Palliative care, including symptom alleviation and advance-care planning, is relevant for patients with heart failure (HF). The Supportive and Palliative Care Indicator Tool (SPICT) is a tool for identifying patients who may benefit from palliative-care assistance but has not been validated in patients hospitalized due to HF.
Methods and Results
Clinical backgrounds, symptom burdens and outcomes were evaluated using the SPICT as assessed on admission in consecutive hospitalized patients with HF. SPICT-positive was defined when 2 or more general indicators and a New York Heart Association class ≥ III were present. Of 601 patients hospitalized due to HF (mean age: 79 ± 12 years; male, 314 [52%]; and mean left ventricular ejection fraction: 44 ± 18%), 100 (17%) patients were SPICT-positive. SPICT-positive patients were older (85 ± 9 vs 78 ± 12 years; P < 0.001) and had higher clinical frailty scales (6 ± 1 vs 4 ± 1 points; P < 0.001), whereas symptom burdens assessed by the Integrated Palliative care Outcome Scale were not different (17 [13, 28] vs 20 [11, 26] points; P = 0.97) when compared with patients who were SPICT-negative. During the median follow-up period of 518 days, 178 patients (30%) died. Being SPICT-positive was independently associated with higher all-cause mortality (hazard ratio: 3.49, 95% confidence interval: 2.41–5.05; P < 0.001) after adjusting for age, sex, New York Heart Association class IV, Get-With-The-Guideline risk score, N-terminal pro B-type natriuretic peptide levels, and left ventricular ejection fractions.
Conclusions
In patients admitted for HF, being SPICT-positive was significantly associated with higher all-cause mortality rates, suggesting the utility of the SPICT as an indicator to initiate advance-care planning for end-of-life care among patients hospitalized due to HF.
{"title":"Validation of a Supportive and Palliative Care Indicator Tool Among Patients Hospitalized Due to Heart Failure","authors":"YASUHIRO HAMATANI MD, PhD , KANAKO TERAMOTO MD, MPH, PhD , YURIKA IKEYAMA-HIDESHIMA RN , SOSHIRO OGATA PhD, MHS , ATSUKO KUNUGIDA RN , KENJIRO ISHIGAMI MD , KIMIHITO MINAMI MD , MAKI YAMAGUCHI RN , MINA TAKAMOTO , JUN NAKASHIMA , MITSUYO YAMAGUCHI RN , MISAKI SAKAI RN , TAE KINOSHITA MD , MORITAKE IGUCHI MD, PhD , KUNIHIRO NISHIMURA MD, PhD , MASAHARU AKAO MD, PhD","doi":"10.1016/j.cardfail.2024.04.016","DOIUrl":"10.1016/j.cardfail.2024.04.016","url":null,"abstract":"<div><h3>Background</h3><div>Palliative care, including symptom alleviation and advance-care planning, is relevant for patients with heart failure (HF). The Supportive and Palliative Care Indicator Tool (SPICT) is a tool for identifying patients who may benefit from palliative-care assistance but has not been validated in patients hospitalized due to HF.</div></div><div><h3>Methods and Results</h3><div>Clinical backgrounds, symptom burdens and outcomes were evaluated using the SPICT as assessed on admission in consecutive hospitalized patients with HF. SPICT-positive was defined when 2 or more general indicators and a New York Heart Association class ≥ III were present. Of 601 patients hospitalized due to HF (mean age: 79 ± 12 years; male, 314 [52%]; and mean left ventricular ejection fraction: 44 ± 18%), 100 (17%) patients were SPICT-positive. SPICT-positive patients were older (85 ± 9 vs 78 ± 12 years; <em>P</em> < 0.001) and had higher clinical frailty scales (6 ± 1 vs 4 ± 1 points; <em>P</em> < 0.001), whereas symptom burdens assessed by the Integrated Palliative care Outcome Scale were not different (17 [13, 28] vs 20 [11, 26] points; <em>P</em> = 0.97) when compared with patients who were SPICT-negative. During the median follow-up period of 518 days, 178 patients (30%) died. Being SPICT-positive was independently associated with higher all-cause mortality (hazard ratio: 3.49, 95% confidence interval: 2.41–5.05; <em>P</em> < 0.001) after adjusting for age, sex, New York Heart Association class IV, Get-With-The-Guideline risk score, N-terminal pro B-type natriuretic peptide levels, and left ventricular ejection fractions.</div></div><div><h3>Conclusions</h3><div>In patients admitted for HF, being SPICT-positive was significantly associated with higher all-cause mortality rates, suggesting the utility of the SPICT as an indicator to initiate advance-care planning for end-of-life care among patients hospitalized due to HF.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 16-25"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.06.014
Elizabeth Ko MD , Mohammad Ahmed DO , Matthew Nudy MD , Rahul Bussa MD , Jatin Bussa , Mario Gonzalez MD , Gerald Naccarelli MD , Behzad Soleimani MD , Ankit Maheshwari MD
Background
There is conflicting data on the association between pre-orthotopic heart transplant (OHT) amiodarone use and post-OHT graft dysfunction (GD) leading to heterogeneity in clinical practice.
