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Aims
The aims of the study were to study the demographical and clinicopathological characteristics of patients presenting with heart failure and evaluate the 1 year outcomes and to identify risk predictors if any.
Methods and results
A prospective observational study was conducted in consecutive patients of systolic heart failure. The study was di...
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Introduction:
A new drug with prognostic impact on heart failure, sacubitril/valsartan, has been introduced in current guidelines. However, randomized trial results can be compromised by lack of representativeness. We aimed to assess the representativeness of the PARADIGM-HF trial in a real-world population of patients with heart failure.
Methods...
Citations
... Ischaemic heart disease is the most common cause of HF and is associated with worse prognosis compared with patients with non-ischaemic aetiology. 3,4 Therefore, taken into consideration the potential specific treatment strategy of ischaemic HF, it is important to differentiate it from non-ischaemic HF. 5 Regarding prognosis and different therapeutic approaches, HF aetiology is usually specified with cardiac magnetic resonance (CMR), computed tomography, or invasive coronary angiography. [6][7][8] The 3D STE with its capability to analyse the myocardial mechanics is a cost-effective imaging modality. ...
Aims
The aim of this pilot study was to compare selected three‐dimensional speckle tracking echocardiography (3D STE) parameters in patients with ischaemic and non‐ischaemic aetiology of heart failure (HF) and to identify indices that can differentiate the two pathologies.
Methods and results
Forty patients with left ventricular ejection fraction (LVEF) ≤ 40% were included to the study: 20 patients (age 63 ± 9.0 years, LVEF 29.0 ± 11.3%) with ischaemic cardiomyopathy and 20 patients (age 64.0 ± 11.0 years, LVEF 27.3 ± 7.5%) with non‐ischaemic cardiomyopathy. All patients underwent two‐dimensional (2D) and three‐dimensional (3D) transthoracic echocardiography. Standard echocardiographic parameters, global longitudinal strain, and rotational parameters of left ventricle (LV) were assessed using 3D speckle tracking (3D STE). There were no differences in standard and STE parameters between the two groups. Among rotational parameters, the LV apical rotation (4.9 ± 3.5° vs. 2.3 ± 2.4°, P = 0.0022) was significantly higher in patients with ischaemic HF. Among all echocardiographic parameters, a cut‐off value of 3.28° (area under the curve 0.78; 95% confidence interval, 0.62 to 0.93) was able to distinguish the ischaemic and non‐ischaemic aetiology of HF with a sensitivity of 80% and specificity of 75%.
Conclusions
This is the first study that compares 3D STE parameters between patients with ischaemic and non‐ischaemic cardiomyopathy. It was proved that the apical rotation was significantly higher in patients with ischaemic cardiomyopathy. Our findings suggest that 3D STE might be useful in non‐invasive differentiation between ischaemic and non‐ischaemic aetiology of HF.
... For example, invasive procedures such as coronary angiography were performed less often in women than men (1.4% vs. 2.8%, p < 0.001) [36]. Sheppard [32] also found that women underwent fewer non-invasive assessments of [45]; Lee (2004) [37] Confirmed by a cardiologist, using standard Framingham criteria or exacerbation of a previously documented HF; Framingham criteria (including symptoms, physical examination, chest x-ray and echocardiographic findings) ...
Background:
Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender.
Methods:
We conducted a scoping review using the Arksey and O'Malley framework to include full text articles published between 2002 and 2017 drawn from multiple databases (MEDLINE, EMBASE), grey literature (i.e. National Technical information, Duck Duck Go), and expert consultation. Eligible articles included an index heart failure episode, readmission rates, and sex/gender-based analysis.
