First Hospitalization for Heart Failure in Outpatients With Stable Coronary Artery Disease: Determinants, Role of Incident Myocardial Infarction, and Prognosis

Lamblin, Nicolas; Meurice, Thibaud; Tricot, Olivier; Groote, P. De; Lemesle, Gilles; Bauters, Christophe

doi:10.1016/j.cardfail.2018.09.013

Cited by 29 publications

(45 citation statements)

References 22 publications

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“…Most studies in patients with stable CAD focus on outcomes directly related to atherothrombosis, such as CV death, MI and stroke, 2,8,10,[18][19][20][21] but the presence of HF is recognized as an important prognostic factor. [10][11][12] However, data on HF incidence are generally limited to patients requiring hospitalization. 6,11,13,14 The key novel aspect of the present analysis is the reported onset of HF not requiring hospitalization in the setting of real-life practice.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] However, data on HF incidence are generally limited to patients requiring hospitalization. 6,11,13,14 The key novel aspect of the present analysis is the reported onset of HF not requiring hospitalization in the setting of real-life practice.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] In any case, development of HF puts patients at high risk for mortality. [9][10][11][12] Although the incidence of HF events has been previously studied in patients with stable CAD and in those with a history of MI, 6,11,13,14 within the entire spectrum of chronic coronary syndromes, HF outcomes remain relatively poorly explored, which is especially relevant in patients who do not require hospital admission. 7,8 In addition, previous data come mainly from clinical trials, as opposed to registries which provide data more representative of routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry

Parma

Jasilek

Greenlaw

et al. 2020

European J of Heart Fail

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Aim The contemporary incidence of heart failure (HF) in patients with chronic coronary syndrome is unclear. We aimed to study the incidence and predictors of cardiovascular (CV) death, HF hospitalization or new‐onset HF not requiring hospitalization, in patients included in the CLARIFY registry. Methods and results CLARIFY is a contemporary, international registry of ambulatory patients with chronic coronary artery disease, conducted in 45 countries. At baseline, data on demographics, ethnicity, CV risk factors, medical history, cardiac parameters and medication were collected. Patients were followed up yearly up to 5 years. In this analysis, 26 769 patients with no HF history were included. At 5‐year follow‐up, 4393 patients (16.4%) reached the primary endpoint comprising CV death, HF hospitalization, or new‐onset HF. Only 16.7% of them (n = 732) required hospitalization for HF. All‐cause death occurred in 6.6% of patients (61.4% were CV). Age over 70 years, left ventricular ejection fraction <50%, Canadian Cardiovascular Society class ≥2 angina, atrial fibrillation or paced rhythm on the ECG, body mass index <20 kg/m2, and a history of stroke, were the most robust predictors of the primary outcome. Age <50 years, Asian ethnicity, and percutaneous revascularization were negative predictors of the outcome. Conclusion A sizeable proportion of patients with chronic coronary syndrome develop HF, which only infrequently requires hospitalization. Early identification of patients with HF may lead to early treatment, and help to further decrease mortality and morbidity. This concept needs confirmation in future studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry

Parma

Jasilek

Greenlaw

et al. 2020

European J of Heart Fail

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“…In patients with established ASCVD, however, one would predict that the first CV event during follow‐up would be recurrent MI/CVA, rather than hospitalization for HF. This was evaluated in a recent, prospective, registry study from France in which the authors studied 3871 (30% with T2DM) outpatients with stable coronary artery disease and no baseline history of hospitalization for HF . After 5 years, more patients were hospitalized for HF than for MI (211 vs 163).…”

Section: Clinical Relevance Of Ascvd Versus Hf In Diabetesmentioning

confidence: 99%

“…This was evaluated in a recent, prospective, registry study from France in which the authors studied 3871 (30% with T2DM) outpatients with stable coronary artery disease and no baseline history of hospitalization for HF. 11 After 5 years, more patients were hospitalized for HF than for MI (211 vs 163). Most hospitalizations for HF (62.6%) occurred in patients with LV ejection fraction (EF) >50% at inclusion and most (92.4%) were not preceded by incident MI.…”

Section: Clinical Relevance Of Ascvd Versus Hf In Diabetesmentioning

confidence: 99%

Navigating the “MACE” in Cardiovascular Outcomes Trials and decoding the relevance of Atherosclerotic Cardiovascular Disease benefits versus Heart Failure benefits

