Risk Of Heart Failure Mortality Research Articles

Non-thyroidal illness syndrome and the prognosis of heart failure: a systematic review and meta-analysis

Heart failure (HF) is a complex and multifactorial syndrome caused by impaired heart function. The high morbidity and mortality of HF cause a heavy burden of illness worldwide. Non-thyroidal illness syndrome (NTIS) refers to aberrant serum thyroid parameters in patients without past thyroid disease. Observational studies have indicated that NTIS is associated with a higher risk of all-cause mortality in HF. This meta-analysis aimed to investigate the association between NTIS and HF prognosis. Medline, Embase, Web of Science, and the Cochrane database were searched for any studies reporting an association between NTIS and HF prognosis from inception to July 1st 2022. A meta-analysis was then performed. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). The heterogeneity of the results was assessed with I2 and Cochran's Q statistics. Sensitivity analysis and publication bias analysis were also conducted. A total of 626 studies were retrieved, and 18 studies were finally included in the meta-analysis. The results showed that NTIS in HF patients was significantly associated with an increased risk of all-cause mortality and major cardiovascular events (MACE), but not with in-hospital mortality. The stability of the data was validated by the sensitivity analysis. There was no indication of a publication bias in the pooled results for all-cause mortality and MACE. This meta-analysis showed that NTIS was associated with a worse outcome in HF patients. However, the association between NTIS and in-hospital mortality of HF patients requires further investigation.

Structural Model of Biomedical and Contextual Factors Predicting In-Hospital Mortality due to Heart Failure.

Background: Among the clinical predictors of a heart failure (HF) prognosis, different personal factors have been established in previous research, mainly age, gender, anemia, renal insufficiency and diabetes, as well as mediators (pulmonary embolism, hypertension, chronic obstructive pulmonary disease (COPD), arrhythmias and dyslipidemia). We do not know the role played by contextual and individual factors in the prediction of in-hospital mortality. Methods: The present study has added hospital and management factors (year, type of hospital, length of stay, number of diagnoses and procedures, and readmissions) in predicting exitus to establish a structural predictive model. The project was approved by the Ethics Committee of the province of Almeria. Results: A total of 529,606 subjects participated, through databases of the Spanish National Health System. A predictive model was constructed using correlation analysis (SPSS 24.0) and structural equation models (SEM) analysis (AMOS 20.0) that met the appropriate statistical values (chi-square, usually fit indices and the root-mean-square error approximation) which met the criteria of statistical significance. Individual factors, such as age, gender and chronic obstructive pulmonary disease, were found to positively predict mortality risk. Isolated contextual factors (hospitals with a greater number of beds, especially, and also the number of procedures performed, which negatively predicted the risk of death. Conclusions: It was, therefore, possible to introduce contextual variables to explain the behavior of mortality in patients with HF. The size or level of large hospital complexes, as well as procedural effort, are key contextual variables in estimating the risk of mortality in HF.

Temporal variation in the association between temperature and cause-specific mortality in 15 German cities

BackgroundThere is limited evidence of temporal changes in the association between air temperature and the risk of cause-specific cardiovascular [CVD] and respiratory [RD] mortality. MethodWe explored temporal variations in the association between short-term exposures to air temperature and non-accidental and cause-specific CVD and RD mortality in the 15 largest German cities over 24 years (1993–2016) using time-stratified time series analysis. We applied location-specific confounder-adjusted Poisson regression with distributed lag non-linear models with a lag period of 14 days to estimate the temperature–mortality associations. We then pooled the estimates by a multivariate meta-analytical model. We analysed the whole study period and the periods 1993–2004 and 2005–16, separately. We also carried out age- and sex-stratified analysis. Cold and heat effects are reported as relative risk [RR] at the 1st and the 99th temperature percentile, relative to the 25th and the 75th percentile, respectively. ResultWe analysed a total of 3,159,292 non-accidental, 1,063,198 CVD and 183,027 RD deaths. Cold-related RR for CVD mortality was seen to rise consistently over time from 1.04 (95% confidence interval [95% CI] 1.02, 1.06) in the period 1993–2004 to 1.10 (95% CI 1.09, 1.11) in the period 2005–16. A similar increase in cold-related RR was also observed for RD mortality with risk increasing from 0.99 (95% CI 0.96, 1.03) to 1.07 (95% CI 1.03, 1.10). Cold-related ischemic, cerebrovascular, and heart failure mortality risk were seen to be increasing over time. Similarly, COPD, the commonly speculated driver of heat-related RD mortality was found to have a constant heat-related risk over time. Males were increasingly vulnerable to cold with time for all causes of death. Females showed increasing sensitivity to cold for CVD mortality. Our results indicated a significant increased cold and heat vulnerability of the youngest age-groups (<64) to non-accidental and RD mortality, respectively. Similarly, the older age group (>65) were found to have significantly increased susceptibility to cold for CVD mortality. ConclusionWe found evidence of rising population susceptibility to both heat- and cold-related CVD and RD mortality risk from 1993 to 2016. Climate change mitigation and targeted adaptation strategies might help to reduce the number of temperature-related deaths in the future.