Methods
We performed a meta-analysis to evaluate whether pre-OHT amiodarone use was associated with meaningful increases in the incidence of GD, 30-day mortality, and 1-year mortality. Studies were identified by searching PubMed and the Cochrane Register of Clinical Trials. The Mantel-Haenszel method was used to calculate odds ratios (OR) and 95% confidence intervals (CI95) for each endpoint.
Results
17 retrospective studies were identified that included 48,782 patients. 14 studies (n = 48,018) reported GD as an outcome. Pre-OHT amiodarone use was associated with increased odds of GD (OR 1.3, CI95 1.2-1.5, p < 0.001). 10 studies (n = 45,875) reported 30-day mortality based on amiodarone use. Pre-OHT amiodarone use was associated with increased odds of 30-day mortality (OR 1.4, CI95 1.2-1.5, p < 0.001). 5 studies (n = 41,404) reported 1-year mortality based on amiodarone use. Pre-OHT amiodarone use was associated with increased odds of 1-year mortality (OR 1.2, CI95 1.1-1.4, p < 0.001). The increase in absolute risk of GD, 30-day mortality, and 1-year mortality for patients with pre-OHT amiodarone use was 1.3%, 1.2%, and 1.4%, respectively.
Conclusion
Pre-OHT amiodarone exposure was associated with increased odds of GD, 30-day mortality, and 1-year mortality. The increase in absolute risk for each endpoint was modest, and it is unclear to what extent, if any, pre-OHT amiodarone use should influence assessment of OHT candidacy.
{"title":"Association of Amiodarone Use Prior to Orthotopic Heart Transplant with Post-Transplant Graft Dysfunction and All-Cause Mortality: A Systematic Review and Meta-Analysis","authors":"Elizabeth Ko MD , Mohammad Ahmed DO , Matthew Nudy MD , Rahul Bussa MD , Jatin Bussa , Mario Gonzalez MD , Gerald Naccarelli MD , Behzad Soleimani MD , Ankit Maheshwari MD","doi":"10.1016/j.cardfail.2024.06.014","DOIUrl":"10.1016/j.cardfail.2024.06.014","url":null,"abstract":"<div><h3>Background</h3><div>There is conflicting data on the association between pre-orthotopic heart transplant (OHT) amiodarone use and post-OHT graft dysfunction (GD) leading to heterogeneity in clinical practice.</div></div><div><h3>Methods</h3><div>We performed a meta-analysis to evaluate whether pre-OHT amiodarone use was associated with meaningful increases in the incidence of GD, 30-day mortality, and 1-year mortality. Studies were identified by searching PubMed and the Cochrane Register of Clinical Trials. The Mantel-Haenszel method was used to calculate odds ratios (OR) and 95% confidence intervals (CI<sub>95</sub>) for each endpoint.</div></div><div><h3>Results</h3><div>17 retrospective studies were identified that included 48,782 patients. 14 studies (n = 48,018) reported GD as an outcome. Pre-OHT amiodarone use was associated with increased odds of GD (OR 1.3, CI<sub>95</sub> 1.2-1.5, p < 0.001). 10 studies (n = 45,875) reported 30-day mortality based on amiodarone use. Pre-OHT amiodarone use was associated with increased odds of 30-day mortality (OR 1.4, CI<sub>95</sub> 1.2-1.5, p < 0.001). 5 studies (n = 41,404) reported 1-year mortality based on amiodarone use. Pre-OHT amiodarone use was associated with increased odds of 1-year mortality (OR 1.2, CI<sub>95</sub> 1.1-1.4, p < 0.001). The increase in absolute risk of GD, 30-day mortality, and 1-year mortality for patients with pre-OHT amiodarone use was 1.3%, 1.2%, and 1.4%, respectively.</div></div><div><h3>Conclusion</h3><div>Pre-OHT amiodarone exposure was associated with increased odds of GD, 30-day mortality, and 1-year mortality. The increase in absolute risk for each endpoint was modest, and it is unclear to what extent, if any, pre-OHT amiodarone use should influence assessment of OHT candidacy.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 149-153"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.07.001
Biykem Bozkurt MD, PhD (Chair), Tariq Ahmad MD, MPH, Kevin Alexander MD, William L. Baker PharmD, Kelly Bosak PhD, APRN, Khadijah Breathett MD, MS, Spencer Carter MD, Mark H. Drazner MD, MSc, Shannon M. Dunlay MD MS, Gregg C. Fonarow MD, Stephen J. Greene MD, Paul Heidenreich MD, Jennifer E. Ho MD, Eileen Hsich MD, Nasrien E. Ibrahim MD, Lenette M. Jones PhD, RN, Sadiya S. Khan MD, MSc, Prateeti Khazanie MD, MPH, Todd Koelling MD, Christopher S. Lee RN, PhD, Boback Ziaeian MD, PhD
{"title":"HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics An Updated 2024 Report from the Heart Failure Society of America","authors":"Biykem Bozkurt MD, PhD (Chair), Tariq Ahmad MD, MPH, Kevin Alexander MD, William L. Baker PharmD, Kelly Bosak PhD, APRN, Khadijah Breathett MD, MS, Spencer Carter MD, Mark H. Drazner MD, MSc, Shannon M. Dunlay MD MS, Gregg C. Fonarow MD, Stephen J. Greene MD, Paul Heidenreich MD, Jennifer E. Ho MD, Eileen Hsich MD, Nasrien E. Ibrahim MD, Lenette M. Jones PhD, RN, Sadiya S. Khan MD, MSc, Prateeti Khazanie MD, MPH, Todd Koelling MD, Christopher S. Lee RN, PhD, Boback Ziaeian MD, PhD","doi":"10.1016/j.cardfail.2024.07.001","DOIUrl":"10.1016/j.cardfail.2024.07.001","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 66-116"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.11.001
COLLEEN K. MCILVENNAN PhD, DNP, ANP , ADAM DEVORE MD, MHS , LARRY A. ALLEN MD, MHS
{"title":"Do We Need More Tools? Searching the Toolbox for Ways to Identify Palliative Care Needs in Patients With Heart Failure","authors":"COLLEEN K. MCILVENNAN PhD, DNP, ANP , ADAM DEVORE MD, MHS , LARRY A. ALLEN MD, MHS","doi":"10.1016/j.cardfail.2024.11.001","DOIUrl":"10.1016/j.cardfail.2024.11.001","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 26-28"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertrophic cardiomyopathy (HCM), a genetic disease of cardiac sarcomere, has varied clinical presentation. Speckle tracking echocardiography (STE) is being increasingly used in HCM and there is data that global longitudinal strain (GLS) abnormalities on STE correlate with cardiac magnetic resonance (CMR) abnormalities which have a proven prognostic significance. There is lack of such data on Indian HCM patients.
