Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.06.013
Antonio Cannata MD , Mehrdad A. Mizani PhD , Daniel I. Bromage PhD , Susan E. Piper MD , Suzanna M.C. Hardman PhD , Cathie Sudlow PhD , Mark de Belder MD , Paul A. Scott MD , John Deanfield FRCP , Roy S. Gardner MD , Andrew L. Clark MD , John G.F. Cleland MD , Theresa A. McDonagh MD , CVD-COVID-UK/COVID-IMPACT Consortium
Background
For patients with acute heart failure (HF), specialist HF care during admission improves diagnosis and treatments.
Objectives
The authors aimed to investigate the association of HF specialist care with in-hospital and longer term prognosis.
Methods
The authors used data from the National Heart Failure Audit from January 1, 2018, to December 31, 2022, linked to electronic records for hospitalization and deaths. All-cause mortality was the primary outcome measure and in-hospital mortality the secondary outcome measure.
Results
Data for 227,170 patients admitted to hospital with HF (median age: 81 years; IQR: 72-88 years), were analyzed. Approximately 80% of acute HF admissions received support from HF specialists. Thirty-nine percent of patients (n = 70,720) were seen by a multidisciplinary team (HF physicians and heart failure specialist nurses [HFSNs]), 22% (n = 40,330) were seen by HFSNs alone, and the remaining 39% (n = 71,700) were seen exclusively by specialist HF physicians. At discharge, more patients who received HF specialist care were prescribed medical therapy for HF and had specialized follow-up. Conversely, diuretic agents were prescribed to fewer patients. HF specialist care was independently associated with a higher rate of prescribing HF therapies at discharge and a lower likelihood of receiving diuretic therapy (OR: 0.90 [95% CI: 0.86-0.95]; P < 0.001). HF specialist care was associated with better long-term survival (HR: 0.89 [95% CI: 0.87-0.90]; P < 0.001) and lower in-hospital mortality (OR: 0.92 [95% CI: 0.0.88-0.97]; P < 0.001).
Conclusions
Receiving HF specialist care during admission for HF is associated with a higher rate of implementation of medical therapy, fewer discharges on diuretic therapy, and lower in-hospital and long-term mortality across the left ventricular ejection fraction spectrum, especially for patients with heart failure with reduced ejection fraction.
{"title":"Heart Failure Specialist Care and Long-Term Outcomes for Patients Admitted With Acute Heart Failure","authors":"Antonio Cannata MD , Mehrdad A. Mizani PhD , Daniel I. Bromage PhD , Susan E. Piper MD , Suzanna M.C. Hardman PhD , Cathie Sudlow PhD , Mark de Belder MD , Paul A. Scott MD , John Deanfield FRCP , Roy S. Gardner MD , Andrew L. Clark MD , John G.F. Cleland MD , Theresa A. McDonagh MD , CVD-COVID-UK/COVID-IMPACT Consortium","doi":"10.1016/j.jchf.2024.06.013","DOIUrl":"10.1016/j.jchf.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><div>For patients with acute heart failure (HF), specialist HF care during admission improves diagnosis and treatments.</div></div><div><h3>Objectives</h3><div>The authors aimed to investigate the association of HF specialist care with in-hospital and longer term prognosis.</div></div><div><h3>Methods</h3><div>The authors used data from the National Heart Failure Audit from January 1, 2018, to December 31, 2022, linked to electronic records for hospitalization and deaths. All-cause mortality was the primary outcome measure and in-hospital mortality the secondary outcome measure.</div></div><div><h3>Results</h3><div>Data for 227,170 patients admitted to hospital with HF (median age: 81 years; IQR: 72-88 years), were analyzed. Approximately 80% of acute HF admissions received support from HF specialists. Thirty-nine percent of patients (n = 70,720) were seen by a multidisciplinary team (HF physicians and heart failure specialist nurses [HFSNs]), 22% (n = 40,330) were seen by HFSNs alone, and the remaining 39% (n = 71,700) were seen exclusively by specialist HF physicians. At discharge, more patients who received HF specialist care were prescribed medical therapy for HF and had specialized follow-up. Conversely, diuretic agents were prescribed to fewer patients. HF specialist care was independently associated with a higher rate of prescribing HF therapies at discharge and a lower likelihood of receiving diuretic therapy (OR: 0.90 [95% CI: 0.86-0.95]; <em>P <</em> 0.001). HF specialist care was associated with better long-term survival (HR: 0.89 [95% CI: 0.87-0.90]; <em>P <</em> 0.001) and lower in-hospital mortality (OR: 0.92 [95% CI: 0.0.88-0.97]; <em>P <</em> 0.001).