Long-term Risk Of Heart Failure Research Articles

Long-term risk of cardiovascular side-effects following attention-deficit hyperactivity disorder treatment with sympathomimetic amines

Abstract Background In recent years, patients diagnosed with attention-deficit/hyperactivity disorder (ADHD) has risen markedly, and treatment with sympathomimetic amines has proven effective in mitigating symptoms. However, due to sympathomimetic amines’ amplifying effect on heart rate and blood pressure, long-term cardiovascular drug-safety should be scrutinized. Purpose We investigated long-term risk of heart failure, acute coronary syndrome, and stroke associated with long-term sympathomimetic amine treatment. Methods Using nationwide Danish registers, we identified all patients >18 years of age initiated on sympathomimetic amines (methylphenidate, atomoxetine, lisdexamphetamine, or dexamphetamine) during 1998–2020. Follow-up began one year after patients’ first claimed prescription for patients without known history of heart failure, acute coronary syndrome, or stroke. Exposure was defined according to claimed prescriptions of sympathomimetic amines within 180 days prior to follow-up start and categorized as "discontinued", "low dosage", or "high dosage". Outcomes were heart failure, acute coronary syndrome, stroke, and a composite of all outcomes. We reported standardized 10-year absolute risk (AR) with 95% confidence intervals (CI) and risk ratios (RR) from fitted multivariable cause-specific Cox models with competing risk of death, comparing patients according to their exposure. Similar analyses were conducted at landmarks 1, 2, 3, 4, and 5 years after initial follow-up start where only patients still in treatment at the previous landmark were eligible. Results At follow-up start, 27,724 (36%) patients (42% female, median age: 29 [interquartile range (IQR) 23–41]) had discontinued treatment, 37,772 (49%) patients (47% female, median age: 31 [IQR 24–40]) were categorized as low dosage, and 11,924 (15%) patients (45% female, median age: 30 [IQR 23–41]) as high dosage. Comparing high dosage with discontinuation, there was a significant association with elevated 10-year absolute risk of heart failure (RR 1.7 [95% CI 1.2–2.2], numbers needed to harm [NNH]: 188), stroke (RR 1.3 [95% CI 1.0–1.6], NNH: 190), and the composite outcome (RR 1.4 [95% CI 1.1–1.6], NNH: 93), but not with acute coronary syndrome (RR 1.2 [95% CI 0.8–1.5]) (Figure 1). Comparing high dosage with low dosage, RRs of 1.4 (95% CI 1.0–1.9), 1.0 (95% CI 0.7–1.3), 1.2 (95% CI 1.0–1.5), and 1.2 (95% CI 1.1–1.4) were correspondingly found for the association with 10-year absolute risk of heart failure, acute coronary syndrome, stroke, and the composite outcome (Figure 1). Comparing low dosage with discontinuation, no significant associations were found (Figure 1). Landmark analyses yielded comparable results (Figure 2). Conclusion Effective and well-indicated treatment for ADHD is key; but a possible association with elevated cardiovascular risk in a young patient group should emphasize the need for risk factor mitigation and shared decision making based on available evidence.Figure 1Figure 2

Abstract 17225: Association Between Moderate and Vigorous Physical Activity on Long-Term Heart Failure Risk: The Cooper Center Longitudinal Study

Introduction: Regular physical activity (PA) is associated with a lower risk of heart failure (HF). However, the relative contributions of moderate and vigorous intensity exercise on HF risk is still unclear. We characterized the association between moderate (MPA) and vigorous physical activity (VPA) on the long-term risk for HF. Methods: We included participants free from baseline coronary disease in the Cooper Center Longitudinal Study (CCLS) who were Medicare eligible at age 65 years. PA was measured from a self-report instrument that included duration (minutes/week) and intensity of exercise (METs), with moderate intensity as 3-6 METs and vigorous intensity as 6 METs. Incident HF was defined as a HF hospitalization event (primary diagnosis) from Medicare claims files. MPA and VPA were considered separately as continuous variables. The association between baseline PA and incident HF was evaluated by Cox proportional hazards models adjusted for standard HF risk factors. Results: Of 32,322 individuals (mean age 50.9, 74.2% men), the mean number of hours/week of MPA and VPA was 1.2 and 1.4, respectively. 56.42% reported zero MPA and 42.6% reported zero VPA. Higher levels of VPA, but not MPA, were associated with a lower burden of HF risk factors. After 275,373 person-years of follow-up, we observed 954 incident HF hospitalizations. MPA was not significantly associated with HF risk in either model. VPA was inversely associated with HF risk in age-adjusted models. After multivariable adjustment, VPA was not associated with HF risk (see table). Conclusions: Midlife VPA, but not MPA, was associated with a lower risk for HF. However, after additional adjustment for traditional HF risk factors, the association between higher VPA and HF risk was no longer significant. These findings suggest that the inverse association between midlife VPA and long-term HF risk may be mediated by a more favorable risk factor profile.