Hupfeld

Mudaliar

2019

Diabetes Obesity Metabolism

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The publication of results from recent cardiovascular outcome trials (CVOTs) has transformed the landscape of diabetes treatment. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose co-transporter-2 (SGLT2) inhibitors have demonstrated CV benefits in large, well-conducted, randomized studies. Today, empagliflozin, canagliflozin and liraglutide are US Food and Drug Administrationapproved not only for glucose-lowering, but also to reduce the risk of cardiovascular (CV) events/CV mortality in people with type 2 diabetes (T2DM) and established CV disease (CVD)/high CVD risk. Although the CVOTs were primarily powered for CV safety (non-inferiority), they also demonstrated CV efficacy (superiority). This initially surprised many in the diabetes community, but the replication of the CV benefits with different compounds in the same class alleviated concerns about the CV benefits being chance findings. However, many questions remain. While the heterogeneity in the CV benefits in the various CVOTs can be attributed to the variability in CV risk in the different studies, the reason(s) for the differences in the CV benefits between the GLP-1RA class and the SGLT2 inhibitor class appear to be more com-plex. An analysis of major adverse cardiovascular events (MACE) in the CVOTs shows that the CV benefits of GLP-1RAs are predominantly specific to atherosclerotic CV events (non-fatal myocardial infarction [MI], non-fatal stroke and CV death). By contrast, the SGLT2 inhibitors do not have any significant effects on atherosclerotic CV events (non-fatal MI/stroke). Their benefits are predominantly on hospitalization for heart failure (HF), suggesting effects primarily on myocardial function ("the pump"), and not on the "pipes" (coronary arteries). In the present review, we discuss the rationale for the conduct of CVOTs, highlight the inability of the classic three-point MACE to capture the entire spectrum of atherosclerotic and non-atherosclerotic CVD morbidity, especially HF in T2DM, and discuss the results of the CVOTs with a focus on the clinical significance of atherosclerotic CVD (ASCVD) versus HF, which develops in a sizeable proportion of people with diabetes and without prior ASCVD.

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Diabetes mellitus and risk of new‐onset and recurrent heart failure: a systematic review and meta‐analysis

et al. 2020

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Despite mounting evidence of the positive relationship between diabetes mellitus (DM) and heart failure (HF), the entire context of the magnitude of risk for HF in relation to DM remains insufficiently understood. The principal reason is because new-onset HF (HF occurring in participants without a history of HF) and recurrent HF (HF re-occurring in patients with a history of HF) are not discriminated. This meta-analysis aims to comprehensively and separately assess the risk of new-onset and recurrent HF depending on the presence or absence of DM. We systematically searched cohort studies that examined the relationship between DM and new-onset or recurrent HF using EMBASE and MEDLINE (from 1 Jan 1950 to 28 Jul 2019). The risk ratio (RR) for HF in individuals with DM compared with those without DM was pooled with a random-effects model. Seventy-four and 38 eligible studies presented data on RRs for new-onset and recurrent HF, respectively. For new-onset HF, the pooled RR [95% confidence interval (CI)] of 69 studies that examined HF as a whole [i.e. combining HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)] was 2.14 (1.96-2.34). The large between-study heterogeneity (I 2 = 99.7%, P < 0.001) was significantly explained by mean age [pooled RR (95% CI) 2.60 (2.38-2.84) for mean age < 60 years vs. pooled RR (95% CI) 1.95 (1.79-2.13) for mean age ≥ 60 years] (P < 0.001). Pooled RRs (95% CI) of seven and eight studies, respectively, that separately examined HFpEF and HFrEF risk were 2.22 (2.02-2.43) for HFpEF and 2.73 (2.71-2.75) for HFrEF. The risk magnitudes between HFpEF and HFrEF were not significantly different in studies that examined both HFpEF and HFrEF risks (P = 0.86). For recurrent HF, pooled RR (95% CI) of the 38 studies was 1.39 (1.33-1.45). The large between-study heterogeneity (I 2 = 80.1%, P < 0.001) was significantly explained by the proportion of men [pooled RR (95% CI) 1.53 (1.40-1.68) for < 65% men vs. 1.32 (1.25-1.39) for ≥65% men (P = 0.01)] or the large pooled RR for studies of only participants with HFpEF [pooled RR (95% CI), 1.73 (1.32-2.26) (P = 0.002)]. Results indicate that DM is a significant risk factor for both new-onset and recurrent HF. It is suggested that the risk magnitude is large for new-onset HF especially in young populations and for recurrent HF especially in women or individuals with HFpEF. DM is associated with future HFpEF and HFrEF to the same extent.

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First Hospitalization for Heart Failure in Outpatients With Stable Coronary Artery Disease: Determinants, Role of Incident Myocardial Infarction, and Prognosis

Cited by 29 publications

References 22 publications

Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry

Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry

Navigating the “MACE” in Cardiovascular Outcomes Trials and decoding the relevance of Atherosclerotic Cardiovascular Disease benefits versus Heart Failure benefits

Diabetes mellitus and risk of new‐onset and recurrent heart failure: a systematic review and meta‐analysis

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