Methods
After informed written consent, enrolled patients underwent detailed 2D-transthoracic echocardiography (TTE) including GLS imaging and 24-hr Holter monitoring. CMR was done in approximately half of the enrolled patients, based on treating cardiologist's discretion.
Results
We enrolled 150 HCM patients from February 2022 to July 2023. All patients underwent TTE and Holter, while CMR was done in 74 patients. The mean age of patients was 46.7 years (SD 13.6) and 80% were males. Exertional dyspnea was present in 72%, angina in 48% and history of syncope in 21% cases. Majority of the patients were in New York Heart Association (NYHA) functional class II (70%) followed by NYHA I (18.6%) and NYHA III (11.3%). A positive family history in the form of either a known relative with confirmed HCM or sudden death (possibly related to HCM) was present in 10.6% of patients. Atrial fibrillation (paroxysmal or persistent) was diagnosed in 11.3% of the enrolled cases. Non sustained ventricular tachycardia (NSVT) runs were present in 21 (14%) patients on Holter.
The most common HCM phenotype was asymmetric septal hypertrophy (76%). Concentric left ventricular hypertrophy was present in 10.6% while a diagnosis of apical HCM was made in 12.7% patients. 53% of patients had significant left ventricular outflow tract obstruction (LVOTO), with continuous wave doppler gradients of ≥ 30 mmHg either at rest or with provocation. Systolic anterior motion of anterior mitral leaflet (AML) was present in 90 (60%) cases. Mitral regurgitation was present in 80 (53.3%) of the cases which was mild in majority of the cases (70 cases or 46.7%). Tissue doppler data was available in 136 (90.6%) patients. Using a cut-off value of 7cm/s for medial e’ and 10cm/s for lateral e’, the medial e’ was reduced in 126 (92.6%) cases and lateral e’ was reduced in 130 (95.6%) cases. The peak left ventricular global longitudinal strain (GLS) was available in 126 patients. The mean value of peak GLS was - 12.1 % (SD 4.1) with values ranging from -4% to -24%. The average value of peak GLS in non-obstructive HCM was -12.7% as compared to -11.4% in the obstructive HCM group. However, this difference was not statistically different with a p value of 0.08).
{"title":"Clinical-imaging Profile And Correlations Of Global Longitudinal Strain Abnormalities In Indian Hypertrophic Cardiomyopathy Patients","authors":"Mohsin Mantoo, Sandeep Seth, Nitish Naik, Priya Jagia, Satyavir Yadav, Rakesh Yadav","doi":"10.1016/j.cardfail.2024.10.021","DOIUrl":"10.1016/j.cardfail.2024.10.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypertrophic cardiomyopathy (HCM), a genetic disease of cardiac sarcomere, has varied clinical presentation. Speckle tracking echocardiography (STE) is being increasingly used in HCM and there is data that global longitudinal strain (GLS) abnormalities on STE correlate with cardiac magnetic resonance (CMR) abnormalities which have a proven prognostic significance. There is lack of such data on Indian HCM patients.</div></div><div><h3>Methods</h3><div>After informed written consent, enrolled patients underwent detailed 2D-transthoracic echocardiography (TTE) including GLS imaging and 24-hr Holter monitoring. CMR was done in approximately half of the enrolled patients, based on treating cardiologist's discretion.</div></div><div><h3>Results</h3><div>We enrolled 150 HCM patients from February 2022 to July 2023. All patients underwent TTE and Holter, while CMR was done in 74 patients. The mean age of patients was 46.7 years (SD 13.6) and 80% were males. Exertional dyspnea was present in 72%, angina in 48% and history of syncope in 21% cases. Majority of the patients were in New York Heart Association (NYHA) functional class II (70%) followed by NYHA I (18.6%) and NYHA III (11.3%). A positive family history in the form of either a known relative with confirmed HCM or sudden death (possibly related to HCM) was present in 10.6% of patients. Atrial fibrillation (paroxysmal or persistent) was diagnosed in 11.3% of the enrolled cases. Non sustained ventricular tachycardia (NSVT) runs were present in 21 (14%) patients on Holter.</div><div>The most common HCM phenotype was asymmetric septal hypertrophy (76%). Concentric left ventricular hypertrophy was present in 10.6% while a diagnosis of apical HCM was made in 12.7% patients. 53% of patients had significant left ventricular outflow tract obstruction (LVOTO), with continuous wave doppler gradients of ≥ 30 mmHg either at rest or with provocation. Systolic anterior motion of anterior mitral leaflet (AML) was present in 90 (60%) cases. Mitral regurgitation was present in 80 (53.3%) of the cases which was mild in majority of the cases (70 cases or 46.7%). Tissue doppler data was available in 136 (90.6%) patients. Using a cut-off value of 7cm/s for medial e’ and 10cm/s for lateral e’, the medial e’ was reduced in 126 (92.6%) cases and lateral e’ was reduced in 130 (95.6%) cases. The peak left ventricular global longitudinal strain (GLS) was available in 126 patients. The mean value of peak GLS was - 12.1 % (SD 4.1) with values ranging from -4% to -24%. The average value of peak GLS in non-obstructive HCM was -12.7% as compared to -11.4% in the obstructive HCM group. However, this difference was not statistically different with a p value of 0.08).</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 185"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.10.043
