Journal of Cardiac Failure最新文献

Background: Data on left ventricular ejection fraction (LVEF) recovery in patients with anthracycline-induced cardiomyopathy (AIC) are limited.

Objectives: To evaluate LVEF recovery rate, its predictors and association with cardiovascular outcomes in a contemporary and diverse AIC cohort.

Methods: This retrospective study analyzed patients diagnosed with AIC from 2010-2023 at two U.S. university-hospitals and an affiliated cancer-center. LVEF recovery, defined as ≥10% improvement in LVEF to a value ≥50% within 3 years of AIC detection, was assessed using Cox proportional-hazards accounting for competing risks. The association between LVEF recovery and the composite of heart failure (HF) hospitalizations, mechanical circulatory support, heart-transplantation or cardiovascular death was assessed using Cox regression analysis with LVEF recovery as a time-dependent factor.

Results: Among 167 patients with AIC (median age 67 (Q1, Q3: 53, 74) years, 53% female), majority had lymphoma (55%) or breast cancer (23%). The median time from first anthracycline exposure to AIC detection was 631 (219, 3569) days and the median LVEF was 38 (29, 45)%. At the detection of AIC, 69% had symptomatic HF. LVEF recovered in 38% (n=63) at a median of 349 (137, 691) days from AIC detection. Age≥60 years at anthracycline exposure, non-white race, diabetes mellitus, longer interval between anthracycline exposure and AIC detection and LV dilation were associated with a lower likelihood of recovery, while statin use and AIC detection after 2022 were associated with a higher likelihood of recovery. LVEF recovery was not associated with cardiovascular outcomes.

Conclusion: In this contemporary and diverse AIC cohort, 38% achieved LVEF recovery. Routine screening for AIC and statin therapy may improve recovery rates.

Background: Inflammation plays a key role in the development of heart failure (HF), and diet is a known modifiable factor that modulates systemic inflammation. The dietary inflammatory score (DIS) is a tool that quantifies the inflammatory components of diet. We sought to determine whether the DIS is associated with incident HF events.

Methods: We examined a total of 17,975 participants without HF at baseline who were in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The main exposure variable was the DIS quartile, which was derived from the Food Frequency Questionnaire obtained at baseline study enrollment. The main outcome was an incident HF event, defined as hospitalization due to HF or death. To examine the association between the DIS and incident HF events, we conducted Cox proportional hazard regression modeling, adjusting for total energy intake, sociodemographic factors and pro-inflammatory lifestyle behaviors.

Results: The sample mean age was 64 + 9.2 years, 55.8% were female, and 32.3% were Black. Over a median follow-up of 11.1 years, we observed 900 incident HF events, including 752 hospitalizations and 148 deaths due to HF. In an adjusted model, the highest DIS quartile (Q4) was associated with incident HF (HR 1.26 95% CI 1.03-1.54). Of note, these findings remained, even after adjusting for comorbid conditions and physiological parameters. In an age-stratified analysis, the association was present only in those aged < 65 years (Q4: HR 1.65 95% CI 1.08-2.51). Moreover, the association was present for heart failure with reserved ejection fraction (Q4: HR 1.44 95% CI 1.07-1.94) but not for heart failure with preserved ejection fraction.

Conclusion: The highest DIS quartile was associated with incident HF events. These findings indicate the potential value of specific dietary patterns to prevent HF.

Background: Guidelines recommend timely follow-up with a cardiology specialist for patients hospitalized with heart failure (HF), but it is unknown whether the timeliness of specialty cardiovascular care after discharge correlates with clinical risk. We south to assess the association between estimated mortality risk and post-HF hospitalization cardiology follow-up.

Methods and results: In a cohort of veterans hospitalized with HF in acute care Veterans Health Administration (VA) hospitals between January 1, 2018, and September 15, 2022, we estimated the association of mortality risk at discharge with postdischarge cardiology encounters via logistic regression. We also evaluated the association between cardiology visits and sociodemographic and clinical characteristics, and described variability in postdischarge follow-up rates across VA facilities. We identified a cohort of 84,348 veterans hospitalized with HF with 120,619 hospital admissions. Of a subcohort of 57,554 veterans with 79,866 hospitalizations surviving at least 1 year after discharge, 32.1% of hospitalizations were followed by a cardiology visit within 2 weeks, and 49.3% within 1 month. Marginal probabilities of 2-week and 1-month follow-up were higher for hospitalizations in the highest-risk quintile than those in the lowest-risk quintile (34% vs. 30% and 51% vs. 47%, respectively; P < 0.001 for both intervals). In a time-to-event model in the full cohort, there was a slightly negative association between risk and likelihood of 1-month follow-up (coefficient for MAGGIC score = -0.004, 95% confidence interval [CI] -0.005 to -0.003). Black veterans were less likely to have either 2-week or 1-month follow-up (adjusted odds ratios, 0.93 [95% CI 0.90-0.97] for 2 weeks and 0.93 [95% CI 0.89-0.96] for 1 month). Female veterans were also less likely to have follow-up within 1 month of hospital discharge (adjusted odds ratio 0.90 [95% CI 0.90-0.98]). Conversely, patients with a primary vs secondary hospital diagnosis of HF and those with reduced vs preserved ejection fraction were more likely to have 2-week follow-up (adjusted odds ratios 1.67 [95% CI 1.62-1.73] and 1.72 [95% CI 1.67-1.78], respectively) and 1-month follow-up (adjusted odds ratios 1.83 [95% CI 1.78-1.88] and 1.85 [95% CI 1.80-1.90], respectively). The 1-month follow-up rates varied from 5% to 69% across VA facilities.

Conclusions: The rate of visits with a cardiologist within 2 weeks or 1 month after HF hospitalization was low overall, was at most modestly associated with estimated mortality risk at discharge, and varied by sex, race/ethnicity, and across VA facilities. Increasing the visit rate after HF hospitalization should be evaluated as a mechanism to improve outcomes after HF hospitalizations, particularly for higher-risk individuals.