Pub Date : 2025-03-01DOI: 10.1016/j.jchf.2024.11.009
Janice Y. Chyou MD , Wan Ting Tay MAppStat , Jasper Tromp MD, PhD , Wouter Ouwerkerk PhD , Kai Hang Yiu MD, PhD , John G.F. Cleland MD , Sean P. Collins MD , Christiane E. Angermann MD , Georg Ertl MD , Ulf Dahlström MD, PhD , Kenneth Dickstein MD, PhD , Sergio V. Perrone MD , Mathieu Ghadanfar MD , Anja Schweizer PhD , Achim Obergfell MD , Gerasimos Filippatos MD , Carolyn S.P. Lam MBBS, PhD
Background
Atrial fibrillation (AF) and heart failure (HF) each contributes to global disease burden and can coexist. The interplay of prior HF, prior AF, and presenting rhythm have not previously been jointly considered in prognostic implication.
Objectives
The authors sought to assess 1-year all-cause mortality according to permutations of prior HF, prior AF, and AF as presenting rhythm, in a global cohort of patients hospitalized for HF.
Methods
REPORT-HF enrolled patients during hospitalization for acute HF from 44 countries over 6 continents. Cox proportional hazard models were used to compute HRs for the primary outcome of 1-year all-cause mortality.
Results
Of 13,401 participants (median age 67 years, 61% men), 58% had prior HF. AF prevalence (prior or newly detected) at HF admission was 39%, varying by left ventricular ejection fraction and race subgroups. Compared with patients with no prior HF, no prior AF, and presenting in sinus rhythm, 1-year all-cause mortality was elevated in patients with prior HF, prior AF, and presenting in AF (adjusted HR: 1.54 [95% CI: 1.34-1.78]; P < 0.001) and in patients with prior HF, no prior AF, and presenting in AF (adjusted HR: 1.51 [95% CI: 1.20-1.90]; P < 0.001), but not in patients with no prior HF and with prior AF or presenting in AF. These results were conserved across left ventricular ejection fraction and race subgroups.
Conclusions
In a global cohort of patients hospitalized for HF, permutations of prior HF, prior AF, and AF as presenting rhythm differentiate outcome. History of prior HF influences the prognostic implications of AF in patients hospitalized for HF. (Global Noninterventional Heart Failure Disease Registry [REPORT-HF]; NCT02595814)
{"title":"Prognostic Implications and Global Perspectives of Atrial Fibrillation in Patients Hospitalized for Heart Failure","authors":"Janice Y. Chyou MD , Wan Ting Tay MAppStat , Jasper Tromp MD, PhD , Wouter Ouwerkerk PhD , Kai Hang Yiu MD, PhD , John G.F. Cleland MD , Sean P. Collins MD , Christiane E. Angermann MD , Georg Ertl MD , Ulf Dahlström MD, PhD , Kenneth Dickstein MD, PhD , Sergio V. Perrone MD , Mathieu Ghadanfar MD , Anja Schweizer PhD , Achim Obergfell MD , Gerasimos Filippatos MD , Carolyn S.P. Lam MBBS, PhD","doi":"10.1016/j.jchf.2024.11.009","DOIUrl":"10.1016/j.jchf.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) and heart failure (HF) each contributes to global disease burden and can coexist. The interplay of prior HF, prior AF, and presenting rhythm have not previously been jointly considered in prognostic implication.</div></div><div><h3>Objectives</h3><div>The authors sought to assess 1-year all-cause mortality according to permutations of prior HF, prior AF, and AF as presenting rhythm, in a global cohort of patients hospitalized for HF.</div></div><div><h3>Methods</h3><div>REPORT-HF enrolled patients during hospitalization for acute HF from 44 countries over 6 continents. Cox proportional hazard models were used to compute HRs for the primary outcome of 1-year all-cause mortality.</div></div><div><h3>Results</h3><div>Of 13,401 participants (median age 67 years, 61% men), 58% had prior HF. AF prevalence (prior or newly detected) at HF admission was 39%, varying by left ventricular ejection fraction and race subgroups. Compared with patients with no prior HF, no prior AF, and presenting in sinus rhythm, 1-year all-cause mortality was elevated in patients with prior HF, prior AF, and presenting in AF (adjusted HR: 1.54 [95% CI: 1.34-1.78]; <em>P</em> < 0.001) and in patients with prior HF, no prior AF, and presenting in AF (adjusted HR: 1.51 [95% CI: 1.20-1.90]; <em>P</em> < 0.001), but not in patients with no prior HF and with prior AF or presenting in AF. These results were conserved across left ventricular ejection fraction and race subgroups.