Clinical trajectory of patients with a worsening heart failure event and reduced ventricular ejection fraction

Clare, Robert; Hofmann, Paul; Chiswell, Karen; DeVore, Adam D.; Vemulapalli, Sreekanth; Felker, G. Michael; Kelsey, Anita M.; DeWald, Tracy A.; Sarocco, Phil; Mentz, Robert J

doi:10.1016/j.ahj.2021.12.003

Cited by 4 publications

(4 citation statements)

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“…Following the title and abstract screening process, 292 studies were deemed eligible for full‐text screening. Ultimately, during the final phase of full‐text screening, 65 studies (comprising 88 cohorts) met the inclusion criteria and were included in the subsequent meta‐analysis 10–74 . One additional study was identified through a manual cross‐reference of the included studies, bringing the total to 66 studies 75 (online supplementary Figure ).…”

Section: Resultsmentioning

confidence: 99%

The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis

Shakoor,

Abou Kamar,

Malgie

et al. 2023

European J of Heart Fail

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Background and aimsHeart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all‐cause mortality and HF hospitalizations associated with new‐onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF (adv. HF).MethodsWe performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30‐day and one‐year all‐cause mortality, as well as one‐year HF hospitalization. Studies were pooled using random effects meta‐analysis, and mixed‐effects meta‐regression was used to compare the different HF groups.ResultsAmong the 15.759 studies screened, 66 were included representing 862.046 HF patients. Pooled 30‐day mortality rates did not reveal a significant distinction between hospital‐admitted patients, with rates of 10.13% for new‐onset HF and 8.11% for WHF (p = 0.10). However, the one‐year mortality risk differed and increased stepwise from CHF to adv. HF, with a rate of 8.47% (95% CI 7.24–9.89) for CHF, 21.15% (95% CI 17.78–24.95) for new‐onset HF, 26.84% (95% CI 23.74–30.19) for WHF, and 29.74% (95% CI 24.15–36.10) for adv HF. Readmission rates for HF at one year followed a similar trend.ConclusionsOur meta‐analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards adv. HF.This article is protected by copyright. All rights reserved.

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Section: Resultsmentioning

confidence: 99%

The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis

Shakoor,

Abou Kamar,

Malgie

et al. 2023

European J of Heart Fail

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“…Regarding structural analysis, those patients with ≥2 previous admission for HF have a larger baseline diastolic diameter and volume, suggesting, together with other data discussed above, that the disease in this subgroup is more advanced. Regarding the analysis of ventricular function, both groups have a similar baseline LVEF, although there are disparate results in previous studies because some authors observe a greater tendency for WHF in those with lower baseline LVEF, even within HFrEF [ 19 ], while other studies suggest that the worse prognosis is independent of baseline LVEF [ 1 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients

Perea-Armijo,

López-Aguilera,

González-Manzanares

et al. 2023

JCM

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Background: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term. Methods: A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0–1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed. Results: The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month. Conclusions: Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.

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“…This corresponds to the death date recorded in the DUHS electronic health record and is sourced from deaths recorded as part of health care delivery, deaths reported in the Social Security Administration Death Master File (provided through the National Technical Information Service) and from North Carolina death certificates. 19,20 Prior internal analyses have demonstrated high sensitivity (94%) and specificity (>99%) in ascertaining mortality by this methodology compared with other gold standard techniques including the National Death Index and call center follow-up. Data from C3 and DEDUCE were linked by the patient's DUHS electronic medical record number and dates of service.…”

Section: Data Sources and Ascertainmentmentioning

confidence: 98%

“…Data were extracted from source systems in December 2021, but follow-up was censored in June 30, 2021, to allow for up to 5 months latency in recording of deaths and clinical data. 19,20 What Is New? What Are the Clinical Implications?…”

Section: Data Sources and Ascertainmentmentioning

confidence: 99%

Echocardiographic Features Beyond Ejection Fraction and Associated Outcomes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction

Peters

Clare

Chiswell

et al. 2023

Circ: Heart Failure

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Background: Heart failure (HF) guidelines recommend assessment of left ventricular ejection fraction (LVEF) to classify patients and guide therapy implementation. However, LVEF alone may be insufficient to adequately characterize patients with HF, especially those with mildly reduced or preserved LVEF. Recommendations on additional testing are lacking, and there are limited data on use of echocardiographic features beyond LVEF in patients with heart failure with mildly reduced or preserved LVEF. Methods: In patients with HF with mildly reduced or preserved LVEF identified in a large US health care system, the association of the following metrics with mortality was evaluated: LV global longitudinal strain (LV GLS>–16), left atrial volume index (>28 mL/m 2 ), left ventricular hypertrophy (LVH), and E/e´>13 and e´<9. A multivariable model for mortality was constructed including age, sex, and key comorbidities followed by stepwise selection of echocardiographic features. Characteristics and outcomes of subgroups with normal versus abnormal LV GLS and LVEF were evaluated. Results: Among 2337 patients with complete echocardiographic data assessed between 2017 and 2020, the following features were associated with all-cause mortality on univariate analysis over 3 years of follow-up: E/e´+e´, LV GLS, left atrial volume index (all P <0.01). In the multivariable model ( C -index=0.65), only abnormal LV GLS was independently associated with all-cause mortality (HR, 1.35 [95% CI, 1.11–1.63]; P =0.002). Among patients with LVEF>55%, 498/1255 (40%) demonstrated abnormal LV GLS. Regardless of specific LVEF, patients with abnormal LV GLS demonstrated a higher burden of multiple comorbidities and higher event rates compared with patients with normal LV GLS. Conclusions: In a large, real-world HF with mildly reduced or preserved LVEF population, echocardiographic features, led by LV GLS, were associated with adverse outcomes irrespective of LVEF. A large proportion of patients demonstrate adverse myocardial function by LV GLS despite preserved LVEF and may represent a key cohort of interest for HF medical therapies and future clinical studies.

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Clinical trajectory of patients with a worsening heart failure event and reduced ventricular ejection fraction

Cited by 4 publications

References 14 publications

The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis

The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis

The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients

Echocardiographic Features Beyond Ejection Fraction and Associated Outcomes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction

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