Abstract P177: Circulating Ketone Bodies and Mortality in Heart Failure: A Community Cohort Study

Background: Heart failure (HF) is associated with metabolic alterations, including ketogenesis. However, determinants of ketogenesis and risk of mortality in HF is not defined. Total ketone bodies (KB) include β-hydroxybutyrate, acetoacetate, and acetone and can be measured in plasma by nuclear magnetic resonance (NMR). The aim of this study is to determine the relationship between KB and clinical characteristics in a community HF cohort and to assess the association between KB and all-cause mortality. Methods: A population-based cohort of 1,389 HF patients was prospectively enrolled between 2003 and 2012. Plasma KB was measured by LP4 NMR LipoProfile ® assay/test on the Vantera® NMR analyzer platform. A conditional inference tree method (ctree R Package) was used to determine optimal KB group cut points. Associations between clinical characteristics and KB were measured with Wilcoxon rank sum test and Pearson’s Chi-squared test. Kaplan-Meier method estimated survival. Cox regression analyses were used to estimate associations between KB concentrations and mortality. Results: Among the 1,382 HF patients with KB measurements, the median age was 78 years (IQR 68-84) and 52% were men. Median KB was 180 μM (IQR 134-308). Patients were divided into two groups with lower KB (≤471.5 μM) and higher KB (&gt;471.5 μM). Patients with higher KB (N=210) had lower BMI, higher BNP, and were more likely to be in the New York Heart Association class III-IV; however, these patients were less likely to have hyperlipidemia, coronary disease, or diabetes mellitus (P &lt; 0.05). Age, sex, creatinine, ejection fraction, or Meta-Analysis Global Group in Chronic HF (MAGGIC) score did not differ by KB group. Higher KB was associated with worse survival (figure). After adjustment for the MAGGIC score, higher KB was associated with increased risk of mortality (HR 1.3; 95% CI, 1.08-1.48). Conclusions: In this community HF cohort, higher KB was associated with increased mortality, independent of the MAGGIC score.

Associations between rheumatoid arthritis, incident heart failure, and left ventricular ejection fraction

Rheumatoid arthritis (RA) is an independent risk factor for heart failure (HF). Yet, the association between RA and left ventricular ejection fraction (LVEF) in incident HF is not well studied, nor are outcomes of HF in RA by LVEF. We identified incident HF patients between 2003 and 2018 through the Swedish Heart Failure Registry, enriched with data from national health registers. Using logistic regression, associations between a prior diagnosis of RA and LVEF among HF patients and vs age, sex, and geographical area matched general population controls without HF were assessed. Additionally, associations between HF with vs without a prior diagnosis of RA, by LVEF, and outcomes up to 5 years after HF diagnosis were investigated using Cox regression. LVEF was primarily dichotomized at 40% and secondarily categorized as <40%, 40% to 49%, and ≥50%. Covariates included demographics and cardiovascular comorbidities. Among 20,916 incident HF patients, 331 (1.6%) had RA vs 1,047/103,501 (1.0%) of HF-free controls. The odds ratio (OR) for RA was 1.4 (95% CI: 1.1-1.8) in LVEF<40% vs HF-free controls and 1.6 (95% CI: 1.3-2.0) in LVEF≥40% vs HF-free controls. Among HF patients, RA was more common in HF with LVEF ≥40% (1.9%) vs LVEF<40% (1.3%), corresponding to OR 1.4 (95% CI: 1.1-1.7). No associations between RA and cardiovascular outcomes were observed across LVEF. An association between RA and all-cause mortality was observed only for patients with LVEF<40% (hazard ratio: 1.4; 95% CI: 1.1-1.8). RA was independently associated with incident HF, particularly HF with LVEF≥40%. RA did not associate with cardiovascular outcomes following HF diagnosis but was associated with increased risk of all-cause mortality in HF with LVEF<40%.

A Common Variant of ARRB2 Promoter Region Associated with the Prognosis of Heart Failure

Introduction: The role of ARRB2 in cardiovascular disease has recently gained increasing attention. However, the association between ARRB2 polymorphisms and heart failure (HF) has not yet been investigated. Methods: A total of 2,386 hospitalized patients with chronic HF were enrolled as the first cohort and followed up for a mean period of 20.2 months. Meanwhile, ethnically and geographically matched 3,000 individuals without evidence of HF were included as healthy controls. We genotyped the common variant in ARRB2 gene to identify the association between variant and HF. A replicated independent cohort enrolling 837 patients with chronic HF was applied to validate the observed association. A series of function analyses were conducted to illuminate the underlying mechanism. Results: We identified a common variant rs75428611 associated with the prognosis of HF in two-stage population: adjusted p = 0.001, hazard ratio (HR) = 1.31 (1.11–1.54) in additive model and adjusted p = 0.001, HR = 1.39 (1.14–1.69) in dominant model in first-stage population; adjusted p = 0.04, HR = 1.41 (1.02–1.95) in additive model and adjusted p = 0.03, HR = 1.51 (1.03–2.20) in dominant model in replicated stage. However, rs75428611 did not significantly associate with the risk of HF. Functional analysis indicated that rs75428611‐G allele increased the promoter activity and the mRNA expression level of ARRB2 by facilitating transcription factor SRF binding but not the A allele. Conclusions: Our findings demonstrated that rs75428611 in promoter of ARRB2 was associated with the risk of HF mortality. It is a promising potential treatment target for HF.