</div></div><div><h3>Conclusions</h3><div>Receiving HF specialist care during admission for HF is associated with a higher rate of implementation of medical therapy, fewer discharges on diuretic therapy, and lower in-hospital and long-term mortality across the left ventricular ejection fraction spectrum, especially for patients with heart failure with reduced ejection fraction.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 402-413"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.09.016
Rashmi Jain MD , Evan P. Kransdorf MD, PhD , Jennifer Cowger MD , Valluvan Jeevanandam MD , Jon A. Kobashigawa MD
The number of candidates on the waiting list for heart transplantation (HT) continues to far outweigh the number of available organs, and the donor heart nonuse rate in the United States remains significantly higher than that of other regions such as Europe. Although predicting outcomes in HT remains challenging, our overall understanding of the factors that play a role in post-HT outcomes continues to grow. We observe that many donor risk factors that are deemed “high-risk” do not necessarily always adversely affect post-HT outcomes, but are in fact nuanced and interact with other donor and recipient risk factors. The field of HT continues to evolve, with ongoing development of technologies for organ preservation during transport, expansion of the practice of donation after circulatory death, and proposed changes to organ allocation policy. As such, the field must continue to refine its processes for donor selection and risk prediction in HT.
{"title":"Donor Selection for Heart Transplantation in 2025","authors":"Rashmi Jain MD , Evan P. Kransdorf MD, PhD , Jennifer Cowger MD , Valluvan Jeevanandam MD , Jon A. Kobashigawa MD","doi":"10.1016/j.jchf.2024.09.016","DOIUrl":"10.1016/j.jchf.2024.09.016","url":null,"abstract":"<div><div>The number of candidates on the waiting list for heart transplantation (HT) continues to far outweigh the number of available organs, and the donor heart nonuse rate in the United States remains significantly higher than that of other regions such as Europe. Although predicting outcomes in HT remains challenging, our overall understanding of the factors that play a role in post-HT outcomes continues to grow. We observe that many donor risk factors that are deemed “high-risk” do not necessarily always adversely affect post-HT outcomes, but are in fact nuanced and interact with other donor and recipient risk factors. The field of HT continues to evolve, with ongoing development of technologies for organ preservation during transport, expansion of the practice of donation after circulatory death, and proposed changes to organ allocation policy. As such, the field must continue to refine its processes for donor selection and risk prediction in HT.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 389-401"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2025.01.006
Sean P. Collins MD, MSC , Hasan K. Siddiqi MD, MSCR , Lynne Warner Stevenson MD
{"title":"Wet and Sent Home From Heart Failure Hospitalization","authors":"Sean P. Collins MD, MSC , Hasan K. Siddiqi MD, MSCR , Lynne Warner Stevenson MD","doi":"10.1016/j.jchf.2025.01.006","DOIUrl":"10.1016/j.jchf.2025.01.006","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 430-434"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.11.008
Sam Aiyad Ali MD , Naja Emborg Vinding MD , Jawad H. Butt MD , Johanna Krøll MD , Johan E. Larsson MD , Morten Schou MD, PhD , Emil L. Fosbøl MD, PhD , Brian B. Løgstrup MD, PhD, DMsc , Inge Schjødt RN, PhD , Pardeep S. Jhund MD , Lars Køber MD, DMSc , Finn Gustafsson MD, DMSc , Naveed Sattar MBChB, PhD , John J.V. McMurray MD , Søren Lund Kristensen MD, PhD
Background
Worldwide, major health care variations exist in patients with heart failure (HF).
Objectives
In this study, the authors sought to examine and compare immigrants grouped by region of origin and native Danish patients presenting with new-onset heart failure with reduced ejection fraction (HFrEF).