Association between the neutrophil-to-lymphocyte ratio and risk of in-hospital heart failure and arrhythmia in patients with acute myocardial infarction.

This study was to probe into the relationship between the neutrophil-to-lymphocyte ratio (NLR) and both in-hospital and long-term heart failure risk in patients with acute myocardial infarction (AMI). 990 patients with AMI, including 386 with non-ST-segment elevation myocardial infarction (NSTEMI) and 604 with segment elevation myocardial infarction (STEMI) were recruited between January 2019 and March 2022. The in-hospital acute heart failure (AHF) and arrhythmia events were recorded. The NLR was significantly greater in the AHF group in STEMI and NSTEMI patients, with a higher frequency of arrhythmia in comparison to the non-AHF group. A high NLR was related to a high level of myocardial injury markers, accompanied with more AHF and arrhythmia events. Multivariate logistic regression analyses revealed that high NLR is independently linked with increased in-hospital AHF and arrhythmia risk. Receiver operating characteristic curve analyses revealed that the prognostic value of NLR for in-hospital AHF was 0.704 in STEMI patients and 0.766 in NSTEMI patients. However, during a median follow-up of 28 months with 32 heart failure patients, there was no significant difference between the low NLR group (n = 18) and the high NLR group (n = 14). Further analysis showed that the two groups did not significantly differ in the occurrence of heart failure within 12 months of discharge. Our results indicate that NLR is an independent risk factor of in-hospital AHF in AMI patients. However, NLR has no value in predicting long-term heart failure.

Importance of familial predisposition to heart failure to the risk of anthracycline-related cardiotoxicity: A nationwide study

Anthracycline-based chemotherapy has improved the prognosis of various malignancies, but increases the long-term risk of heart failure (HF). Identification of patients at risk prior to treatment initiation is warranted. Therefore, the aim of this study was to evaluate if a familial predisposition to HF increases the risk of anthracycline related HF. Using nationwide Danish registries, all patients treated with anthracycline from 2004 to 16 were identified. The primary outcome was long-term HF risk. First-degree relatives were identified in the Danish Family Registry and exposure was defined as a first-degree biological relative with prior HF. Risk of HF was evaluated in a cumulative incidence function and the association in a multivariable Cox regression model. A total of 11,651 patients (median age 49.1 years (IQR: 43.6-53.7), 12.2% male) were included after exclusion of 46 with preanthracycline HF. Median follow-up was 3.8 years (IQR 1.9-6.4). In the group with a first-degree relative with HF (n=1,608) 35 patients (2.2%) were diagnosed with HF vs 133 (1.3%) in the group without a first-degree relative with HF (n=10,043), corresponding to incidence rates per 1,000 patient-years of 5.2 (CI:3.8-7.3) vs 3.0 (CI:2.5-3.5). The cumulative incidence of HF after 10 years was higher in the first-degree relative group (3.2% vs 2.0%, P=.004); adjusted hazard ratio 1.53 (CI:1.05-2.23, P=.03). In this nationwide register-based study having a first-degree relative with HF was associated with increased risk of anthracycline related HF, suggesting that attention towards family predisposition may be warranted when estimating the risk of anthracycline related cardiotoxicity.