Results:
The search generated 5887 articles, of which 746 underwent full abstract text consideration for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies stratified data for sex. Good inter-rater agreement was reached: 83% title/abstract; 88% full text; kappa: 0.69 (95%CI: 0.53-0.85). Twelve of 34 studies reported higher heart failure readmission rates for men and six studies reported higher heart failure readmission rates for women. Using non composite endpoints, five studies reported higher HF readmission rates for men compared to three studies reporting higher HF readmission rates for women. Overall, there was heterogeneity between studies when examined by sex, but one observation emerged that was related to the timing of readmissions. Readmission rates for men were higher when follow-up duration was longer than 1 year. Women were more likely to experience higher readmission rates than men when time to event was less than 1 year.
Conclusions:
Future studies should consider different time horizons in their designs and avoid the use of composite measures, such as readmission rates combined with mortality, which are highly skewed by sex. Co-interventions and targeted post-discharge approaches with attention to sex would be of benefit to the HF patient population.
... Studyof bendopnea have shown sex differences between patients. The male sex was shown to be intrinsically associated with bendopnea (OR 8.45, 95% [9] and to have a significant effect on the risk of re-hospitalization [10]. Our findings are comparable to the results of that study. ...
... There are still no large population-based clinical trials to assess adverse outcomes in patients with CHF and bendopnea. For example, Sajeev et al. [10] showed a higher rate of hospitalizations due to CHF in patients with orthopnea versus bendopnea. However, it should be noted that the study group included twice as many patients with orthopnea than with bendopnea. ...
Aim To evaluate the risk of major cardiovascular complications (CVC) in patients with chronic heart failure (CHF) with intermediate and preserved ejection fraction (EF) depending on the presence of bendopnea symptom. Material and methods The study included 104 patients with stage II CHF and left ventricular EF ≥40 %. Mean age of the patients was 72.8±10.6 years. A test for detection of bendopnea symptom was performed for all patients. Two groups were formed: group 1, 69 patients with the bendopnea symptom and group 2, 35 patients with a negative test. Follow-up duration was 24 months. The composite endpoint (CEP) was death and hospitalization for any CVC. Results Mean time to the bendopnea symptom was 17.3±6.61 s. At two years of follow-up, the CEP was observed in 36 (34.6 %) patients, including 30 (43.5 %) patients in group 1 and 6 (17.1 %) patients in group 2. 12 patients died, and 9 of them had the bendopnea symptom. 21 patients of group 1 were hospitalized for CVC. Risk of CEP was significantly 1.7 times higher for men (relative risk, RR 1.7 [1.1; 2.6]) than for women. The presence of bendopnea symptom increased the risk of CEP 1.4 times (ОР 1.4 [1.1;1.9]) for women and 2.3 times (RR 2.3 [1.4; 3.6]) for men. Conclusion Results of the study demonstrated an unfavorable effect of bendopnea symptom on risk of CEP during the two-year follow-up of CHF patients with preserved and intermediate EF.
... Связь бендопноэ с неблагоприятным клиническим прогнозом подтверждена и в более позднем исследовании [6]. Бендопноэ статистически незначимо ассоциировалось с риском декомпенсации ХСН в течение года (ОШ 2,9, p>0,05) [13] и летальностью больных [14]. ...
Aim. To assess clinical and prognostic significance of dyspnea when leaning forward in elderly outpatients.Material and methods. The open, prospective, non-randomized study included 55 outpatients >60 years old with class II-IV (NYHA) chronic heart failure (CHF) as a result of coronary artery disease or hypertension and body mass index (BMI) <30 kg/m2. Routine physical examination, laboratory tests and echocardiography were conducted.Results. Dyspnea when leaning forward was detected in 45% of patients. Bendopnea was associated with a history of myocardial infarction (p<0,001, odds ratio (OR) 11,5, 95% confidence interval (CI) 2,7-47,8), left ventricular aneurysm (p=0,005, OR 9,4, 95% CI 1,7-54,5), increased end-systolic dimension (p=0,003, OR 18,4, 95% CI 2,69-12,5), low ejection fraction (p<0,001, OR 19, 2, 95% CI 4,46-8,23) and hospitalizations (p=0,004, OR 2,6, 95% CI 1,4-4,9).Conclusion. Thus, 45% of patients >60 years old with a BMI <30,0 kg/ m2 had dyspnea when leaning forward. It was not depended on BMI, and was closely associated with the clinical severity, echocardiographic parameters and hospitalizations. The results obtained allow us considering this symptom as a marker of severity of clinical condition and stasis in elderly outpatients with chronic heart failure without concomitant obesity.