Methods
The authors used data from the Danish Heart Failure Registry and administrative registries comprising information on medication, comorbidity, vital status, income level, and education. The co-primary outcomes were uptitration of guideline-directed medical therapy (GDMT) and a composite of HF hospitalization and all-cause death.
Results
Overall, 55,918 patients were included, of whom 94.8% were native Danish patients, 3.0% originated from Europe/Central Asia, 1.1% from the Middle East/North Africa, 0.6% from South Asia, and 0.5% from other regions. Patients from the non-Western areas were around 10 years younger (median age 62 vs 72 years) and had more diabetes (38%-50% vs 20%) and ischemic heart disease (67%-74% vs 48%) and less atrial fibrillation (9%-15% vs 32%) compared with Danish patients (all P < 0.001). At 12 months’ follow-up, no major differences in attainment of ≥50% target daily doses of GDMT were observed across groups. The crude 3-year cumulative risk of HF hospitalization or all-cause death ranged from 25% to 37% and was lowest for non-Western immigrants, although this difference does not persist in age- and sex-matched analyses.
Conclusions
Patients in Denmark with HFrEF originating from non-Western parts of the world were younger and had more ischemic heart disease and diabetes and less atrial fibrillation compared with native Danish patients. The likelihood of GDMT uptitration at 12 months was similar to that of native Danish patients, whereas their risk of HF hospitalization or all-cause death was lower, although the difference between the 2 groups diminished in age- and sex-matched analyses.
{"title":"Disparities Among Immigrants and Native Patients in Denmark With New-Onset Heart Failure With Reduced Ejection Fraction","authors":"Sam Aiyad Ali MD , Naja Emborg Vinding MD , Jawad H. Butt MD , Johanna Krøll MD , Johan E. Larsson MD , Morten Schou MD, PhD , Emil L. Fosbøl MD, PhD , Brian B. Løgstrup MD, PhD, DMsc , Inge Schjødt RN, PhD , Pardeep S. Jhund MD , Lars Køber MD, DMSc , Finn Gustafsson MD, DMSc , Naveed Sattar MBChB, PhD , John J.V. McMurray MD , Søren Lund Kristensen MD, PhD","doi":"10.1016/j.jchf.2024.11.008","DOIUrl":"10.1016/j.jchf.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Worldwide, major health care variations exist in patients with heart failure (HF).</div></div><div><h3>Objectives</h3><div>In this study, the authors sought to examine and compare immigrants grouped by region of origin and native Danish patients presenting with new-onset heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>The authors used data from the Danish Heart Failure Registry and administrative registries comprising information on medication, comorbidity, vital status, income level, and education. The co-primary outcomes were uptitration of guideline-directed medical therapy (GDMT) and a composite of HF hospitalization and all-cause death.</div></div><div><h3>Results</h3><div>Overall, 55,918 patients were included, of whom 94.8% were native Danish patients, 3.0% originated from Europe/Central Asia, 1.1% from the Middle East/North Africa, 0.6% from South Asia, and 0.5% from other regions. Patients from the non-Western areas were around 10 years younger (median age 62 vs 72 years) and had more diabetes (38%-50% vs 20%) and ischemic heart disease (67%-74% vs 48%) and less atrial fibrillation (9%-15% vs 32%) compared with Danish patients (all <em>P</em> < 0.001). At 12 months’ follow-up, no major differences in attainment of ≥50% target daily doses of GDMT were observed across groups. The crude 3-year cumulative risk of HF hospitalization or all-cause death ranged from 25% to 37% and was lowest for non-Western immigrants, although this difference does not persist in age- and sex-matched analyses.</div></div><div><h3>Conclusions</h3><div>Patients in Denmark with HFrEF originating from non-Western parts of the world were younger and had more ischemic heart disease and diabetes and less atrial fibrillation compared with native Danish patients. The likelihood of GDMT uptitration at 12 months was similar to that of native Danish patients, whereas their risk of HF hospitalization or all-cause death was lower, although the difference between the 2 groups diminished in age- and sex-matched analyses.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 483-493"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.09.013
Matteo Pagnesi MD, PhD , Laura Staal PhD , Jozine M. ter Maaten MD, PhD , Iris E. Beldhuis MD , Gad Cotter MD , Beth A. Davison PhD , Niels Jongs PhD , G. Michael Felker MD, MHS , Gerasimos Filippatos MD , Barry H. Greenberg MD , Peter S. Pang MD , Piotr Ponikowski MD, PhD , Carlo Mario Lombardi MD , Marianna Adamo MD, PhD , Thomas Severin MD , Claudio Gimpelewicz MD , Adriaan A. Voors MD, PhD , John R. Teerlink MD , Marco Metra MD
Background
The prognostic importance of residual congestion after acute heart failure (AHF) hospitalization is still debated.