The association between exposure to clozapine, olanzapine, and quetiapine and the outcomes perimyocarditis and heart failure: A population-based cohort study

The risk of cardiac adverse events following clozapine use is debated and is unknown for the chemically related and widely used antipsychotics olanzapine and quetiapine. National Swedish registers were used to identify all patients 16–75 years old with antipsychotic dispensations between 2005 and 2018. The short-term outcome was a diagnosis of perimyocarditis (pericarditis and/or myocarditis) within two months of first dispensation, and the long-term outcome was heart failure (including cardiomyopathy) within three years. Cox regressions with time varying exposure were used to estimate hazard rates (HR) and their 95% confidence intervals (CI). A total of 201,045 individuals were included in the cohort. The risk of developing perimyocarditis during clozapine treatment tripled compared to no antipsychotic treatment (HR 3.4, CI 1.6–7.3), although the absolute rate remained comparably low. The long-term risk of heart failure during clozapine treatment was also elevated (HR 1.3, CI 1.1–1.7). Treatment with either or both olanzapine or quetiapine was not associated with an increased relative risk of perimyocarditis, or heart failure compared to no antipsychotic treatment. Clozapine use is therefore associated with a substantially elevated short-term risk of perimyocarditis and an increased risk of heart failure within three years.

Association between the diagnostic classification of newly diagnosed coronary artery disease and future heart failure development.

The first clinical manifestation of coronary artery disease (CAD) varies widely from unheralded myocardial infarction (MI) to mild, incidentally detected disease. The primary objective of this study was to quantify the association between different initial CAD diagnostic classifications and future heart failure. This retrospective study incorporated the electronic health record of a single integrated health care system. Newly diagnosed CAD was classified into a mutually exclusive hierarchy as MI, CAD with coronary artery bypass graft (CABG), CAD with percutaneous coronary intervention, CAD only, unstable angina, and stable angina. An acute CAD presentation was defined when the diagnosis was associated with a hospital admission. New heart failure was identified after the CAD diagnosis. Among 28 693 newly diagnosed CAD patients, initial presentation was acute in 47% and manifested as MI in 26%. Within 30 days of CAD diagnosis, MI [hazard ratio (HR) = 5.1; 95% confidence interval: 4.1-6.5] and unstable angina (3.2; 2.4-4.4) classifications were associated with the highest heart failure risk (compared to stable angina), as was acute presentation (2.9; 2.7-3.2). Among stable, heart failure-free CAD patients followed on average 7.4 years, initial MI (adjusted HR = 1.6; 1.4-1.7) and CAD with CABG (1.5; 1.2-1.8) were associated with higher long-term heart failure risk, but an initial acute presentation was not (1.0; 0.9-1.0). Nearly 50% of initial CAD diagnoses are associated with hospitalization, and these patients are at high risk of early heart failure. Among stable CAD patients, MI remained the diagnostic classification associated with the highest long-term heart failure risk, however, having an initial acute CAD presentation was not associated with long-term heart failure.

A machine learning-derived echocardiographic algorithm identifies people at risk of heart failure with distinct cardiac structure, function, and response to spironolactone: Findings from the HOMAGE trial.

An echocardiographic algorithm derived by machine learning (e'VM) characterizes pre-clinical individuals with different cardiac structure and function, biomarkers, and long-term risk of heart failure (HF). Our aim was the external validation of the e'VM algorithm and to explore whether it may identify subgroups who benefit from spironolactone. The HOMAGE (Heart OMics in AGEing) trial enrolled participants at high risk of developing HF randomly assigned to spironolactone or placebo over 9 months. The e'VM algorithm was applied to 416 participants (mean age 74 ± 7 years, 25% women) with available echocardiographic variables (i.e. e' mean, left ventricular end-diastolic volume and mass indexed by body surface area [LVMi]). The effects of spironolactone on changes in echocardiographic and biomarker variables were assessed across e'VM phenotypes. A majority (>80%) had either a 'diastolic changes' (D), or 'diastolic changes with structural remodelling' (D/S) phenotype. The D/S phenotype had the highest LVMi, left atrial volume, E/e', natriuretic peptide and troponin levels (all p < 0.05). Spironolactone significantly reduced E/e' and B-type natriuretic peptide (BNP) levels in the D/S phenotype (p < 0.01), but not in other phenotypes (p > 0.10; pinteraction <0.05 for both). These interactions were not observed when considering guideline-recommended echocardiographic structural and functional abnormalities. The magnitude of effects of spironolactone on LVMi, left atrial volume and a type I collagen marker was numerically higher in the D/S phenotype than the D phenotype but the interaction test did not reach significance. In the HOMAGE trial, the e'VM algorithm identified echocardiographic phenotypes with distinct responses to spironolactone as assessed by changes in E/e' and BNP.