... Inicialmente, foram encontrados 1530 artigos, dos quais 21 artigos (07-27) selecionados para essa revisão, sendo observado que a maioria são estudos de coortes -n=14 (08-09, 11,[15][16][18][19][20][21][22][23][25][26][27] , seguidos por metanálise -n=2 (07,14), do tipo comparativo e descritivo (10) , consulta ao prontuário (12) , uma revisão bibliográfica (13) , entrevista semiestruturada (17) e, por fim um, estudo randomizado (24) . ...
... Em relação ao ano de publicação, um artigo data de 2012 (16) , seguidos dos anos de 2013 -n= 4 (17,19,24,27) , 2014 -n= 6 (13- Rodrigues, V.C.; Correia, D.M.S.; Santoro, D.C.; A Hipertensão Arterial como principal fator de risco para insuficiência cardíaca: Revisão integrativa de literatura 15,21,[26][27] , 2015 -n= 4 (12,(19)(20)25) , 2016 -n= 3 (10)(11)18) e 2017 -n= 3 (07-09) . ...
... Quanto ao idioma, grande parte foi publicado em inglês (11)(12)(13)15,(17)(18)(19)22,(24)(25)(26)(27)(28)(29)31) , mas foram encontrados quatro em espanhol (14,20,23,30) e dois em português (16,21) . Os estudos selecionados foram desenvolvidos nos seguintes países: Estados Unidos -n= 6 (11,15,17,19,22,24) , Espanha -n= 4 (10,16,29,26) , Brasil -n= 2 (12,17) , Índia -n= 1 (09) , Região da Ásia -n=1 (14) , Suécia e França -n=1 (21) , Finlândia -n=1 (22) , Austrália -n= 1 (23) , Alemanha, Sérvia, Eslovênia e Montenegro -n=1 (24) , Canadá -n=1 (25) e China -n= 1 (27) . ...
Objetivo: identificar evidências sobre a hipertensão arterial como o principal fator de risco para Insuficiência cardíaca. Método: revisão integrativa da literatura, realizada entre 2012 a 2017, disponíveis na íntegra nas bases de dados: MEDLINE, SciELO e LILACS, utilizando a estratégia PICo. Resultados: dos 1530 artigos identificados, foram selecionados 21 estudos, os quais foram agrupados em cinco modalidades: a hipertensão arterial como principal causa de insuficiência cardíaca; insuficiência cardíaca e a hipertensão resistente; a hipertensão arterial como fator predisponente para doenças cardiovasculares e insuficiência cardíaca; hipertensão arterial e outros fatores de risco para insuficiência cardíaca; avaliação de grupos de risco quanto ao desenvolvimento de insuficiência cardíaca. Conclusão: a hipertensão torna-se o principal fator de risco para o desenvolvimento da insuficiência cardíaca e demais doenças cardiovasculares, principalmente quando não tratada e agregada a outros fatores de risco, comobirdades e estilo de vida.
... Sajeev et al reported that patients without bendopnea were associated with a higher rate of HF readmission. 6 However, two other studies reported no significant difference. A pooled analysis showed that the rate of readmission was not associated with bendopnea. ...
Background:
Bendopnea is a symptom mediated by increased ventricular filling pressure during bending forward. Presence of bendopnea in patients can be easily evaluated without additional maneuver in several countries whose norms, habits, culture, and occupation relates to a higher frequency of bending forward. This information may prove valuable in routine clinical practice. We aimed to analyze the latest evidence on bendopnea in order to further define the clinical significance of this symptom.