Objectives
The authors aimed to assess the impact of residual congestion in a large cohort of patients with AHF enrolled in the RELAX-AHF-2 (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF) trial.
Methods
Residual congestion was assessed at day 5 after admission among hospitalized patients using an established composite congestion score (CCS) based on the presence of orthopnea, peripheral edema, and increased jugular venous pressure, ranging from 0 to 8 points. The primary endpoint was a composite of cardiovascular death or rehospitalization for heart failure or renal failure at 180 days.
Results
Among the 5,900 AHF patients included in this analysis, 3,380 (57.3%) had at least 1 sign of congestion (ie, CCS ≥1) and 1,066 (18.1%) had a CCS ≥3 at day 5 after admission. Patients with residual congestion at day 5 were more symptomatic, had more comorbidities, received higher doses of loop diuretic agents in-hospital, albeit with lower diuretic response, were less likely to have hemoconcentration, and were more likely to have worsening renal function at day 5. After multivariable adjustment for clinically meaningful variables, any sign of residual congestion and CCS ≥3 at day 5 were both independently associated with a higher risk of the primary endpoint (adjusted HR: 1.32 [95% CI: 1.15-1.51]; P < 0.001 and adjusted HR: 1.62 [95% CI: 1.39-1.88]; both P < 0.001).
Conclusions
Among patients with AHF who were still hospitalized at day 5, residual congestion was common and independently associated with worse outcome. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778)
{"title":"Decongestion and Outcomes in Patients Hospitalized for Acute Heart Failure","authors":"Matteo Pagnesi MD, PhD , Laura Staal PhD , Jozine M. ter Maaten MD, PhD , Iris E. Beldhuis MD , Gad Cotter MD , Beth A. Davison PhD , Niels Jongs PhD , G. Michael Felker MD, MHS , Gerasimos Filippatos MD , Barry H. Greenberg MD , Peter S. Pang MD , Piotr Ponikowski MD, PhD , Carlo Mario Lombardi MD , Marianna Adamo MD, PhD , Thomas Severin MD , Claudio Gimpelewicz MD , Adriaan A. Voors MD, PhD , John R. Teerlink MD , Marco Metra MD","doi":"10.1016/j.jchf.2024.09.013","DOIUrl":"10.1016/j.jchf.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic importance of residual congestion after acute heart failure (AHF) hospitalization is still debated.</div></div><div><h3>Objectives</h3><div>The authors aimed to assess the impact of residual congestion in a large cohort of patients with AHF enrolled in the RELAX-AHF-2 (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF) trial.</div></div><div><h3>Methods</h3><div>Residual congestion was assessed at day 5 after admission among hospitalized patients using an established composite congestion score (CCS) based on the presence of orthopnea, peripheral edema, and increased jugular venous pressure, ranging from 0 to 8 points. The primary endpoint was a composite of cardiovascular death or rehospitalization for heart failure or renal failure at 180 days.</div></div><div><h3>Results</h3><div>Among the 5,900 AHF patients included in this analysis, 3,380 (57.3%) had at least 1 sign of congestion (ie, CCS ≥1) and 1,066 (18.1%) had a CCS ≥3 at day 5 after admission. Patients with residual congestion at day 5 were more symptomatic, had more comorbidities, received higher doses of loop diuretic agents in-hospital, albeit with lower diuretic response, were less likely to have hemoconcentration, and were more likely to have worsening renal function at day 5. After multivariable adjustment for clinically meaningful variables, any sign of residual congestion and CCS ≥3 at day 5 were both independently associated with a higher risk of the primary endpoint (adjusted HR: 1.32 [95% CI: 1.15-1.51]; <em>P <</em> 0.001 and adjusted HR: 1.62 [95% CI: 1.39-1.88]; both <em>P <</em> 0.001).</div></div><div><h3>Conclusions</h3><div>Among patients with AHF who were still hospitalized at day 5, residual congestion was common and independently associated with worse outcome. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; <span><span>NCT01870778</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 414-429"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.09.022
Hailun Qin MD , Jasper Tromp MD, PhD , Jozine M. ter Maaten MD, PhD , Geert H.D. Voordes MD , Bart J. van Essen MD , Mark André de la Rambelje MSc , Camilla C.S. van der Hoef MD , Bernadet T. Santema MD, PhD , Carolyn S.P. Lam MD, PhD , Adriaan A. Voors MD, PhD
Background
Previous studies have examined clinical predictors of incident heart failure (HF) in men and women. However, potential mechanisms through which these clinical predictors relate to the onset of HF remain to be established.