Abstract P3-03-13: Long-term heart failure risk of trastuzumab with or without anthracyclines in early stage breast cancer: A SEER-Medicare Database Analysis

Abstract Background: Cardiotoxicity associated with use of trastuzumab (T) in breast cancer has been assessed in multiple studies with short-term follow up. However, long-term risk of clinical heart failure (CHF) with the use of T, either with or without anthracyclines (A), is poorly understood. Since the approval of T for use in early-stage breast cancer (ESBC) in 2006, long-term follow up data is now available in the SEER-Medicare database. Methods: We performed a retrospective cohort study in patients (pts) with ESBC identified in the SEER-Medicare database, diagnosed between 2005-2016, excluding pts with in-situ or metastatic disease at time of diagnosis or a history of CHF prior to diagnosis. Primary exposure variables were identified using HCPCS codes and included receipt of T or A. The reference baseline population used for univariate logistic regression of the primary exposure variables was pts with ESBC who received neither T nor A. For multivariate analyses, to avoid co-linearity in the final model, the exposure variables were categorized as either having or not having the exposure (i.e. with or without T, with or without A). The primary outcome variable was CHF, identified using codes 428.0-9, 402.11, 402.91 (ICD9) and I50.0-9, I110 (ICD10). Covariates used in multivariate logistic regression (MLR) included hypertension (HTN), valve disease, hyperthyroidism, diabetes (DM), emphysema, coronary artery disease (CAD), left sided radiation, age, and race. MLR models were constructed using a stepwise-up approach and confirmed using the stepwise-down method with a cutoff of p&amp;lt; 0.05 for inclusion in the final model. Results: A total of 244,129 pts were identified with a median follow up of 6.7 years (7.7 years in the T cohort). Median age was 68. Other demographics are listed in Table 1. Of these, 10,603 were HER2-positive (HER2+) pts who all received T and all of whom also received some form of chemotherapy. Of the HER2+ pts, 19.1% (2,026) also received A in addition to T as part of their treatment regimen. Pts who received T had significantly higher baseline rates of HTN, valve disease, hyperthyroidism, DM, emphysema, and CAD as compared to pts who did not receive T. Compared to pts who received T without A, pts who received T with A had significantly higher baseline rates of HTN, valve disease, hyperthyroidism, emphysema, and CAD with no difference in baseline rate of DM. Risk of CHF with exposure variables are summarized in Table 2. The overall rate of CHF for the entire 244,129 population was 21.3% with a rate of 20.8% in pts who did not receive any T or A (the baseline population). The rate of CHF in pts who received T without A was 19.1% (OR 0.90, 95% CI 0.85-0.95), and 29.0% for those who received T with A (OR 1.55, 95% CI 1.41-1.71). Associations of covariates of interest with risk of CHF as well as MLR models are summarized in Table 3. After adjusting for all baseline cardiac comorbidities as well as other covariates, receipt of T was associated with a reduced risk of CHF (OR 0.74, 95% CI 0.70-0.79, p&amp;lt; 0.001), and receipt of A remained associated with an increased risk of CHF (OR 1.19, 95% CI 1.15-1.24, p&amp;lt; 0.001). Conclusions: With long-term follow up, the addition of A to T significantly increased the risk of CHF over T without A (from 19.1% to 29.0%) in pts with ESBC. Additionally, pts who received T without A had a similar risk of CHF compared to the baseline population who received neither T nor A. After adjusting for potential confounders in the MLR model, T was associated with a slightly decreased overall risk of CHF, while A remained associated with an increased risk of CHF. Possible explanations for these findings include potential increased cardiac monitoring in the T population which may have led to optimization of cardiac comorbidities, which were higher in the T population at baseline. Taken together, these data indicate concern with use of T plus A in ESBC regarding the long-term development of clinical CHF; especially when non-A regimens with similar efficacy are available. Table 1: Demographics Table 2: Risk of Heart Failure with Primary Exposure Variables Table 3: Univariate and Multivariate Analyses Citation Format: Nicholas P. McAndrew, Karissa Britten, Xiaoyan Wang, Eric Yang, Sara Hurvitz, Dennis Slamon. Long-term heart failure risk of trastuzumab with or without anthracyclines in early stage breast cancer: A SEER-Medicare Database Analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-13.