Schuyler Jones , Stefan Anker , Javed Butler , Deepak L Bhatt , Josephine Harrington , Mark C Petrie , Mikhail Sumin , Isabella Zwiener , Jay A Udell , Adrian F Hernandez
Background
Prior studies have suggested that sex differences exist following myocardial infarction (MI) with regards to the application of guideline-directed medical therapy and the risk of death and development of heart failure.
Methods
The EMPACT-MI study randomized 6522 patients in a 1:1 fashion to empagliflozin and placebo following hospital admission for acute myocardial infarction and either new reduction in left ventricular ejection fraction and/or symptoms/signs of heart failure requiring treatment. The primary endpoint was time to first hospitalization for heart failure (HHF) or all-cause death. Key secondary endpoints included total number of HHF or all-cause mortality, further endpoints included time to first HHF and time to all-cause death. In this subgroup analysis of EMPACT-MI, we examined the association of sex with clinical characteristics, outcomes, and treatment differences in the EMPACT-MI study.
Results
A total of 1,625 women (24.9% of overall population) were randomized in the study; 812 were randomized to empagliflozin, 813 to placebo. When compared with men, women were older, more likely to have diabetes mellitus at baseline, more likely to present with NSTEMI, and less likely to undergo revascularization. Women were also more likely to have signs or symptoms of congestion requiring treatment and >2 risk enrichment criteria at baseline.
Over a median of 17.9 months of follow up, in the placebo group, women had similar risk for a first HHF or all-cause death compared with men (hazard ratio=0.84, 95% CI 0.65-1.10, p=0.2019). If this abstract is accepted, the treatment effect of empagliflozin initiated after acute MI on key trial outcomes will be presented in men and women. The primary results of EMPACT-MI will be presented and the embargo will be lifted at the American College of Cardiology in early April 2024.
Conclusions
The risk of HHF or all-cause death was similar in women and in men. The treatment effect of empagliflozin versus placebo on the key trial endpoints according to sex will be presented.
{"title":"The Association Of Sex With Clinical Outcomes After Myocardial Infarction: A Subgroup Analysis Of The EMPACT-MI Study","authors":"Schuyler Jones , Stefan Anker , Javed Butler , Deepak L Bhatt , Josephine Harrington , Mark C Petrie , Mikhail Sumin , Isabella Zwiener , Jay A Udell , Adrian F Hernandez","doi":"10.1016/j.cardfail.2024.10.043","DOIUrl":"10.1016/j.cardfail.2024.10.043","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies have suggested that sex differences exist following myocardial infarction (MI) with regards to the application of guideline-directed medical therapy and the risk of death and development of heart failure.</div></div><div><h3>Methods</h3><div>The EMPACT-MI study randomized 6522 patients in a 1:1 fashion to empagliflozin and placebo following hospital admission for acute myocardial infarction and either new reduction in left ventricular ejection fraction and/or symptoms/signs of heart failure requiring treatment. The primary endpoint was time to first hospitalization for heart failure (HHF) or all-cause death. Key secondary endpoints included total number of HHF or all-cause mortality, further endpoints included time to first HHF and time to all-cause death. In this subgroup analysis of EMPACT-MI, we examined the association of sex with clinical characteristics, outcomes, and treatment differences in the EMPACT-MI study.</div></div><div><h3>Results</h3><div>A total of 1,625 women (24.9% of overall population) were randomized in the study; 812 were randomized to empagliflozin, 813 to placebo. When compared with men, women were older, more likely to have diabetes mellitus at baseline, more likely to present with NSTEMI, and less likely to undergo revascularization. Women were also more likely to have signs or symptoms of congestion requiring treatment and >2 risk enrichment criteria at baseline.</div><div>Over a median of 17.9 months of follow up, in the placebo group, women had similar risk for a first HHF or all-cause death compared with men (hazard ratio=0.84, 95% CI 0.65-1.10, p=0.2019). If this abstract is accepted, the treatment effect of empagliflozin initiated after acute MI on key trial outcomes will be presented in men and women. The primary results of EMPACT-MI will be presented and the embargo will be lifted at the American College of Cardiology in early April 2024.</div></div><div><h3>Conclusions</h3><div>The risk of HHF or all-cause death was similar in women and in men. The treatment effect of empagliflozin versus placebo on the key trial endpoints according to sex will be presented.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 195"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.10.044
Quin E. Denfeld , Christopher V. Chien , Shirin O. Hiatt , Mary Roberts Davis , S. Albert Camacho , Christopher S. Lee
Introduction
Physical frailty affects a significant number of adults with heart failure (HF), conferring worse clinical and patient-reported outcomes. While the biological (including sex) and physiological factors contributing to physical frailty in HF are beginning to be understood, the contributing role of social determinants of health have not been studied.