Objectives
The authors studied the association between clinical and proteomic risk profiles of new-onset HF in men and women.
Methods
Incident HF was studied in 478,479 participants from the UK Biobank. The association between new-onset HF and 8 common modifiable traditional risk factors, including obesity, smoking status, socioeconomic status, atrial fibrillation, type 2 diabetes, hypertension, hyperlipidemia, and history of myocardial infarction, was assessed in men and women. Proteomics data (2,923 unique proteins, Olink) was available in 22,695 men and 27,421 women. Pathway over-representation analyses were performed to identify biological pathways in men and women with and without new-onset HF. Principal component analyses were performed to extract weighted scores for each pathway. Subsequently, weighted scores were used in mediation analyses to investigate how the pathways mediated the association between risk factors and new-onset HF.
Results
During a median follow-up time of 12 years, HF incident rate was 3.60 per 1,000 person-years in men and 1.72 per 1,000 person-years in women (P < 0.001). The strongest risk factor for future HF was a history of myocardial infarction (HR: 2.61; 95% CI: 2.46-2.77) in men and atrial fibrillation (HR: 4.10; 95% CI: 3.58-4.71) in women. When a risk factor was present in women, it conferred a higher risk of new-onset HF compared with the presence of the same risk factor in men. Both in men and women, the population-attributable risk was highest for hypertension (25% in men, 29% in women) and obesity (16% in men, 21% in women). Pathway analyses of protein profiles indicated several inflammatory pathways, and neutrophil degranulation in particular, to be activated both in men and women who developed HF. These inflammatory pathways modestly (22% in men and 24% in women) contributed to the association between hypertension and new-onset HF, but showed a stronger contribution (33% in men and 47% in women) to the association between obesity and new-onset HF.
Conclusions
In men and women, the most prominent risk factors for new-onset HF were hypertension and obesity, but they conferred a greater risk of new-onset HF in women. New-onset HF in both men and women was associated with pathophysiological pathways related to neutrophil degranulation and immunomodulation; and these pathways partly mediated the association between hypertension, obesity, and new-onset HF.
{"title":"Clinical and Proteomic Risk Profiles of New-Onset Heart Failure in Men and Women","authors":"Hailun Qin MD , Jasper Tromp MD, PhD , Jozine M. ter Maaten MD, PhD , Geert H.D. Voordes MD , Bart J. van Essen MD , Mark André de la Rambelje MSc , Camilla C.S. van der Hoef MD , Bernadet T. Santema MD, PhD , Carolyn S.P. Lam MD, PhD , Adriaan A. Voors MD, PhD","doi":"10.1016/j.jchf.2024.09.022","DOIUrl":"10.1016/j.jchf.2024.09.022","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have examined clinical predictors of incident heart failure (HF) in men and women. However, potential mechanisms through which these clinical predictors relate to the onset of HF remain to be established.</div></div><div><h3>Objectives</h3><div>The authors studied the association between clinical and proteomic risk profiles of new-onset HF in men and women.</div></div><div><h3>Methods</h3><div>Incident HF was studied in 478,479 participants from the UK Biobank. The association between new-onset HF and 8 common modifiable traditional risk factors, including obesity, smoking status, socioeconomic status, atrial fibrillation, type 2 diabetes, hypertension, hyperlipidemia, and history of myocardial infarction, was assessed in men and women. Proteomics data (2,923 unique proteins, Olink) was available in 22,695 men and 27,421 women. Pathway over-representation analyses were performed to identify biological pathways in men and women with and without new-onset HF. Principal component analyses were performed to extract weighted scores for each pathway. Subsequently, weighted scores were used in mediation analyses to investigate how the pathways mediated the association between risk factors and new-onset HF.