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.

Long-term risk of adverse cardiovascular outcomes associated with cutaneous lupus erythematosus: a nationwide cohort study.

Autoimmune diseases, including systemic lupus erythematosus, have been associated with a substantial risk of cardiovascular morbidity and mortality. However, data on the long-term risk of incident heart failure and other adverse cardiovascular outcomes among patients diagnosed with cutaneous lupus erythematosus (CLE) are limited. In this cohort study, all patients ≥ 18years with newly diagnosed CLE between 1996 and 2018 were identified through Danish nationwide registries and matched 1:4 by age, sex, and comorbidity with individuals without CLE. Incident adverse cardiovascular outcomes, including heart failure, were compared between the matched groups, overall, and according to sex. Of 2085 patients diagnosed with CLE, 2062 patients were matched with 8248 control subjects from the Danish background population (median age 50years [25th-75th percentile: 37-62years]; 22.3% men). The median follow-up was 6.2years. The 10-year cumulative incidences and adjusted hazard ratios (HR) of outcomes were as follows: heart failure: 3.29% (95% CI, 2.42-4.36%) for CLE patients versus 2.59% (2.20-3.02%) for the background population, HR 1.67 (95% CI, 1.24-2.24); atrial fibrillation or flutter: 5.15% (3.99-6.52%) versus 3.84% (3.37-4.36%), HR 1.40 (1.09-1.80); the composite of ICD implantation, ventricular arrhythmia, or cardiac arrest: 0.72% (0.34-1.40%) versus 0.44% (0.29-0.64%), HR 1.71 (0.85-3.45); the composite of pacemaker implantation, atrioventricular block, or sinoatrial dysfunction: 0.91% (0.48-1.59%) versus 0.54% (0.37-0.76%), HR 1.32 (0.72-2.41); myocardial infarction: 3.05% (2.18-4.15%) versus 1.59% (1.29-1.93%), HR 2.15 (1.53-3.00); ischemic stroke: 3.25% (2.38-4.32%) versus 2.50% (2.13-2.93%), HR 1.56 (1.16-2.10); and venous thromboembolism: 2.74% (1.94-3.75%) versus 2.05% (1.71-2.44%), HR 1.60 (1.16-2.21). Sex did not modify the association between CLE and adverse cardiovascular outcomes (Pinteraction ≥ 0.12 for all outcomes). Patients with CLE had a higher associated risk of adverse cardiovascular outcomes compared with the background population, irrespective of sex. Key Points • Findings: In this nationwide cohort study, including 2062 patients with cutaneous lupus erythematosus and 8248 matched controls, cutaneous lupus erythematosus was associated with an increased long-term risk of heart failure, cardiac arrhythmias, and thromboembolic events, irrespective of sex.

PO-647-05 FEASIBILITY AND SAFETY OF HIS BUNDLE PACING COMBINED WITH AV NODE ABLATION: DATA FROM A MULTICENTRIC REGISTRY

Atrioventricular node ablation (AVNA) and ventricular pacing can be an effective option in patients with non-controlled atrial fibrillation. Right ventricular pacing (RVP) induces ventricular desynchronization and increases the long-term risk of heart failure. His bundle pacing (HBP) is an appealing alternative, however there is still limited data about the feasibility of AVNA after HBP.

Association Between Left Ventricular Relative Wall Thickness and Acute Kidney Injury After Noncardiac Surgery.