</div></div><div><h3>Conclusions</h3><div>In a global cohort of patients hospitalized for HF, permutations of prior HF, prior AF, and AF as presenting rhythm differentiate outcome. History of prior HF influences the prognostic implications of AF in patients hospitalized for HF. (Global Noninterventional Heart Failure Disease Registry [REPORT-HF]; <span><span>NCT02595814</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 453-464"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364449","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.2024.11.022
Gracia Fahed MD , John Isaiah Jimenez BS , Marina I. Adrianzen Fonseca MD , Jonathan Hu BS , Gabriela Spencer-Bonilla MD , Francois Haddad MD , Jesus E. Pino Moreno MD , Ronald M. Witteles MD , Kevin M. Alexander MD
{"title":"The Impact of Social Determinants of Health on Timely Detection in Transthyretin Cardiac Amyloidosis","authors":"Gracia Fahed MD , John Isaiah Jimenez BS , Marina I. Adrianzen Fonseca MD , Jonathan Hu BS , Gabriela Spencer-Bonilla MD , Francois Haddad MD , Jesus E. Pino Moreno MD , Ronald M. Witteles MD , Kevin M. Alexander MD","doi":"10.1016/j.jchf.2024.11.022","DOIUrl":"10.1016/j.jchf.2024.11.022","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 530-532"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548165","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 : 2025-02-27DOI: 10.1016/j.jchf.2024.12.010
Toru Kondo, Pardeep S Jhund, Inder S Anand, Brian L Claggett, Akshay S Desai, Kieran F Docherty, Carolyn S P Lam, Martin P Lefkowitz, Aldo P Maggioni, Felipe A Martinez, Margaret M Redfield, Jean L Rouleau, Dirk J Van Veldhuisen, Faiez Zannad, Michael R Zile, Milton Packer, Scott D Solomon, John J V McMurray
Background: Recent trials of new heart failure (HF) treatments suggest the effect of therapy may vary by N-terminal pro-B type natriuretic peptide (NT-proBNP) level.
Objectives: The authors examined the efficacy of sacubitril/valsartan according to NT-proBNP levels in patients with reduced, mildly reduced, and preserved left ventricular ejection fraction (LVEF) enrolled in PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Converting-Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial) and PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Receptor Blockers Global Outcomes in HF with Preserved Ejection Fraction).
Methods: Individual patient data from PARADIGM-HF and PARAGON-HF were pooled and participants were divided into categories defined by quintiles of NT-proBNP level. The primary outcome examined was the composite of HF hospitalization or cardiovascular death.
Results: Among the 13,195 patients enrolled in both trials, 13,142 (99.6%) had a baseline NT-proBNP level measured. The rate of the primary outcome (per 100 person-years) increased with NT-proBNP levels: quintile 1, 5.9 (95% CI: 5.3-6.5); quintile 2, 7.5 (95% CI: 6.9-8.2); quintile 3, 9.0 (95% CI: 8.2-9.7); quintile 4, 12.0 (95% CI: 11.1-12.9); and quintile 5, 20.8 (95% CI: 19.6-22.2). The relative risk reduction in the primary outcome with sacubitril/valsartan was consistent across NT-proBNP levels: the HR in quintile 1 was 0.79 (95% CI: 0.65-0.96); quintile 2, 0.87 (95% CI: 0.72-1.04); quintile 3, 0.79 (95% CI: 0.66-0.93); quintile 4, 0.85 (95% CI: 0.73-0.99); and quintile 5, 0.86 (95% CI: 0.76-0.97; P for interaction = 0.86). The absolute risk reduction was greatest in NT-proBNP quintile 5; the number needed to treat for the primary outcome over the median follow-up of 31 months was 16 in quintile 5 vs 37 in quintile 1.
Conclusions: The relative risk reductions with sacubitril/valsartan were consistent irrespective of NT-proBNP level in HF patients across the range of LVEF. Consequently, the absolute risk reductions were greatest in patients with higher NT-proBNP levels. (PARADIGM-HF; NCT01035255; and PARAGON-HF; NCT01920711).