PS-C24-2: SYSTOLIC BLOOD PRESSURE AND MORTALITY IN ELDERLY PATIENTS WITH HEART FAILURE

Background: Optimal blood pressure levels in elderly patients are controversial. Our previous results demonstrated that systolic blood pressure (SBP) lowering to less than 140 mmHg might not improve the prognosis in elderly hypertensive patients with frailty. Optimal blood pressure levels for elderly patients with heart failure (HF) have not yet been established. Objective: To examine the association between SBP level and mortality in elderly outpatients with or without HF. Design and setting and participants: A prospective cohort study of older patients in an outpatient setting in Okinawa (Nambu Cohort Study) included 630 patients. Data were collected from 2017 to 2021. Patients were stratified into four categories according to SBP levels of more or less than 140mmHg and presence or absence of HF. Results: A total of 630 patients, with a median (IQR) age of 78 (71 - 84) years and 50% of whom were men, were followed for a median duration of 42 (34 - 43) months. 56% of them had SBP less than 140 mmHg, and 21% were diagnosed as HF. All-cause mortality occurred in 39 (11%) and 31 (11%) of patients with SBP less than 140 mmHg vs. SBP more than 140 mmHg, respectively (HR 1.02, 95%CI 0.64 - 1.65). Likewise, 32 (24%) and 38 (8%) of patients with HF vs. without HF were dead, respectively (HR 3.75, 95% CI 2.33 - 6.00). Adjusted HR (95%CI) for all-cause death of each category patients was as follows; SBP less than 140 mmHg / Non-HF (Reference), SBP more than 140mmHg / Non-HF 1.41 (0.74 - 2.71), SBP less than 140 mmHg / HF 2.71 (1.40 - 5.29), SBP more than 140mmHg / HF 3.75 (1.67 - 8.09) (Figure). Conclusion: In an elderly outpatient setting, an SBP level of more than 140mmHg was likely associated with an increased risk of all-cause mortality in HF and non-HF patients but not statistically significant. On the other hand, HF was associated with increased mortality risk.

Baseline mitochondrial DNA copy number and heart failure incidence and its role in overall and heart failure mortality in middle-aged women.

Heart failure (HF) is a leading cause of death in both men and women. However, risk factors seem to differ for men and women and significant gaps in sex-specific knowledge exist. Mitochondria are critical for cardiomyocytes and in this study, we investigated the role of baseline mitochondrial DNA copy number (mtDNA-CN) in HF incidence in middle-aged women and its possible role in the association between myocardial infarction (MI) and HF. Finally, we also investigated whether baseline mtDNA-CN was associated with overall and HF mortality. Baseline levels of mtDNA-CN were quantified by droplet digital PCR in a population-based follow-up study of middle-aged (50-59 years) Swedish women (n = 2,508). The median follow-up period was 17 years. Levels of mtDNA-CN were associated with age, BMI, alcohol, smoking, education, physical activity and lipid biomarkers. Multivariable Cox regression analysis adjusted for potential confounders showed that each standard deviation decrease of baseline mtDNA-CN was associated with higher incidence of HF (HR = 1.34; 95% CI=1.11-1.63). Similar results were obtained when mtDNA-CN levels were categorized into quartiles with lowest vs. highest quartile showing the highest risk of HF incidence (HR = 2.04 95% CI=1.14; 3.63). We could not detect any role of mtDNA-CN in the association between MI and HF incidence. Lower baseline mtDNA-CN levels were associated with both overall (HR = 1.27; 95% CI=1.10-1.46) and HF mortality (HR = 1.93; 95% CI=1.04-3.60); however, in multivariable analysis adjusted for potential confounders, the higher risks of HF mortality were no longer significant (HR=1.57; 95% CI=0.85-2.90). In conclusion, low baseline mtDNA-CN is an easily quantifiable molecular risk factor for HF incidence and may be a risk factor for overall and HF-related mortality.