Acute kidney injury (AKI) after major noncardiac surgery is commonly attributed to cardiovascular dysfunction. Identifying novel associations between preoperative cardiovascular markers and kidney injury may guide risk stratification and perioperative intervention. Increased left ventricular relative wall thickness (RWT), routinely measured on echocardiography, is associated with myocardial dysfunction and long-term risk of heart failure in patients with preserved left ventricular ejection fraction (LVEF); however, its relationship to postoperative complications has not been studied. We evaluated the association between preoperative RWT and AKI in high-risk noncardiac surgical patients with preserved LVEF. Patients ≥18 years of age having major noncardiac surgery (high-risk elective intra-abdominal or noncardiac intrathoracic surgery) between July 1, 2016, and June 30, 2018, who had transthoracic echocardiography in the previous 12 months were eligible. Patients with preoperative creatinine ≥2 mg/dL or reduced LVEF (<50%) were excluded. The association between RWT and AKI, defined as an increase in serum creatinine by 0.3 mg/dL from baseline within 48 hours or by 50% within 7 days after surgery, was assessed using multivariable logistic regression adjusted for preoperative covariates. An additional model adjusted for intraoperative covariates, which are strongly associated with AKI, especially hypotension. RWT was modeled continuously, associating the change in odds of AKI for each 0.1 increase in RWT. The study included 1041 patients (mean ± standard deviation [SD] age 62 ± 15 years; 59% female). A total of 145 subjects (13.9%) developed AKI within 7 days. For RWT quartiles 1 through 4, respectively, 20 of 262 (7.6%), 40 of 259 (15.4%), 39 of 263 (14.8%), and 46 of 257 (17.9%) developed AKI. Log-odds and proportion with AKI increased across the observed RWT values. After adjusting for confounders (demographics, American Society of Anesthesiologists [ASA] physical status, comorbidities, baseline creatinine, antihypertensive medications, and left ventricular mass index), each RWT increase of 0.1 was associated with an estimated 26% increased odds of developing AKI (odds ratio [OR]; 95% confidence interval [CI]) of 1.26 (1.09-1.46; P = .002). After adjusting for intraoperative covariates (length of surgery, presence of an arterial line, intraoperative hypotension, crystalloid administration, transfusion, and urine output), RWT remained independently associated with the odds of AKI (OR; 95% CI) of 1.28 (1.13-1.47; P = .001). Increased RWT was also independently associated with hospital length of stay and adjusted hazard ratio (HR [95% CI]) of 0.94 (0.89-0.99; P = .018). Left ventricular RWT is a novel cardiovascular factor associated with AKI within 7 days after high-risk noncardiac surgery among patients with preserved LVEF. Application of this commonly available measurement of risk stratification or perioperative intervention warrants further investigation.

Long-term Risk of Death and Hospitalization in Patients With Heart Failure and Takotsubo Syndrome: Insights From a Nationwide Cohort

BackgroundData concerning the long-term risk of heart failure (HF) in patients with takotsubo syndrome (TTS) are sparse. We compared the rates of death and hospitalization due to HF with matched individuals from the background population and patients with ST-segment elevation myocardial infarction (STEMI). MethodsIn this nationwide observational cohort study, all patients with first-time TTS (2011–2018) who were alive at discharge were identified by using data from Danish nationwide registries. These were matched for age and sex with individuals from the background population (1:4 matching) and with patients with STEMI who were alive at discharge (1:3 matching). ResultsA total of 881 patients with TTS who were alive at discharge were identified (median age 70 years; 89.4% men). During a mean follow-up of 2.9 years, the incidence rates of death, HF hospitalization, and TTS recurrence in survivors of TTS were 6.9, 0.9 and 1.1 events per 100 person-years. The corresponding absolute 3-year risks were 9.3%, 1.8% and 2.5%, respectively. Survivors of TTS had higher associated rates of death compared with the background population (hazard ratio [HR] 2.05 [95% CI, 1.62–2.60]) and survivors of STEMI (HR 1.69 [1.34–2.13]). Similarly, survivors of TTS had higher associated rates of hospitalization due to HF compared with the background population (HR 4.24 [1.88–9.53]), but lower rates compared with survivors of STEMI (HR 0.34 [0.20–0.56]). Propensity-score matched analyses yielded similar results. ConclusionsSurvivors of TTS had significantly higher associated mortality rates than the background population and survivors of STEMI. Survivors of TTS had lower HF hospitalization rates than survivors of STEMI, but the rates were higher than those of the background population.

High fitness levels attenuate the increased risk of heart failure due to low socioeconomic status: A cohort study

High fitness levels attenuate the increased risk of heart failure due to low socioeconomic status: A cohort study

Association of Neutrophil Lymphocyte Ratio, Systemic Inflammation Response Index, and Metabolic Syndrome with Long-Term Risk of Heart Failure: A Population-Based Prospective Study

Association of Neutrophil Lymphocyte Ratio, Systemic Inflammation Response Index, and Metabolic Syndrome with Long-Term Risk of Heart Failure: A Population-Based Prospective Study

Pre-term delivery and long-term risk of heart failure in women: a national cohort and co-sibling study.