Purpose
To identify associations between social determinants of health (SDOH) and physical frailty among adults with HF.
Methods
We performed a secondary analysis of combined data from two studies of adults with New York Heart Association (NYHA) functional class I-IV HF. Physical frailty was measured with the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity. We examined the following SDOH factors: race/ethnicity (Non-Hispanic White vs. all other races/ethnicities), level of education (bachelor's degree or higher vs. some college vs. high school or less), financial status (have enough or more than enough to make ends meet vs. do not have enough to make ends meet), employment status (employed vs. retired/unemployed), marital status (married/living with domestic partner vs. single/divorced/widowed), and having someone to confide in (yes vs. no). Logistic regression (odds ratios (OR) with 95% confidence intervals (CI)), adjusted for the known contributors (age, sex, NYHA class, and comorbidity index), was used to identify SDOH predictors of physical frailty. We also explored the influence of sex on associations between each SDOH factor and physical frailty using interaction testing.
Results
The sample (n = 160) was 61.7±14.6 years, 44% female, and 62% were NYHA class III/IV. Physical frailty was identified in 44% of the sample. Significant predictors of physical frailty were female sex (OR 3.67, 95% CI [1.62, 8.33]) and being retired/unemployed (OR 3.86, 95% CI [1.38, 10.80]). A nested logistic regression model demonstrated that the block of SDOH factors significantly predicted physical frailty above and beyond age, sex, NYHA class, and comorbidity index (Wald chi2 = 14.09, p < 0.05; Δ pseudo R2 = 8%). Finally, lower education was a stronger predictor of physical frailty for women than for men (interaction p < 0.05).
Conclusions
SDOH, individually and in combination, are potential significant contributors to physical frailty in HF. Retirement or unemployment was a notable predictor of frailty, indicating that it warrants further research and clinical evaluation as a potential sentinel event for adults with HF. Additionally, female sex continues to be strongly associated with and influences predictors of physical frailty in HF.
{"title":"Are Social Determinants Of Health Related To Physical Frailty In Heart Failure?","authors":"Quin E. Denfeld , Christopher V. Chien , Shirin O. Hiatt , Mary Roberts Davis , S. Albert Camacho , Christopher S. Lee","doi":"10.1016/j.cardfail.2024.10.044","DOIUrl":"10.1016/j.cardfail.2024.10.044","url":null,"abstract":"<div><h3>Introduction</h3><div>Physical frailty affects a significant number of adults with heart failure (HF), conferring worse clinical and patient-reported outcomes. While the biological (including sex) and physiological factors contributing to physical frailty in HF are beginning to be understood, the contributing role of social determinants of health have not been studied.</div></div><div><h3>Purpose</h3><div>To identify associations between social determinants of health (SDOH) and physical frailty among adults with HF.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of combined data from two studies of adults with New York Heart Association (NYHA) functional class I-IV HF. Physical frailty was measured with the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity. We examined the following SDOH factors: race/ethnicity (Non-Hispanic White vs. all other races/ethnicities), level of education (bachelor's degree or higher vs. some college vs. high school or less), financial status (have enough or more than enough to make ends meet vs. do not have enough to make ends meet), employment status (employed vs. retired/unemployed), marital status (married/living with domestic partner vs. single/divorced/widowed), and having someone to confide in (yes vs. no). Logistic regression (odds ratios (OR) with 95% confidence intervals (CI)), adjusted for the known contributors (age, sex, NYHA class, and comorbidity index), was used to identify SDOH predictors of physical frailty. We also explored the influence of sex on associations between each SDOH factor and physical frailty using interaction testing.</div></div><div><h3>Results</h3><div>The sample (n = 160) was 61.7±14.6 years, 44% female, and 62% were NYHA class III/IV. Physical frailty was identified in 44% of the sample. Significant predictors of physical frailty were female sex (OR 3.67, 95% CI [1.62, 8.33]) and being retired/unemployed (OR 3.86, 95% CI [1.38, 10.80]). A nested logistic regression model demonstrated that the block of SDOH factors significantly predicted physical frailty above and beyond age, sex, NYHA class, and comorbidity index (Wald chi<sup>2</sup> = 14.09, p < 0.05; Δ pseudo R<sup>2</sup> = 8%). Finally, lower education was a stronger predictor of physical frailty for women than for men (interaction p < 0.05).</div></div><div><h3>Conclusions</h3><div>SDOH, individually and in combination, are potential significant contributors to physical frailty in HF. Retirement or unemployment was a notable predictor of frailty, indicating that it warrants further research and clinical evaluation as a potential sentinel event for adults with HF. Additionally, female sex continues to be strongly associated with and influences predictors of physical frailty in HF.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 195-196"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.10.061
Alena Novikova , Maria Poltavskaya , Ilya Giverts , Maria Pavlova , Petr Chomakhidze , Alexandra Bykova , Nadegda Potemkina , Anna Shmeleva , Afina Bestavashvili , Dinara Mesitskaya , Zubeida Kuli-Zade , Nana Gogiberidze , Anna Levshina , Alina Zatsepina , Natalia Plaksina , Dmitry Shchekochikhin , Denis Andreev
Objective
State-of-the-art therapy improves the five-year survival rate of patients under the age of 20 with cranial and craniospinal tumors up to 74 %. We aimed to assess echocardiographic parameters and exercise performance in subjects following complex treatment for cranial and craniospinal tumors in childhood.