MR-proADM is a strong independent predictor of long-term all-cause mortality risk in patients with chronic heart failure: results from the E-INH study

Abstract Background Mid-regional proadrenomedullin (MR-proADM) is a blood biomarker indicating critical illness. Its short-term prognostic relevance has been investigated in several conditions including heart failure (HF). Yet, the long-term prognostic utility is unknown. Methods We conducted a post-hoc analysis of the Extended Interdisciplinary Network for Heart Failure (E-INH) study, which investigated the long-term effects of a HF nurse-led remote patient care program (HeartNetCare-HFTM [HNC]). Patients from nine regional centers in Germany hospitalized with HF and a left ventricular ejection fraction (LVEF) &amp;lt;40% were randomized into HNC vs. Usual Care. MR-proADM and other standard biomarkers for disease progression and systemic inflammation were measured from venous blood collected at study inclusion, i.e. during index hospitalization. The prognostic utility was assessed using Kaplan-Meier plots and Cox proportional hazard models, and compared with other biomarkers by ROC curves. Results From 919 out of the 1022 recruited patients (90%), baseline levels of MR-proADM were available: median MR-proADM 0.89 (quartiles 0.63, 1.28) nmol/l; mean age 68±12 years; 28% women; 45% in class III or IV of the New York Heart Association (NYHA) classification. Median LVEF was 31 (25, 37) %. Median levels of NT-proBNP, high sensitive C-reactive protein (hsCRP), tumor necrosis factor (TNF)-a, and interleukin-6 (IL-6) were 3045 (1087, 7759) pg/ml, 9.2 (3.3, 25.2) mg/l, 13.4 (10.4, 17.5) pg/ml, and 4.9 (2.0, 11.4) pg/ml, respectively. Higher levels of MR-proADM at baseline were associated with age, female sex, NYHA class, NT-proBNP, hsCRP, IL-6, and TNF-α, while there was an inverse association with LVEF. In the course of 10 years of follow-up, 691 (68%) patients died. Unadjusted MR-proADM strongly predicted all-cause death when used as a continuous variable (HR 1.31 per nmol/l, 95% CI 1.26–1.37; p&amp;lt;0.001) or when grouped into quartiles (HR 1.85, 95% CI 1.71–2.0; p&amp;lt;0.001). Adjustments for age, sex and NYHA functional class did not materially alter the strong association. Plotting quartiles of MR-proADM in a Kaplan-Meier curve (see Figure 1) confirmed this findings. As shown in Figure 2, MR-proADM had the highest area under the curve (AUC) in ROC analysis when compared to other biomarkers. Conclusion MR-proADM appears to be a strong and independent predictor for long-term all-cause mortality risk in HF with reduced ejection fraction (HFrEF). Therefore, assessing MR-proADM may contribute to better categorization of risk and tailored care. Its clinical utility needs to be investigated in future studies. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): BMBF

P1514: MULTI-PARAMETRIC CARDIAC MAGNETIC RESONANCE FOR RISK PREDICTION OF HEART FAILURE DEATH IN THALASSEMIA MAJOR

Background: Iron-induced heart failure (HF) is the main cause of mortality in patients with thalassemia major (TM). Cardiovascular Magnetic Resonance (CMR) plays a key role in the management of these patients, assessing myocardial iron overload (MIO), biventricular function, and myocardial fibrosis. Aims: We evaluated the prognostic value of CMR parameters in predicting death for HF. Methods: We followed prospectively 1681 white TM patients who performed a baseline CMR exam within the Myocardial Iron Overload in Thalassemia (MIOT) network. All prognostic variables associated with the outcome at the univariate Cox model were placed in the multivariate model and were ruled out if they did not significantly improve the adjustment. Results: At baseline the mean age was 31.11±9.01 years and 874 (52.0%) patients were females. During a mean follow-up of 4.76±2.07 years, 47.3% of the patients changed at least once the chelation regimen, that is switched to a different type of chelator or underwent dose/frequency modification. Sixteen (1.0%) patients died for heart failure. No association was detected between age or gender and HF mortality. Patients who died for HF had significantly lower baseline global heart T2* values (19.45±15.11 ms vs 29.52±12.02 ms, P=0.006) and significantly higher baseline MR liver iron concentration (LIC) values (19.17±15.95 mg/g dw vs 8.72±10.63 mg/g dw, P=0.005) than patients still alive or died for a different cause, but the presence of a pathologic MRI LIC (>3 mg/g dw) was not associated with an increased risk of HF mortality. Heart iron, ventricular dysfunction, and ventricular dilatation were significant univariate prognosticators. In the multivariate analysis the independent predictive factors were a global heart T2*<10 ms (compared to a global heart T2*≥20 ms) (hazard ratio-HR=5.38, 95%CI=1.79-16.22, P=0.003) and ventricular dilatation (HR=4.59, 95%CI=1.55-13.59, P=0.006). The Figure shows the Kaplan–Meier survival curves. The log-rank test revealed a significant difference in the curves for each predictor (severe MIO: P<0.0001 and ventricular dilatation: P<0.0001). Image:Summary/Conclusion: We detected few HF deaths thanks to a MR-guided patient-specific adjustment of the chelation therapy. Severe MIO and ventricular dilatation identified TM patients at high risk for heart failure death. So, a widespread program using CMR exploiting its multi-parametric potential can have considerable power for further opening the prognosis of TM patients.