Women who deliver pre-term have higher future risks of hypertension and ischaemic heart disease, but long-term risks of heart failure (HF) are unknown. We examined these risks in a large national cohort. All 2 201 284 women with a singleton delivery in Sweden during 1973-2015 were followed up for inpatient or outpatient HF diagnoses through 2015. Cox regression was used to compute hazard ratios (HRs) for HF associated with pregnancy duration, adjusting for other maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and/or environmental) factors. In 48.2 million person-years of follow-up, 19 922 women were diagnosed with HF (median age: 60.7 years). Within 10 years after delivery, the adjusted HR was 2.96 [95% confidence interval (CI): 2.48-3.53] for HF associated with pre-term (gestational age: <37 weeks) compared with full-term (39-41 weeks) delivery. Stratified HRs were 4.27 (2.54-7.17) for extremely pre-term (22-27 weeks), 3.39 (2.57-4.48) for moderately pre-term (28-33 weeks), 2.70 (2.19-3.32) for late pre-term (34-36 weeks), and 1.70 (1.45-1.98) for early term (37-38 weeks). These HRs declined but remained elevated at 10-19 years (pre-term vs. full term: HR: 2.19; 95% CI: 1.94-2.46), 20-29 years (1.80; 1.67-1.95), and 30-43 years (1.56; 1.47-1.66) after delivery, and were not explained by shared familial factors. Pre-term and early term delivery were associated with markedly increased future hazards for HF, which persisted after adjusting for other maternal and familial factors and remained elevated 40 years later. Pre-term and early-term delivery should be recognized as risk factors for HF across the life course. What are the long-term hazards for heart failure (HF) across the life course in women who deliver preterm? Preterm and early term delivery were associated with ∼3- and 1.7-fold adjusted hazards for HF in the next 10 years vs. full-term delivery. These hazards declined but remained elevated 40 years later, and were not explained by shared familial factors. Preterm and early term delivery were associated with increased future hazards for HF, which persisted for 40 years after adjusting for other maternal and familial factors. Preterm and early term delivery should be recognized as lifelong risk factors for HF.

Long-term Risk of Heart Failure and Other Adverse Cardiovascular Outcomes in Granulomatosis With Polyangiitis: A Nationwide Cohort Study.

To examine the long-term rates of heart failure (HF) and other adverse cardiovascular (CV) outcomes in a nationwide cohort of patients diagnosed with granulomatosis with polyangiitis (GPA) compared with the general population. Using Danish nationwide registries, patients with newly diagnosed GPA were identified and matched 1:4 by age, sex, and comorbidities with subjects from the general population. Outcomes were compared using Cox regression. Due to violation of the proportional hazard assumption, landmark analyses for the first year and from 1 year were performed. Of the 1923 patients with GPA, 1781 patients (median age 59 yrs, 47.9% men) were matched with 7124 subjects from the general population. The median follow-up was 6.4 years. The absolute 10-year risk of HF was 6.8% (95% CI 5.5-8.2%) for patients with GPA and 5.9% (5.3-6.6%) for the general population. During the first year after diagnosis, GPA was associated with a significantly higher rate of HF (hazard ratio [HR] 3.60, 95% CI, 2.28-5.67) and other adverse outcomes, including atrial fibrillation/flutter (HR 6.50, 95% CI 4.43-9.55) and ischemic stroke (HR 3.24, 95% CI 1.92-5.48), compared with the general population. After the first year, GPA was not associated with higher rates of HF or other CV outcomes compared with the general population, except atrial fibrillation/flutter (HR 1.38, 95% CI 1.12-1.70). During the first year after diagnosis, the rates of HF and other CV outcomes were higher in patients with GPA compared with the general population. However, after the first year, the rates of HF and other CV outcomes, except atrial fibrillation/flutter, were similar to those in the general population.

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.

