, 417 patients (61.4%) had low, 141 (20.8%) borderline, and 121 (17.8%) high NT‐proBNP. Mortality was 5.8%, 20.6%, and 36.4% for patients with low, borderline, and high NT‐proBNP, respectively. In lasso‐adjusted models, high NT‐proBNP was associated with higher mortality [hazard ratio (HR) 2.15; 95% confidence interval (CI) 1.06–4.39; P = 0.034] and composite endpoint rates (HR 1.66; 95%CI 1.04–2.66; P = 0.035). Patients with high NT‐proBNP had 32%, 33%, and 33% fewer out‐of‐hospital, ICU‐free, and ventilator‐free days compared with low NT‐proBNP counterparts. Results were consistent across age, sex, and race, and regardless of coronary artery disease or hypertension, except for stronger mortality signal with high NT‐proBNP in women.ConclusionsIn patients with COVID‐19 and no HF history, high admission NT‐proBNP is associated with higher mortality and healthcare resources utilization. Preventive strategies may be required for these patients.