Methods
48 subjects who underwent cranial and craniospinal irradiation for CNS tumors in childhood were compared to 20 healthy controls. Examination included cardiopulmonary exercise testing (CPET), hormone studies and echocardiography.
Results
According to CPET parameters cancer survivors showed significantly impaired exercise tolerance compared to healthy volunteers resulting in lower peak VO2 (19.8 vs 30.3 ml*min/kg; p<0.001), lower percent from predicted peak VO2 (58.6% vs 85.8%; p<0.001) and lower ventilatory efficacy (VE/VCO2 29.9 vs 23.6; p=0.044; peak PetCO2 36.3 vs 40.6 mm Hg; p=0.009). Poor exercise tolerance was associated with a younger age at the time of treatment initiation. 5 patients from the main group (10.4%) demonstrated abnormal echocardiographic parameters including thickening and calcification of the aortic valve leaflets and diffuse reduction in the systolic LV and RV function. Hormonal derangements like somatotropin insufficiency, hypocorticism, hypothyroidism, hypogonadism in cancer survivors correlated both with exercise intolerance and echocardiographic abnormalities.
Conclusion
Exercise intolerance and cardiac dysfunction coupled with hormonal deficits are not uncommon among patients following treatment for intracranial and craniospinal tumors at a young age. Obtained data confirms the importance of regular cardiovascular risk assessment in childhood cancer survivors.
{"title":"Exercise Intolerance And Cardiac Dysfunction Following Treatment For Intracranial And Craniospinal Tumors In Childhood","authors":"Alena Novikova , Maria Poltavskaya , Ilya Giverts , Maria Pavlova , Petr Chomakhidze , Alexandra Bykova , Nadegda Potemkina , Anna Shmeleva , Afina Bestavashvili , Dinara Mesitskaya , Zubeida Kuli-Zade , Nana Gogiberidze , Anna Levshina , Alina Zatsepina , Natalia Plaksina , Dmitry Shchekochikhin , Denis Andreev","doi":"10.1016/j.cardfail.2024.10.061","DOIUrl":"10.1016/j.cardfail.2024.10.061","url":null,"abstract":"<div><h3>Objective</h3><div>State-of-the-art therapy improves the five-year survival rate of patients under the age of 20 with cranial and craniospinal tumors up to 74 %. We aimed to assess echocardiographic parameters and exercise performance in subjects following complex treatment for cranial and craniospinal tumors in childhood.</div></div><div><h3>Methods</h3><div>48 subjects who underwent cranial and craniospinal irradiation for CNS tumors in childhood were compared to 20 healthy controls. Examination included cardiopulmonary exercise testing (CPET), hormone studies and echocardiography.</div></div><div><h3>Results</h3><div>According to CPET parameters cancer survivors showed significantly impaired exercise tolerance compared to healthy volunteers resulting in lower peak VO<sub>2</sub> (19.8 vs 30.3 ml*min/kg; p<0.001), lower percent from predicted peak VO<sub>2</sub> (58.6% vs 85.8%; p<0.001) and lower ventilatory efficacy (VE/VCO<sub>2</sub> 29.9 vs 23.6; p=0.044; peak PetCO<sub>2</sub> 36.3 vs 40.6 mm Hg; p=0.009). Poor exercise tolerance was associated with a younger age at the time of treatment initiation. 5 patients from the main group (10.4%) demonstrated abnormal echocardiographic parameters including thickening and calcification of the aortic valve leaflets and diffuse reduction in the systolic LV and RV function. Hormonal derangements like somatotropin insufficiency, hypocorticism, hypothyroidism, hypogonadism in cancer survivors correlated both with exercise intolerance and echocardiographic abnormalities.</div></div><div><h3>Conclusion</h3><div>Exercise intolerance and cardiac dysfunction coupled with hormonal deficits are not uncommon among patients following treatment for intracranial and craniospinal tumors at a young age. Obtained data confirms the importance of regular cardiovascular risk assessment in childhood cancer survivors.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 203-204"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.10.033
Joao Pedro P. Ferreira , Stefan D Anker , Biff F Palmer , Bertram Pitt , Peter Rossing , Luis M Ruilope , Christoph Wanner , Youssef M.K. Farag , Andrea Horvat-Broecker , Marc Lambelet , Meike Brinker , Katja Rohwedder , Gerasimos Filippatos , Marco Lavagnino
Introduction
Finerenone (FIN) reduced CV and kidney events in patients (pts) with chronic kidney disease (CKD) and type 2 diabetes (T2D) in FIDELITY, a pooled analysis of the FIDELIO-DKD and FIGARO-DKD trials. Clinically relevant hyperkalemia- (HK-) related AEs were infrequent but the perceived risk may limit FIN use in pts with high risk of increased serum K+. Currently, no incident HK risk models exist in pts with CKD and T2D to identify those at high risk. Using FIDELITY data, we developed a risk prediction model and analyzed FIN efficacy in reducing the incidence of cardiorenal outcomes across pts with different HK risk levels.