Abstract P058: Risk Of Heart Failure In Type 2 Diabetes Has Decreased Over Time - A Danish Nationwide Cohort Study

Introduction: Although type 2 diabetes (T2DM) is one of the strongest risk factors for heart failure (HF), there is limited data on contemporary lifetime risk estimates in this segment. Incident HF appears to be decreasing in the general population, but little is known how the risk has changed over time in patients with T2DM. The increasing prevalence and rapidly evolving management of T2DM has furthered interest in the epidemiological relationship between HF and T2DM. We therefore sought to investigate the lifetime risk of HF in people with T2DM and how the long term risk of HF has changed over time in patients with T2DM. Hypothesis: We assessed the hypothesis that there would be a statistically significant reduction in the ten- year risk of HF among patients with T2DM over time in all age groups except the youngest (&lt;50 years old), mimicking trends in the general population and that men would have a higher cumulative risk than women. Methods: We employed the Danish nationwide databases which included information on all Danish citizens’ hospitalizations, outpatient visits, and medication use since 1978 (diagnoses) and 1995 (medications). Using this data, we calculated the cumulative incidence of HF among patients with T2DM who were free from HF at age 30, 40, 50, 60, and 70 years, respectively. We censored people at time of emigration or at Dec 31, 2017 and we used Aalen-Johnsen estimators to adjust for the competing risk of death. Results: A total of 473,685 patients (47% women) had a diagnosis of T2DM between Jan 1, 1995 and Dec 31, 2017. Of those who were free from HF before T2DM onset, 21,030 were diagnosed before the age of 30; 33,786 before age 40; 55,537 before 50 years of age; 85,108 before age 60; and 98,631 before age 70. During follow-up, 48,026 (10%) were diagnosed with HF and 133,561 were censored for death. The cumulative life-time risk of developing HF among people with diabetes at age 50 was 24% (95% CI 21-27%) in females and 27% (25-29%) in men, p for difference &lt;0.0001. Among patients aged 50 years, the 10-year risk of HF decreased from 12.2% (1995-2005) to 9.6% (2005- 2015), p&lt;0.0001. Similar 10-year risks decreased for those free from HF at age 60 year (from 19.0% in 1995-2005 to 13.3% in 2005-2015, p&lt;0.0001) and 70 years old (from 22.2% to 17.1% between 1995-2005 and 2005-2015, p&lt;0.0001). Conclusion: The lifetime risk of HF among patients with T2DM exceeds 1 in 4 for both men and women. There was, however, a decrease in ten-year cumulative incidence of HF over time among patients with T2DM in all age groups.

Long-term prognosis following hospitalization for acute myocarditis – a matched nationwide cohort study

Objective The aim of this study was to examine the long-term risk of heart failure (HF) and all-cause mortality, in patients discharged alive following hospitalization for myocarditis. Background. Prognosis in patients with apparently uncomplicated myocarditis is in general perceived as good, but data on long-term outcomes are sparse. Methods. From nationwide Danish registries we included patients without prior cardiac disease, discharged alive with a first-time diagnosis of myocarditis 1996–2016. Patients were matched 1:10 by age- and sex, with controls from the general population. Risk of HF hospitalization and death in cases and controls was compared by use of adjusted Cox regression analyses. Results. We identified 1557 patients with a first-time diagnosis of myocarditis, 72% men, median age 39 years. Patients with myocarditis had more hypertension, diabetes, and cancer, and received more pharmacotherapy prior to hospitalization compared to matched controls. During a mean follow-up of 8.5 years, the event rate of HF hospitalization was 8.7 vs. 2.2 per 1000 patient-years (py) in cases and controls; HR 4.59 (95% CI; 3.58–5.88) and for all-cause mortality, event rate 21.9 vs 11.2 per 1000 py; HR 2.10 (95% CI; 1.82–2.43). Among 784 patients with no events or HF medication one year after diagnosis, risk of HF hospitalization (HR 2.15; 95% CI; 1.18–3.92), and all-cause mortality (HR 1.62; 95% CI; 1.21–2.16) remained elevated compared to matched controls. Conclusion. Myocarditis in younger patients without prior cardiac disease was associated with a long-term excess risk of HF hospitalization, and death, even in patients free of events and HF medication 1 year after discharge. Highlights Myocarditis ranges from chest discomfort to severe heart failure. In most patients, left ventricular ejection fraction recovers but the long-term adverse cardiac risk is unknown. Patients with myocarditis and no prior cardiac disease were at higher risk of death and heart failure Routine follow-up may be warranted following an episode of acute myocarditis.