Abstract MP77: Circulating Magnesium And Risk Of Major Adverse Cardiac Events Among Patients With Atrial Fibrillation In The Aric Cohort

Background: Serum magnesium (Mg) has been reported to be inversely associated with the risk of atrial fibrillation (AF), coronary artery disease (CAD), and major adverse cardiovascular events (MACE). However, whether high serum Mg is associated with a lower risk of MACE, heart failure (HF), stroke, and all-cause mortality among AF patients remains unclear. Methods: We evaluated prospectively 503 participants of the Atherosclerosis Risk in Communities (ARIC) Study with available serum Mg and a diagnosis of AF at the time of Mg measurement participating in visit 2 (1990-1992, n = 90) or visit 5 (2011-2013, n = 403). Serum Mg was modeled in tertiles and as a continuous variable in standard deviation units. Endpoints (HF, MI, stroke, cardiovascular (CV) death, all-cause mortality, and MACE) were identified and modeled separately using Cox proportional hazard regression adjusting for potential confounders. Results: During a mean follow-up of 7.0 years, there were 105 HF, 50 MI, 36 stroke, 119 CV deaths, 160 total deaths, and 285 MACE. After adjustment for demographic and clinical variables, participants in the 2 nd and 3 rd tertiles of serum Mg had lower rates of most endpoints, with the strongest inverse association for the incidence of MI (Table). Serum Mg modeled linearly as a continuous variable did not show clear associations with endpoints. Due to limited number of events, precision of most estimates of association was relatively low. Conclusion: Higher serum Mg was associated with lower risk of developing incident MI and, to a lesser extent, other cardiovascular endpoints. Further studies in larger AF patient cohorts are needed to evaluate the role of serum Mg in preventing adverse CV outcomes in these patients.

Healthy lifestyle in older adults and life expectancy with and without heart failure

Several lifestyle factors have been linked to risk for heart failure (HF) and premature mortality. The aim of this study was to estimate the impact of a healthy lifestyle on life expectancy with and without HF among men and women from a general population. This study was performed among 6113 participants (mean age 65.8 ± 9.7 years; 58.9% women) from the Rotterdam Study, a large prospective population-based cohort study. A continuous lifestyle score was created based on five lifestyle factors: smoking status, alcohol consumption, diet quality, physical activity and weight status (assessed 1995–2008). The lifestyle score was categorized into three levels: unhealthy (reference), intermediate and healthy. Gompertz regression and multistate life tables were used to estimate the effects of lifestyle on life expectancy with and without HF in men and women separately at ages 45, 65 and 85 years (follow-up until 2016). During an average follow-up of 11.3 years, 699 incident HF events and 2146 deaths occurred. At the age of 45 years, men in the healthy lifestyle category had a 4.4 (95% CI: 4.1–4.7) years longer total life expectancy than men in the unhealthy lifestyle category, and a 4.8 (95% CI: 4.4–5.1) years longer life expectancy free of HF. Among women, the difference in total life-expectancy at the age of 45 years was 3.4 (95% CI: 3.2–3.5) years and was 3.4 (95% CI: 3.3–3.6) years longer for life expectancy without HF. This effect persisted also at older ages. An overall healthy lifestyle can have a positive impact on total life expectancy and life expectancy free of HF.

Disposition of acute decompensated heart failure from the emergency department: An evidence-based review

Acute heart failure (HF) exacerbation is a serious and common condition seen in the Emergency Department (ED) that has significant morbidity and mortality. There are multiple clinical decision tools that Emergency Physicians (EPs) can use to reach an appropriate evidence-based disposition for these patients. This narrative review is an evidence-based discussion of clinical decision-making tools aimed to assist EPs risk stratify patients with AHF and determine disposition. Risk stratification in patients with AHF exacerbation presenting to the ED is paramount in reaching an appropriate disposition decision. High risk features include hypotension, hypoxemia, elevated brain natriuretic peptide (BNP) and/or troponin, elevated creatinine, and hyponatremia. Patients who require continuous vasoactive infusions, respiratory support, or are initially treatment-resistant generally require intensive care unit admission. In most instances, new-onset AHF patients should be admitted for further evaluation. Other AHF patients in the ED can be risk stratified with the Ottawa HF Risk Score (OHFRS), the Multiple Estimation of Risk Based on Spanish Emergency Department Score (MEESSI), or the Emergency HF Mortality Risk Grade (EHFMRG). These tools take various factors into account such as mode of arrival to the ED, vital signs, laboratory values like troponin and pro-BNP, and clinical course. If used appropriately, these scores can predict patients at low risk for adverse outcomes. This article discusses evidence-based disposition of patients in acute decompensated HF presenting to the ED. Knowledge of these factors and risk tools can assist emergency clinicians in determining appropriate disposition of patients with HF.