Methods:
We performed a comprehensive search on bendopnea in heart failure from inception up until January 2019 through PubMed, EuropePMC, EBSCOhost, Cochrane Central Database, and ClinicalTrials.gov.
Results:
There were 283 patients (31.76%) who have bendopnea, and a total of 891 patients from six studies were included. Bendopnea was associated with the presence of dyspnea [odds ratio (OR) 69.70 (17.35-280.07); <0.001], orthopnea [OR 3.02 (2.02-4.52); <0.001], paroxysmal nocturnal dyspnea [OR 2.76 (1.76-4.32); <0.001], and abdominal fullness [OR 7.50 (4.15-13.58); <0.001]. Association with elevated jugular venous pressure was shown in two studies. New York Heart Association (NYHA) functional class IV was more prevalent in patients with bendopnea [OR 7.58 (4.35-13.22); <0.001]. Bendopnea was also associated with increased mortality [OR 2.21 (1.34-3.66); 0.002].
Conclusion:
Bendopnea is associated with the presence of several signs and symptoms. This study also showed that bendopnea is one of the signs and symptoms of advanced heart failure associated with increased mortality. However, owing to the limited number of studies, further investigation is needed before drawing a definite conclusion.
Aims
This study aimed to investigate the prevalence, clinical characteristics, and prognostic value of bendopnea in older patients hospitalized for heart failure.
Methods and results
This post hoc analysis was performed using two prospective, multicentre, observational studies: the FRAGILE-HF (main cohort) and SONIC-HF (validation cohort) cohorts. Patients were categorized based on the presence of bendopnea, which was evaluated before discharge. The primary endpoint was 2-year all-cause mortality after discharge. Among the 1243 patients (median age, 81 years; 57.2% male) in the FRAGILE-HF cohort and 225 (median age, 79 years; 58.2% men) in the SONIC-HF cohort, bendopnea was observed in 31 (2.5%) and 10 (4.4%) patients, respectively. Over a 2-year follow-up period, all-cause death occurred in 20.8 and 21.9% of the patients in the FRAGILE-HF and SONIC-HF cohorts, respectively. Kaplan–Meier survival curves demonstrated significantly higher mortality rates in patients with bendopnea than in those without bendopnea in the FRAGILE-HF (log-rank P = 0.006) and SONIC-HF cohorts (log-rank P = 0.014). Cox proportional hazard analysis identified bendopnea as an independent prognostic factor for all-cause mortality in both the FRAGILE-HF [hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.18–3.78, P = 0.012] and SONIC-HF cohorts (HR 4.20, 95% CI 1.63–10.79, P = 0.003), even after adjusting for conventional risk factors.
Conclusion
Bendopnea was observed in a relatively small proportion of older patients hospitalized for heart failure before discharge. However, its presence was significantly associated with an increased risk of all-cause mortality.
Aim: To evaluate the clinical value of plasma D-dimer/fibrinogen ratio (DFR) in patients hospitalized for heart failure (HF). Methods: Clinical data of 235 patients were retrospectively analyzed. Kaplan–Meier method and Cox regression analysis were used to identify significant prognosticators. Results: The Kaplan–Meier analysis showed that a higher DFR level was significantly associated with an increase in the end point outcomes, including HF readmission, thrombotic events and death (log-rank test: p < 0.001). The multivariate Cox regression analysis showed that the high tertile of DFR was significantly associated with the study end points (HR: 2.18; 95% CI: 1.31–3.62; p = 0.003), compared with the low tertile. Conclusion: DFR is a reliable prognostic indicator for patients hospitalized for HF.