</div></div><div><h3>Results</h3><div>During a median follow-up time of 12 years, HF incident rate was 3.60 per 1,000 person-years in men and 1.72 per 1,000 person-years in women (<em>P <</em> 0.001). The strongest risk factor for future HF was a history of myocardial infarction (HR: 2.61; 95% CI: 2.46-2.77) in men and atrial fibrillation (HR: 4.10; 95% CI: 3.58-4.71) in women. When a risk factor was present in women, it conferred a higher risk of new-onset HF compared with the presence of the same risk factor in men. Both in men and women, the population-attributable risk was highest for hypertension (25% in men, 29% in women) and obesity (16% in men, 21% in women). Pathway analyses of protein profiles indicated several inflammatory pathways, and neutrophil degranulation in particular, to be activated both in men and women who developed HF. These inflammatory pathways modestly (22% in men and 24% in women) contributed to the association between hypertension and new-onset HF, but showed a stronger contribution (33% in men and 47% in women) to the association between obesity and new-onset HF.</div></div><div><h3>Conclusions</h3><div>In men and women, the most prominent risk factors for new-onset HF were hypertension and obesity, but they conferred a greater risk of new-onset HF in women. New-onset HF in both men and women was associated with pathophysiological pathways related to neutrophil degranulation and immunomodulation; and these pathways partly mediated the association between hypertension, obesity, and new-onset HF.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 435-449"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.11.007
Samir Patel MD , Venkatesh K. Raman MD , Charles Faselis MD , Gregg C. Fonarow MD , Phillip H. Lam MD , Amiya A. Ahmed MD , Paul A. Heidenreich MD, MS , Stefan D. Anker MD, PhD , Prakash Deedwania MD , Charity J. Morgan PhD , Sijian Zhang MB, MS , Hans Moore MD , Janani Rangaswami MD , George Bakris MD , Javed Butler MD, MPH, MBA , Helen M. Sheriff MD , Richard M. Allman MD , Qing Zeng-Treitler PhD , Wen-Chih Wu MD, MPH , Ali Ahmed MD, MPH
Background
Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for >3 months, with implications for health. KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF). Less is known about whether these associations vary by left ventricular ejection fraction.
Objectives
This study aims to determine the prevalence and outcomes of KDIGO-defined CKD in heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF).
Methods
Of the 1,446,053 veterans with an HF diagnosis (1991-2017) in the national Veterans Affairs electronic health record data, 365,000 with data on EF had KDIGO-defined CKD or normal kidney function (NKF). CKD was defined as 2 values measured 90 days apart of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (categorized into 4 eGFR stages based on the last eGFR: 45-59 mL/min/1.73 m2, 30-44 mL/min/1.73 m2, 15-29 mL/min/1.73 m2, and <15 mL/min/1.73 m2) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (albuminuria). NKF was defined as 2 values measured >90 days apart of eGFR ≥60 mL/min/1.73 m2, without eGFR <60 mL/min/1.73 m2 or albuminuria for 3 years before HF diagnosis. Patients were categorized into HFpEF (EF ≥50%, n = 85,855), HFmrEF (EF 41%-49%, n = 39,397), and HFrEF (EF ≤40%, n = 139,748). HRs and 95% CIs for 5-year all-cause mortality and HF hospitalization through December 31, 2022, associated with the 5 CKD groups (vs NKF) were estimated using Cox regression.
Results
Among patients with HF and NKF, mortality occurred in 39%, 37%. and 41%, and HF hospitalization occurred in 12%, 15%, and 21% of those with HFpEF, HFmrEF. and HFrEF, respectively. Compared with NKF, CKD was associated with 16%, 19%, and 26% higher multivariable-adjusted risks for death in patients with HFpEF, HFmrEF, and HFrEF, respectively. Respective risks for HF hospitalization were 31%, 33%, and 32% higher. The eGFR-associated risks were incrementally higher with decreasing eGFR, except for eGFR <15 mL/min/1.73 m2, likely because of the initiation of dialysis during follow-up. Albuminuria was associated with 16%, 10%, and 12% higher multivariable-adjusted risks for death and 29, 30%, and 24% for HF hospitalization in HFpEF, HFmrEF, and HFrEF, respectively. All associations were statistically significant.