Abstract 9521: Improvement of Left Ventricular Ejection Fraction After Surgical Revascularization in Patients Eligible for Implantable Cardioverter Defibrillator

Introduction: Left ventricular ejection fraction (LVEF) ≤35% is the cornerstone criterion for implantable cardioverter-defibrillator (ICD) eligibility. But improvement in LVEF may occur in ICD-eligible patients after coronary artery bypass graft surgery (CABG). Methods: We studied the incidence, predictors, and outcomes of LVEF improvement among patients with LVEF ≤35% who underwent CABG as part of the Surgical Treatment for Ischemic Heart Failure (STICH) trial and had pre- and post-operative (4 months) LVEF assessment using the same cardiac imaging modality. Improvement in LVEF was defined as post-operative EF &gt;35% and &gt;5% absolute improvement from baseline. Results: Of the 427 patients (mean age 62±10 and 50 women), 125 (29.2%) had LVEF improvement from 26.8%±5.8% to 43.3%±6.5%; p&lt;0.001. Improvement in LVEF occurred in 20% and 38% of patients with pre-operative LVEF &lt;25% and 30-35%, respectively (Figure). Post-operative improvement in LVEF was 2.20 times more likely in patients with pre-operative LVEF ≥25% (95% CI 1.41-3.43; p&lt;0.001) than those with pre-operative EF &lt;25%. The odds of post-operative LVEF improvement were 1.96 times higher (95% CI 0.91-4.23, p=0.09) in patients with myocardial viability. After adjusting for age, sex, and pre-operative LVEF, improvement in LVEF was associated with a 42% lower risk of all-cause mortality (HR 0.58, 95% CI 0.35-0.96; p=0.03) and 69% lower risk of heart failure mortality (HR 0.31, 95% CI 0.11-0.87; p=0.03). Conclusions: Nearly 1/3 rd of patients with LVEF ≤35% who underwent CABG had a significant improvement in left ventricular systolic function, obviating the need for primary prevention ICD implantation. Post-operative LVEF improvement was associated with a lower risk of death. These results provide patients and clinicians data on the likelihood of ICD eligibility after CABG and support the practice of reassessment of LVEF after revascularization.

Abstract 10616: HIV Infection and the Risk of Heart Failure Hospitalization and Mortality: A Systematic Review and Meta-Analysis of Cohort Studies

Introduction: Incidence of heart failure (HF) is increased among individuals living with human immunodeficiency virus (HIV). Whether HIV adversely affects hospitalization and mortality rates among patients with diagnosed HF has not been systematically evaluated. Hypothesis: We hypothesized that HIV infection would increase the risk of hospitalization and all-cause mortality rates in patients with HF, independent of established risk factors. Methods: We performed a systematic search of PubMed, EMBASE, Cochrane Library and Web of Science through March 7 th , 2021 for cohort studies conducted in adult patients (age≥18 years) with diagnosed HF and ascertainment of HIV infection at baseline. Outcomes assessed include all-cause mortality, HF-associated hospitalization, and all-cause hospitalization. All studies included multivariable adjustments for demographics, cardiovascular risk factors, and comorbidities. Pooled hazard ratio (HR) and 95% confidence intervals (CI) were calculated using a random-effects model. Results: We identified 7 studies consisting of 10,363 HF patients living with HIV and 48,933 HIV negative HF controls. HF patients with HIV had a higher risk of all-cause mortality compared to HIV-negative HF patients, HR (95% CI): 1.20 (1.14, 1.25), I 2 =0%. Similarly, HIV infection was associated with increased risks of both HF-associated hospitalization and all-cause hospitalization, with HR (95% CI) of 1.31 (1.03, 1.65) and 1.27 (1.12, 1.44), respectively; though significant heterogeneity was observed for both of these outcomes, I 2 =80% and 62%, respectively. Conclusions: HIV infection was independently associated with increased risk of all-cause mortality and both HF-associated and all-cause hospitalizations among individuals with HF. Our data may have important implications for HF management in this high-risk population.

Abstract 13560: Household Income Less Than 150% of Federal Poverty Level is Associated With Heart Failure Mortality

Introduction: The per capita cost of managing heart failure (HF) is rising and so is the patient’s financial responsibility. This study examined the association between household income expressed as percentage of federal poverty level (FPL) and HF mortality. Methods: The United States Census National Longitudinal Mortality Study (NLMS), consisting of surveys administered between March 1973 and March 2011, was designed to study the effect of socioeconomic factors on mortality rates in the US. Matching the NLMS database to the National Death Index, we identified and retrospectively analyzed data of all cases of heart failure deaths in the NLMS. For this analysis, we included only records that could be prospectively followed for 11 years from time of survey. Study sample was categorized into three groups by baseline household income expressed as a percentage of FPL: Group 1 ≤ 150%FPL (n=1260); 2 &gt;150% but ≤ 300% (n=1059) and 3 &gt; 300% (n=907). We assessed the association between the 3 groups and risk of mortality using unadjusted and adjusted Cox regression. Kaplan Meir plots were computed and survival between the three groups was compared using log-rank statistics. Result: Among the 1,835,072 records that could be followed for 11 years, there were 3,226 HF deaths. Median (IQR) survival (in years) were 5.6 (2.9 – 8.3), 6.2 (3.4 – 8.6) and 6.3 (3.4 – 8.8) for groups 1, 2, and 3 respectively [p=0.002]. Having income less than 150% FPL was associated with 14% increased risk of mortality (hazards ratio [HR]= 1.14 (1.07 – 1.23; P=0.0002) compared with income &gt;150%FPL. Adjusting for age, race, sex, and health insurance status, income less than 150% was independently associated with a 21% higher risk of mortality (HR=1.21 (1.11 – 1.32; p=&lt;.0001)) compared with income &gt;150%FPL. Conclusion: Low income is associated with increased risk of HF mortality. This finding may help guide planning for social interventions and resource allocation.