Methods
Adults with CKD and T2D receiving RASi were randomized to FIN or placebo (PBO). New-onset HK was defined by serum K+ >5.5 mmol/l. Variables independently associated with HK were identified with Cox models with stepwise selection using PBO data and validated with FIN data. An integer risk score was built based on β-coefficients of variables retained in the final model; the score was divided into low, intermediate, and high HK risk categories. FIN efficacy was assessed across HK risk categories tertiles.
Results
7 baseline variables were independently associated with incident treatment-emergent serum K+ >5.5 mmol/l (Table). Model C-index (SE) was 0.732 (0.012); the model was well-calibrated across HK risk deciles at 2 years. Pts were divided into HK risk categories based on derived integer risk score tertiles: low (0-3 points), intermediate (4-6 points), and high-risk (7-12 points; Table). The score ranged from 0-12 points, with a mean (SD) of 4.7 (2.1) points. Treatment-emergent serum K+ >5.5 mmol/l was increased in pts with a higher HK risk category; 2.7%, 7.0%, and 16.7% of pts assigned PBO reported an event in the low-, intermediate- and high-risk group. In the FIN risk groups, this finding was confirmed (Fig). FIN reduced major CV and kidney event incidence vs PBO irrespective of HK risk category.
Conclusions
Based on FIDELITY data, we developed and validated an easy-to-use integer risk score model for new-onset HK in patients with CKD and T2D. The risk score enables HK risk identification of individual patients, irrespective of FIN treatment. As FIN benefited pts across all HK risk categories, the developed risk score could facilitate tailored follow-up and therapeutic strategies aimed to mitigate HK in high-risk patients with indication for FIN.
{"title":"Hyperkalemia Risk And The Effect Of Finerenone In Patients With Diabetes And Chronic Kidney Disease: An Analysis From Fidelity","authors":"Joao Pedro P. Ferreira , Stefan D Anker , Biff F Palmer , Bertram Pitt , Peter Rossing , Luis M Ruilope , Christoph Wanner , Youssef M.K. Farag , Andrea Horvat-Broecker , Marc Lambelet , Meike Brinker , Katja Rohwedder , Gerasimos Filippatos , Marco Lavagnino","doi":"10.1016/j.cardfail.2024.10.033","DOIUrl":"10.1016/j.cardfail.2024.10.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Finerenone (FIN) reduced CV and kidney events in patients (pts) with chronic kidney disease (CKD) and type 2 diabetes (T2D) in FIDELITY, a pooled analysis of the FIDELIO-DKD and FIGARO-DKD trials. Clinically relevant hyperkalemia- (HK-) related AEs were infrequent but the perceived risk may limit FIN use in pts with high risk of increased serum K+. Currently, no incident HK risk models exist in pts with CKD and T2D to identify those at high risk. Using FIDELITY data, we developed a risk prediction model and analyzed FIN efficacy in reducing the incidence of cardiorenal outcomes across pts with different HK risk levels.</div></div><div><h3>Methods</h3><div>Adults with CKD and T2D receiving RASi were randomized to FIN or placebo (PBO). New-onset HK was defined by serum K+ >5.5 mmol/l. Variables independently associated with HK were identified with Cox models with stepwise selection using PBO data and validated with FIN data. An integer risk score was built based on β-coefficients of variables retained in the final model; the score was divided into low, intermediate, and high HK risk categories. FIN efficacy was assessed across HK risk categories tertiles.</div></div><div><h3>Results</h3><div>7 baseline variables were independently associated with incident treatment-emergent serum K+ >5.5 mmol/l (<strong>Table</strong>). Model C-index (SE) was 0.732 (0.012); the model was well-calibrated across HK risk deciles at 2 years. Pts were divided into HK risk categories based on derived integer risk score tertiles: low (0-3 points), intermediate (4-6 points), and high-risk (7-12 points; <strong>Table</strong>). The score ranged from 0-12 points, with a mean (SD) of 4.7 (2.1) points. Treatment-emergent serum K+ >5.5 mmol/l was increased in pts with a higher HK risk category; 2.7%, 7.0%, and 16.7% of pts assigned PBO reported an event in the low-, intermediate- and high-risk group. In the FIN risk groups, this finding was confirmed (<strong>Fig</strong>). FIN reduced major CV and kidney event incidence vs PBO irrespective of HK risk category.</div></div><div><h3>Conclusions</h3><div>Based on FIDELITY data, we developed and validated an easy-to-use integer risk score model for new-onset HK in patients with CKD and T2D. The risk score enables HK risk identification of individual patients, irrespective of FIN treatment. As FIN benefited pts across all HK risk categories, the developed risk score could facilitate tailored follow-up and therapeutic strategies aimed to mitigate HK in high-risk patients with indication for FIN.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 190-191"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.cardfail.2024.10.051
Eleni Maneta , Christos Kyriakopoulos , Elizabeth Dranow , Thomas Hanff , Josef Stehlik , Omar Wever-Pinzon , Rebecca Cogswell , Jessica Schultz , Andrew Schwartzman , Keyur Shah , Guy Macgowan , Stephan Schueler , Daniel Zimpfer , Ulrich Jorde , Craig Selzman , Snehal Patel , Stavros Drakos
Introduction
A subset of HF patients can experience significant improvement of their cardiac structure and function while on LVAD support.