This dissertation provides the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium levels (< 3.5 or > 5.1 mmol/L) and cardiovascular outcomes within specific populations. For this purpose, the medical databases Medline and Web of Science were systematically searched from inception until November 24, 2017. Data synthesis of 24 relevant studies was performed using random-effects model meta-analyses, which finally comprised the data of 310,825 participants. In the older general population, low serum potassium was associated with a 1.6-fold increased risk of supraventricular arrhythmias (hazard ratio [95%-confidence interval]: 1.62 [1.02; 2.55]). Contrarily, high serum potassium was associated with increased cardiovascular mortality (1.38 [1.14; 1.66]). In patients with acute myocardial infarction, the risk of ventricular arrhythmias was increased for high serum potassium (2.33 [1.60; 3.38]). A U-shaped association was observed both with a composite cardiovascular outcome in hypertensive patients (2.6-fold increased risk with hypokalemia and 1.7-fold increased risk with hyperkalemia), and with cardiovascular mortality in dialysis patients (1.1-fold increased risk with hypokalemia and 1.4-fold increased risk with hyperkalemia) as well as in heart failure patients (not statistically significant). Further, only hyperkalemia was associated with an increased risk of a composite cardiovascular outcome in dialysis patients (1.12 [1.03; 1.23]) and also in chronic kidney disease patients (1.34 [1.06; 1.71]). Due to both a lack of studies and a variety of investigated outcomes and populations, a maximum of six studies was pooled per meta-analysis. The studies included also partly differed with regard to statistical analyses, reporting of results, and cut-off values for serum potassium. However, by using explicit inclusion and exclusion criteria with respect to design, statistical methods and definition of serum potassium cut-off values, the studies pooled in meta-analyses were mostly comparable and similar to the cut-off values proposed by the American Heart Association (reference range: 3.5 to 5.1 mmol/L). Given the heterogeneous covariate adjustment among the studies included, I suggest a key set of covariates, which future studies on this topic could use, namely age, sex, body mass index or other weight measure, smoking, diabetes, hypertension, history of cardiovascular disease, and kidney disease. In conclusion, these results suggest that some populations, especially patients with hypertension or heart failure, might profit from more frequent potassium-monitoring and subsequent interventions, such as change or withdrawal of potassium-influencing drugs, in order to restore normal values and prevent cardiovascular outcomes. Secondly, this dissertation presents the first investigation about the associations of use of diuretics overall, non-potassium-sparing diuretics in specific, and laxatives with cardiovascular mortality in participants with antihypertensive treatment. The drug classes were first analysed distinctly and then jointly to detect potential drug-drug interactions in two large-scale cohort studies. While the German ESTHER study served as a derivation cohort to generate hypotheses, the larger UK Biobank was used as a replication cohort to confirm the findings. Methodologically, Cox proportional hazard regression models were applied to estimate hazard ratios and 95%-confidence intervals in each study. Results from both studies were then combined in an individual patient-data meta-analysis using the random-effects model. Analyses included 4,253 participants, aged 50 to 75 years, from the ESTHER study and 105,359 participants, aged 50 to 69 years, from the UK Biobank. During 14 and 7 years of follow-up, 476 and 1,616 cardiovascular mortality cases were observed in the ESTHER study and the UK Biobank, respectively. Compared to non-users, a 1.6-fold (1.57 [1.29; 1.90]), a 1.4-fold (1.39 [1.26; 1.53]), and no statistically significantly increased [1.13 [0.94; 1.36]) cardiovascular mortality rate was observed in users of diuretics overall, non-potassium-sparing diuretics in specific, and laxatives, respectively. Concurrent use of non-potassium-sparing diuretics and laxatives was associated with a 2-fold increased cardiovascular mortality (2.05 [1.55; 2.71]) when compared to users of neither diuretics nor laxatives. However, a test for interaction slightly missed statistical significance (p=0.075). The major limitations of these analyses include the prevalent user design with regard to laxatives users, no repeated drug assessments, and a limited extent to control for confounding, in particular for the severity of heart failure and coronary heart disease. Nevertheless, an interaction of non-potassium-sparing diuretics and laxatives appears plausible. Therefore, physicians are highly recommended to clarify additional laxatives use and monitor serum potassium levels more closely (e.g. every 3 months) in concurrent users.