Alcohol consumption in young men and risk of heart failure and all-cause mortality- a cohort study

Abstract Aim Wesought to study the association of alcohol consumption with the long-term risk of heart failure and all-cause mortality among adolescent men. Method We included 50 460 men (mean age 18.4 years; SD 0.72) that underwent enlistment for military service during 1968–1969. During this period, alcohol consumption was assessed with questionnaires as part of the enlistment protocol. Questionnaire data was transformed to grams of 100% ethanol/week and categorized as light (1–100 g/week), moderate (101–250 g/week), and high (&amp;gt;250 g/week). Follow-up was done through linkage to the nationwide Swedish patient- and cause of death registries. Risk of heart failure and all-cause mortality during follow-up was calculated with cox proportional hazard models, adjusted for age, conscription year, test centre, body mass index, systolic and diastolic blood pressure, parental education, intelligence quotient, cardiorespiratory fitness and muscle strength, and baseline comorbidities (diabetes mellitus and hypertension). Results During a median follow-up of 51 years, there were 803 incidentheart failure events (mean age at diagnosis, 61 years) and 6254 deaths (mean age: 55 years). Compared with non-drinkers (0 g/week), the adjusted hazard ratios (HR) for light, moderate and high alcohol consumption were 2.34 (1.24–4.40), 2.38 (1.22–4.68), 5.60 (2.68–11.69) for incident heart failure (Figure 1, model 4)and 1.27 (1.04–1.54), 1.66 (1.35–2.05), 2.25 (1.74–2.91) for all-cause mortality,respectively. Conclusion Alcohol consumption in adolescence is strongly associated with heart failure and all-cause mortality in adulthood. Our results suggests that even light alcohol consumption in adolescence is associated with higher long-term risk of heart failure and mortality. Funding Acknowledgement Type of funding sources: None. Figure 1. *Model 1 adjusted for age at conscription, conscription year, test center, body mass index and baseline comorbidities (diabetes mellitus and hypertension). †Model 2 as model 1 but additionally adjusted for systolic and diastolic blood pressure at baseline. ‡Model 3 as model 2 but additionally adjusted for parental education. #Model 4 as model 3 but additionally adjusted for intelligence quotient, cardiorespiratory fitness and muscle strength.

Sex-related differences in mortality following an admission for acute heart failure across left ventricular ejection fraction spectrum

Abstract Background Prognosis in heart failure (HF) may differ between women and men. However, data is conflicting and sex-related differences in prognosis may be determined by left ventricular ejection fraction (LVEF) status. We sought to evaluate the prognostic differences between women and men with HF following an admission for acute HF (AHF). Methods We included 4,812 patients consecutively admitted for AHF in a multicenter registry from 3 hospitals in Valencia (Spain). Study endpoints were all-cause, cardiovascular (CV), and HF-related mortality at 6-months follow-up. Multivariable Cox regression models were fitted to investigate sex-related differences across LVEF status. Results 2,243 (46.6%) patients were women and 2,569 (53.4%) were men. 2,608 (54.2%) patients had HF with preserved ejection fraction. At 6-months follow-up, 645 patients died (13.4%), being 544 (11.3%) and 416 (8.6%) CV and HF-related deaths, respectively. LVEF was not independently associated to mortality risk (HR=1.02; 95% CI 0.99–1.05; p=0.135). After multivariate adjustment, we found no sex-related differences in all-cause mortality (p-value for interaction=0.168). However, a significant interaction between sex and the risk of CV and HF mortality was found across LVEF status (p-value for interaction= 0.030 and 0.007; respectively). Compared to men, women had a significant lower risk of CV-mortality and HF-mortality at LVEF&amp;lt;25% and &amp;lt;42%, respectively. On the contrary, women showed a higher risk of HF-mortality at the upper extreme of LVEF (&amp;gt;75%) (Figure, panel A and B). Conclusions Following an admission for AHF, no sex-related differences were found in the risk of all-cause mortality. However, compared to men, women showed a lower risk of CV and HF-mortality at the lower extreme of LVEF. On the contrary, they showed a higher risk of HF-death at the upper extreme. Funding Acknowledgement Type of funding sources: None.