{"title":"Effects of Sacubitril/Valsartan According to Natriuretic Peptide Levels in Patients Enrolled in PARADIGM-HF and PARAGON-HF.","authors":"Toru Kondo, Pardeep S Jhund, Inder S Anand, Brian L Claggett, Akshay S Desai, Kieran F Docherty, Carolyn S P Lam, Martin P Lefkowitz, Aldo P Maggioni, Felipe A Martinez, Margaret M Redfield, Jean L Rouleau, Dirk J Van Veldhuisen, Faiez Zannad, Michael R Zile, Milton Packer, Scott D Solomon, John J V McMurray","doi":"10.1016/j.jchf.2024.12.010","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.12.010","url":null,"abstract":"<p><strong>Background: </strong>Recent trials of new heart failure (HF) treatments suggest the effect of therapy may vary by N-terminal pro-B type natriuretic peptide (NT-proBNP) level.</p><p><strong>Objectives: </strong>The authors examined the efficacy of sacubitril/valsartan according to NT-proBNP levels in patients with reduced, mildly reduced, and preserved left ventricular ejection fraction (LVEF) enrolled in PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Converting-Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial) and PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Receptor Blockers Global Outcomes in HF with Preserved Ejection Fraction).</p><p><strong>Methods: </strong>Individual patient data from PARADIGM-HF and PARAGON-HF were pooled and participants were divided into categories defined by quintiles of NT-proBNP level. The primary outcome examined was the composite of HF hospitalization or cardiovascular death.</p><p><strong>Results: </strong>Among the 13,195 patients enrolled in both trials, 13,142 (99.6%) had a baseline NT-proBNP level measured. The rate of the primary outcome (per 100 person-years) increased with NT-proBNP levels: quintile 1, 5.9 (95% CI: 5.3-6.5); quintile 2, 7.5 (95% CI: 6.9-8.2); quintile 3, 9.0 (95% CI: 8.2-9.7); quintile 4, 12.0 (95% CI: 11.1-12.9); and quintile 5, 20.8 (95% CI: 19.6-22.2). The relative risk reduction in the primary outcome with sacubitril/valsartan was consistent across NT-proBNP levels: the HR in quintile 1 was 0.79 (95% CI: 0.65-0.96); quintile 2, 0.87 (95% CI: 0.72-1.04); quintile 3, 0.79 (95% CI: 0.66-0.93); quintile 4, 0.85 (95% CI: 0.73-0.99); and quintile 5, 0.86 (95% CI: 0.76-0.97; P for interaction = 0.86). The absolute risk reduction was greatest in NT-proBNP quintile 5; the number needed to treat for the primary outcome over the median follow-up of 31 months was 16 in quintile 5 vs 37 in quintile 1.</p><p><strong>Conclusions: </strong>The relative risk reductions with sacubitril/valsartan were consistent irrespective of NT-proBNP level in HF patients across the range of LVEF. Consequently, the absolute risk reductions were greatest in patients with higher NT-proBNP levels. (PARADIGM-HF; NCT01035255; and PARAGON-HF; NCT01920711).</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633639","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 : 2025-02-26DOI: 10.1016/j.jchf.2025.01.011
Mona Fiuzat, Kimberly Ferlin, Laura Gottschalk, Andrew Farb, Isabella Cavagna, JoAnn Lindenfeld, Bram Zuckerman, Douglas Kelly
{"title":"An Innovative Program for Evidence Generation: HFC Perspective on the FDA Total Product Life Cycle Advisory Program.","authors":"Mona Fiuzat, Kimberly Ferlin, Laura Gottschalk, Andrew Farb, Isabella Cavagna, JoAnn Lindenfeld, Bram Zuckerman, Douglas Kelly","doi":"10.1016/j.jchf.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.01.011","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633626","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 : 2025-02-26DOI: 10.1016/j.jchf.2024.12.012
Kieran F Docherty, Kirsty McDowell, Paul Welsh, Mark C Petrie, Inder Anand, David D Berg, Rudolf A de Boer, Lars Køber, Mikhail N Kosiborod, Felipe A Martinez, Eileen O'Meara, David A Morrow, Piotr Ponikowski, Marc S Sabatine, Naveed Sattar, Morten Schou, Ann Hammarstedt, Mikaela Sjöstrand, Anna Maria Langkilde, Pardeep S Jhund, Scott D Solomon, John J V McMurray
Background: Inflammation may play an important pathophysiological role in the development and progression of heart failure (HF). Interleukin (IL)-6 is a circulating cytokine and is the main regulator of the release of C-reactive protein (CRP).
Objectives: The authors examined the association between IL-6 and high-sensitivity (hs)-CRP and outcomes in patients with HFrEF in the DAPA-HF trial and their relationship with the effect of dapagliflozin.
Methods: Inclusion criteria included: 1) NYHA functional class II-IV; 2) left ventricular ejection fraction ≤40%; 3) elevated N-terminal pro-B-type natriuretic peptide; and 4) estimated glomerular filtration rate ≥30 mL/min/1.73 m2. The primary outcome was a composite of a worsening HF event or cardiovascular death. IL-6 and hs-CRP were measured at baseline and 12 months (Roche Diagnostics). The associations between IL-6 and hs-CRP and outcomes were adjusted for known prognostic variables, including NT-proBNP.