Hypothesis
We sought to investigate the impact of HF etiology on the durability of cardiac improvement and favorable outcomes after LVAD weaning.
Methods
We studied 324 HF patients enrolled in the international multicenter VAD Wean Registry who received a durable continuous-flow LVAD and underwent device support weaning (Figure Panel A). Indications for VAD weaning included: structural/functional cardiac improvement meeting institutional criteria for “myocardial recovery” (responders) or LVAD-related complications accompanied by variable degrees of cardiac improvement (partial responders). Patients were divided into seven categories based on HF etiology: ischemic cardiomyopathy (CM) (n=30), post-myocarditis CM (n=65), peripartum CM (n=53), valvular CM (n=12), chemotherapy-induced CM (n=14) and idiopathic CM (n=150). The primary outcome was 2-year survival free of transplant or LVAD re-implantation. The secondary outcome was the LVEF, measured by echocardiography at 3, 6, 12 and 24 months post-LVAD weaning.
Results
Patients with idiopathic, peripartum and post-myocarditis CM had higher rate of 2-year survival free of transplant or LVAD re-implantation compared to patients with chemotherapy-induced CM (Figure-Panel B) (p-values: 0.009, 0.004, 0.001, respectively). Patients with post-myocarditis CM were also more likely to achieve the primary outcome compared to those with ischemic CM (ICM) (p-value, 0.009). The LVEF changes over time are depicted in the Figure-Panel C and detailed in the Table.
Conclusions
In this multicenter analysis the etiology of HF appears to impact the durability of favorable response after LVAD weaning. The degree of reverse remodeling achieved before VAD weaning and its impact on the durability of response in different HF etiologies warrants further investigation in studies with larger patient population and power.
{"title":"Impact Of HF Etiology On The Sustainability Of Favorable Response After LVAD Weaning: A VAD Wean Registry Analysis","authors":"Eleni Maneta , Christos Kyriakopoulos , Elizabeth Dranow , Thomas Hanff , Josef Stehlik , Omar Wever-Pinzon , Rebecca Cogswell , Jessica Schultz , Andrew Schwartzman , Keyur Shah , Guy Macgowan , Stephan Schueler , Daniel Zimpfer , Ulrich Jorde , Craig Selzman , Snehal Patel , Stavros Drakos","doi":"10.1016/j.cardfail.2024.10.051","DOIUrl":"10.1016/j.cardfail.2024.10.051","url":null,"abstract":"<div><h3>Introduction</h3><div>A subset of HF patients can experience significant improvement of their cardiac structure and function while on LVAD support.</div></div><div><h3>Hypothesis</h3><div>We sought to investigate the impact of HF etiology on the durability of cardiac improvement and favorable outcomes after LVAD weaning.</div></div><div><h3>Methods</h3><div>We studied 324 HF patients enrolled in the international multicenter VAD Wean Registry who received a durable continuous-flow LVAD and underwent device support weaning (Figure Panel A). Indications for VAD weaning included: structural/functional cardiac improvement meeting institutional criteria for “myocardial recovery” (responders) or LVAD-related complications accompanied by variable degrees of cardiac improvement (partial responders). Patients were divided into seven categories based on HF etiology: ischemic cardiomyopathy (CM) (n=30), post-myocarditis CM (n=65), peripartum CM (n=53), valvular CM (n=12), chemotherapy-induced CM (n=14) and idiopathic CM (n=150). The primary outcome was 2-year survival free of transplant or LVAD re-implantation. The secondary outcome was the LVEF, measured by echocardiography at 3, 6, 12 and 24 months post-LVAD weaning.</div></div><div><h3>Results</h3><div>Patients with idiopathic, peripartum and post-myocarditis CM had higher rate of 2-year survival free of transplant or LVAD re-implantation compared to patients with chemotherapy-induced CM (Figure-Panel B) (p-values: 0.009, 0.004, 0.001, respectively). Patients with post-myocarditis CM were also more likely to achieve the primary outcome compared to those with ischemic CM (ICM) (p-value, 0.009). The LVEF changes over time are depicted in the Figure-Panel C and detailed in the Table.</div></div><div><h3>Conclusions</h3><div>In this multicenter analysis the etiology of HF appears to impact the durability of favorable response after LVAD weaning. The degree of reverse remodeling achieved before VAD weaning and its impact on the durability of response in different HF etiologies warrants further investigation in studies with larger patient population and power.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 199-200"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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