Use of antihypertensive medication before diagnosis of atrial fibrillation in Finland – results from the nationwide FinACAF -study

Abstract Background and aims Long-standing arterial hypertension increases the risk of cardiovascular morbidity including atrial fibrillation (AF), coronary heart disease and renal failure. Arterial hypertension is the most common aetiologic factor associated with the development of AF and is also the most prevalent co-morbid cardiovascular disease in patients with AF. Coexisting arterial hypertension together with AF increases further the risk of stroke, heart failure and overall mortality. The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) -study is a nationwide retrospective register-based AF study that combines data from several Finnish health care registers. In this sub-study, we characterized the use of antihypertensive medications in patients with new-onset AF. Methods This sub-study included all adult new-onset AF patients of the FinACAF study from January 2007 to December 2018. Patients were excluded if they were under 18 years of age, had any oral anticoagulant purchase in the year prior to AF diagnosis, or had diagnosis of AF or warfarin purchases between the years 2004–2006. Appropriate data such as anonymized study ID's, ICD-10 diagnoses, and drug purchases (dates, ATC-codes, amounts) were obtained from the National Prescription Register as well as the Finnish Hospital and Primary care registers. The antihypertensive medication purchases from the year preceding the AF diagnosis were analysed and identified by appropriate ATC-codes. Purchases one-month prior to the new-onset AF diagnosis were excluded from in order to avoid confounding by any medication changes due to AF diagnosis. Results Of 229,282 patients with new-onset AF 164,527 (71.8%) had purchased antihypertensive medication during the year prior to the AF diagnosis. The most common antihypertensive drugs used were beta blockers (n=108,510; 47.3%), ACE-inhibitors or angiotensin receptor blockers (n=104,840; 45.7%), diuretics (n=79,270; 34.6%) and selective calcium channel blockers (n=61,610; 26.9%). Diltiazem was purchased by 2,001 patients (0.9%) and verapamil by 1,508 patients (0.7%). At the beginning of the study period, beta-blockers were the most widely used antihypertensive agents, but between 2007 and 2018, RAAS-inhibitors (ACE inhibitors and ARB blockers) became the most widely used group of antihypertensive drugs (Figure 1). Conclusion Most Finnish new-onset AF patients had at least one pre-existing antihypertensive medication in use before the diagnosis of AF. Beta blockers were the most common antihypertensives until the latest years when RAAS-inhibitors became the most prescribed antihypertensive agents, whereas the use of diltiazem and verapamil was marginal in the treatment of hypertension before the AF diagnosis. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Helsinki and Uusimaa Hospital District research fundThe Finnish Foundation for Cardiovascular Research Figure 1. Annual use of antihypertensive medication among Finnish new-onset AF patients prior to diagnosis. Annual number of new-onset AF patients plotted for reference.

A Simple Clinical Risk Score to Predict Post-Discharge Mortality in Chinese Patients Hospitalized with Heart Failure.

ResumoFundamento Doenças cardiovasculares são a principal causa de morte na China. Entretanto, os esforços atuais para se identificar os fatores de risco de morte em pacientes hospitalizados com insuficiência cardíaca (IC) estão direcionados principalmente para a mortalidade durante a internação e a mortalidade após 30 dias nos Estados Unidos. Dessa forma, é necessário um modelo semelhante ao modelo utilizado para prever o risco considerado para procedimentos cirúrgicos cardiovasculares em pacientes para avaliar o risco de pacientes internados com diagnóstico de IC.Objetivo Identificar variáveis que podem prever a mortalidade por IC um ano após a alta hospitalar, e desenvolver um escore de risco para avaliar o risco de morte no período de um ano.Métodos No presente estudo, 1.742 pacientes chineses com IC foram divididos aleatoriamente em dois grupos: um grupo de amostra de derivação e um grupo de amostra de teste. O método de simulação Monte Carlo via Cadeias de Markov foi usado para identificar variáveis que podem prever a mortalidade um ano após a alta hospitalar. Variáveis com uma frequência >1% na análise bivariada, e que foram consideradas clinicamente significativas, foram qualificadas para análises de modelagens posteriores. A probabilidade posterior de que uma variável estava estatística e significativamente associada ao resultado foi calculada como o número total de vezes em que o IC de 95% da variável não coincidiu com 1 (ou seja, o ponto de referência), dividido pelo número total de iterações. Uma variável com uma probabilidade de 0,9 ou mais alta foi considerado um fator de risco robusto para prever o resultado, e foi incluída na lista final de variáveis. O nível de significância estatística adotado foi 5%.Resultados Cinco variáveis que pudessem prever de maneira robusta a mortalidade um ano após a alta hospitalar foram identificadas: idade, sexo feminino, escore da New York Heart Association (Associação de Cardiologia de Nova Iorque) >3, diâmetro do átrio esquerdo, e índice de massa corporal. Os modelos de derivação e de teste tiveram uma área de curva característica de operação do receptor de 0,79. Essas variáveis selecionadas foram utilizadas para avaliar o escore de risco de mortalidade por IC após um ano, e este foi dividido em três grupos (baixo, moderado e alto). O grupo de alto risco corresponde a aproximadamente 86% das mortes, e o grupo de risco moderado corresponde a 12% das mortes.Conclusão Um escore de risco de 5 variáveis simples pode ser utilizado para avaliar a mortalidade um ano após a alta hospitalar de pacientes internados com IC.