Results: Among 2,940 patients, median IL-6 and hs-CRP at baseline were 6.01 pg/mL (Q1-Q3: 4.18-9.28 pg/mL) and 2.05 mg/L (Q1-Q3: 0.83-4.9 mg/L), respectively. Baseline IL-6 tertiles (T) were: T1 ≤4.72 pg/mL; T2 4.73-7.89 pg/mL; and T3 ≥7.90 pg/mL. The adjusted risks of the primary outcome relative to T1 were as follows: T2 = HR 1.34 (95% CI: 1.04-1.73) and T3 = HR 1.80 (95% CI: 1.41-2.31). A rise in IL-6 between baseline and 12 months was associated with worse outcomes. The beneficial effect of dapagliflozin on the primary outcome was consistent regardless of IL-6 concentration (continuous interaction P = 0.57), with similar results for hs-CRP. Dapagliflozin did not reduce IL-6 or hs-CRP at 12 months.
Conclusions: In DAPA-HF, elevated IL-6 and hs-CRP levels were each associated with the risk of worsening HF or cardiovascular death. Dapagliflozin reduced the risk of adverse outcomes regardless of baseline IL-6 or hs-CRP. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).
{"title":"Interleukin-6 in Heart Failure With Reduced Ejection Fraction and the Effect of Dapagliflozin: An Exploratory Analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure Trial.","authors":"Kieran F Docherty, Kirsty McDowell, Paul Welsh, Mark C Petrie, Inder Anand, David D Berg, Rudolf A de Boer, Lars Køber, Mikhail N Kosiborod, Felipe A Martinez, Eileen O'Meara, David A Morrow, Piotr Ponikowski, Marc S Sabatine, Naveed Sattar, Morten Schou, Ann Hammarstedt, Mikaela Sjöstrand, Anna Maria Langkilde, Pardeep S Jhund, Scott D Solomon, John J V McMurray","doi":"10.1016/j.jchf.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.12.012","url":null,"abstract":"<p><strong>Background: </strong>Inflammation may play an important pathophysiological role in the development and progression of heart failure (HF). Interleukin (IL)-6 is a circulating cytokine and is the main regulator of the release of C-reactive protein (CRP).</p><p><strong>Objectives: </strong>The authors examined the association between IL-6 and high-sensitivity (hs)-CRP and outcomes in patients with HFrEF in the DAPA-HF trial and their relationship with the effect of dapagliflozin.</p><p><strong>Methods: </strong>Inclusion criteria included: 1) NYHA functional class II-IV; 2) left ventricular ejection fraction ≤40%; 3) elevated N-terminal pro-B-type natriuretic peptide; and 4) estimated glomerular filtration rate ≥30 mL/min/1.73 m<sup>2</sup>. The primary outcome was a composite of a worsening HF event or cardiovascular death. IL-6 and hs-CRP were measured at baseline and 12 months (Roche Diagnostics). The associations between IL-6 and hs-CRP and outcomes were adjusted for known prognostic variables, including NT-proBNP.</p><p><strong>Results: </strong>Among 2,940 patients, median IL-6 and hs-CRP at baseline were 6.01 pg/mL (Q1-Q3: 4.18-9.28 pg/mL) and 2.05 mg/L (Q1-Q3: 0.83-4.9 mg/L), respectively. Baseline IL-6 tertiles (T) were: T1 ≤4.72 pg/mL; T2 4.73-7.89 pg/mL; and T3 ≥7.90 pg/mL. The adjusted risks of the primary outcome relative to T1 were as follows: T2 = HR 1.34 (95% CI: 1.04-1.73) and T3 = HR 1.80 (95% CI: 1.41-2.31). A rise in IL-6 between baseline and 12 months was associated with worse outcomes. The beneficial effect of dapagliflozin on the primary outcome was consistent regardless of IL-6 concentration (continuous interaction P = 0.57), with similar results for hs-CRP. Dapagliflozin did not reduce IL-6 or hs-CRP at 12 months.</p><p><strong>Conclusions: </strong>In DAPA-HF, elevated IL-6 and hs-CRP levels were each associated with the risk of worsening HF or cardiovascular death. Dapagliflozin reduced the risk of adverse outcomes regardless of baseline IL-6 or hs-CRP. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633881","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 : 2025-02-22DOI: 10.1016/j.jchf.2024.12.011
Garima Sharma, Tiffany L Brazile, Sara A Thorne
{"title":"Heart Failure Risk Linked to Adverse Pregnancy Outcomes: A Timely Opportunity to Reduce Heart Failure Risk in Women.","authors":"Garima Sharma, Tiffany L Brazile, Sara A Thorne","doi":"10.1016/j.jchf.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.12.011","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567156","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}
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