Conclusions
These findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF, and HFrEF.
{"title":"Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF","authors":"Samir Patel MD , Venkatesh K. Raman MD , Charles Faselis MD , Gregg C. Fonarow MD , Phillip H. Lam MD , Amiya A. Ahmed MD , Paul A. Heidenreich MD, MS , Stefan D. Anker MD, PhD , Prakash Deedwania MD , Charity J. Morgan PhD , Sijian Zhang MB, MS , Hans Moore MD , Janani Rangaswami MD , George Bakris MD , Javed Butler MD, MPH, MBA , Helen M. Sheriff MD , Richard M. Allman MD , Qing Zeng-Treitler PhD , Wen-Chih Wu MD, MPH , Ali Ahmed MD, MPH","doi":"10.1016/j.jchf.2024.11.007","DOIUrl":"10.1016/j.jchf.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for >3 months, with implications for health. KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF). Less is known about whether these associations vary by left ventricular ejection fraction.</div></div><div><h3>Objectives</h3><div>This study aims to determine the prevalence and outcomes of KDIGO-defined CKD in heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>Of the 1,446,053 veterans with an HF diagnosis (1991-2017) in the national Veterans Affairs electronic health record data, 365,000 with data on EF had KDIGO-defined CKD or normal kidney function (NKF). CKD was defined as 2 values measured 90 days apart of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m<sup>2</sup> (categorized into 4 eGFR stages based on the last eGFR: 45-59 mL/min/1.73 m<sup>2</sup>, 30-44 mL/min/1.73 m<sup>2</sup>, 15-29 mL/min/1.73 m<sup>2</sup>, and <15 mL/min/1.73 m<sup>2</sup>) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (albuminuria). NKF was defined as 2 values measured >90 days apart of eGFR ≥60 mL/min/1.73 m<sup>2</sup>, without eGFR <60 mL/min/1.73 m<sup>2</sup> or albuminuria for 3 years before HF diagnosis. Patients were categorized into HFpEF (EF ≥50%, n = 85,855), HFmrEF (EF 41%-49%, n = 39,397), and HFrEF (EF ≤40%, n = 139,748). HRs and 95% CIs for 5-year all-cause mortality and HF hospitalization through December 31, 2022, associated with the 5 CKD groups (vs NKF) were estimated using Cox regression.</div></div><div><h3>Results</h3><div>Among patients with HF and NKF, mortality occurred in 39%, 37%. and 41%, and HF hospitalization occurred in 12%, 15%, and 21% of those with HFpEF, HFmrEF. and HFrEF, respectively. Compared with NKF, CKD was associated with 16%, 19%, and 26% higher multivariable-adjusted risks for death in patients with HFpEF, HFmrEF, and HFrEF, respectively. Respective risks for HF hospitalization were 31%, 33%, and 32% higher. The eGFR-associated risks were incrementally higher with decreasing eGFR, except for eGFR <15 mL/min/1.73 m<sup>2</sup>, likely because of the initiation of dialysis during follow-up. Albuminuria was associated with 16%, 10%, and 12% higher multivariable-adjusted risks for death and 29, 30%, and 24% for HF hospitalization in HFpEF, HFmrEF, and HFrEF, respectively. All associations were statistically significant.</div></div><div><h3>Conclusions</h3><div>These findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF, and HFrEF.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 467-479"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.11.016
Vanessa Kirschner BS , Ophelia Yin MD , Lisa Coscia RN, BSN , Prisca C. Diala MD , Negeen Shahandeh MD , Roxanna A. Irani MD, PhD , Serban Constantinescu MD, PhD , Michael J. Moritz MD , Yalda Afshar MD, PhD
Background
Heart transplant recipients (HTRs) during pregnancy are at greater risk for maternal and obstetrical complications and hypertensive disease of pregnancy exacerbates these risks. The impact of preeclampsia on HTRs is unknown.
Objectives
The authors describe characteristics of HTRs who developed preeclampsia and the effect of preeclampsia on graft and pregnancy outcomes.
Methods
This is a retrospective group study of adult HTRs with subsequent pregnancy outcomes of ≥20 weeks’ gestation enrolled in the Transplant Pregnancy Registry International between 1986 and 2022. The primary outcome was graft loss within 2 years from delivery. Secondary outcomes included maternal and neonatal outcomes.
Results
A total of 146 pregnancies and 149 neonates met inclusion criteria. All were livebirths. Forty-two pregnancies (28.8%) were complicated by preeclampsia. HTRs in the preeclampsia group were more likely to be nulliparous (81.0% vs 54.8%; P < 0.01), and have chronic hypertension (73.8% vs 34.6%; P < 0.01). There was no difference in incidence of graft loss at 2 years with (4.8%) or without (2.9%) preeclampsia (P = 0.72). There was no clinically important difference in graft survival in pregnancies with preeclampsia compared with pregnancies without preeclampsia (adjusted HR: 0.79 [95% CI: 0.37-1.69]; P = 0.54). However, rates of severe maternal morbidity were high in both groups: 16.7% in the preeclampsia group and 10.6% in those without preeclampsia. Furthermore, preeclampsia was associated with earlier gestational age at birth (35.0 vs 37.0 weeks; P < 0.01) and lower birth weight (2,310 vs 2,801 grams; P < 0.01).
Conclusions
There was no difference in graft loss from delivery in HTRs who developed preeclampsia during pregnancy. Regardless of preeclampsia, pregnant HTRs are more likely than the general population to experience severe maternal morbidity. These findings provide pertinent information for counseling heart transplant recipients who pursue pregnancy.
{"title":"Heart Transplant and Pregnancy","authors":"Vanessa Kirschner BS , Ophelia Yin MD , Lisa Coscia RN, BSN , Prisca C. Diala MD , Negeen Shahandeh MD , Roxanna A. Irani MD, PhD , Serban Constantinescu MD, PhD , Michael J. Moritz MD , Yalda Afshar MD, PhD","doi":"10.1016/j.jchf.2024.11.016","DOIUrl":"10.1016/j.jchf.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplant recipients (HTRs) during pregnancy are at greater risk for maternal and obstetrical complications and hypertensive disease of pregnancy exacerbates these risks. The impact of preeclampsia on HTRs is unknown.</div></div><div><h3>Objectives</h3><div>The authors describe characteristics of HTRs who developed preeclampsia and the effect of preeclampsia on graft and pregnancy outcomes.</div></div><div><h3>Methods</h3><div>This is a retrospective group study of adult HTRs with subsequent pregnancy outcomes of ≥20 weeks’ gestation enrolled in the Transplant Pregnancy Registry International between 1986 and 2022. The primary outcome was graft loss within 2 years from delivery. Secondary outcomes included maternal and neonatal outcomes.</div></div><div><h3>Results</h3><div>A total of 146 pregnancies and 149 neonates met inclusion criteria. All were livebirths. Forty-two pregnancies (28.8%) were complicated by preeclampsia. HTRs in the preeclampsia group were more likely to be nulliparous (81.0% vs 54.8%; <em>P</em> < 0.01), and have chronic hypertension (73.8% vs 34.6%; <em>P</em> < 0.01). There was no difference in incidence of graft loss at 2 years with (4.8%) or without (2.9%) preeclampsia (<em>P =</em> 0.72). There was no clinically important difference in graft survival in pregnancies with preeclampsia compared with pregnancies without preeclampsia (adjusted HR: 0.79 [95% CI: 0.37-1.69]; <em>P =</em> 0.54). However, rates of severe maternal morbidity were high in both groups: 16.7% in the preeclampsia group and 10.6% in those without preeclampsia. Furthermore, preeclampsia was associated with earlier gestational age at birth (35.0 vs 37.0 weeks; <em>P</em> < 0.01) and lower birth weight (2,310 vs 2,801 grams; <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>There was no difference in graft loss from delivery in HTRs who developed preeclampsia during pregnancy. Regardless of preeclampsia, pregnant HTRs are more likely than the general population to experience severe maternal morbidity. These findings provide pertinent information for counseling heart transplant recipients who pursue pregnancy.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 498-507"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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