Heart Failure and Preserved Left Ventricular Function: Long Term Clinical Outcome

Gotsman, Israel; Zwas, Donna R.; Lotan, Chaim; Keren, Andre

doi:10.1371/journal.pone.0041022

Cited by 15 publications

(13 citation statements)

References 22 publications

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“…The comparison of patients with preserved and depressed LVEF confirmed slightly better prognosis of those with LVEF > 50% [22,23]. Although results of the multivariate Cox proportional hazard model performed for both groups of patients could be influenced by lower number of evaluated patients with preserved LVEF, conclusively we confirmed age > 70 years, creatinine level > 145 μmol/L and heart rate > 80 beats/min as parameters negatively affecting long-term survival.…”

Section: Predictors Of Long-term Mortalitysupporting

confidence: 58%

Long-term survival following acute heart failure: The Acute Heart Failure Database Main registry (AHEAD Main)

Pařenica

Špinar

Vítovec

et al. 2013

European Journal of Internal Medicine

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Section: Predictors Of Long-term Mortalitysupporting

confidence: 58%

Long-term survival following acute heart failure: The Acute Heart Failure Database Main registry (AHEAD Main)

Pařenica

Špinar

Vítovec

et al. 2013

European Journal of Internal Medicine

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“…[23][24][25][26][27][28][29][30] The additional protocol inclusion criterion in TOPCAT of either a prior hospitalization in which heart failure was a prominent feature or an elevated natriuretic peptide level was intended to both improve diagnostic certainty and to augment risk. The assumption that those with a prior hospitalization would have higher risk [31][32][33][34][35] was confirmed only for the patients randomized from the Americas, suggesting that the nonadjudicated qualifying hospitalization criterion enrolled different patient populations. However, multifold lower event rates were also observed in the patients qualifying by natriuretic peptides from Russia/Georgia.…”

Section: Discussionmentioning

confidence: 99%

Regional Variation in Patients and Outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial

et al. 2015

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Background— Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) patients with heart failure and preserved left ventricular ejection fraction assigned to spironolactone did not achieve a significant reduction in the primary composite outcome (time to cardiovascular death, aborted cardiac arrest, or hospitalization for management of heart failure) compared with patients receiving placebo. In a post hoc analysis, an ≈4-fold difference was identified in this composite event rate between the 1678 patients randomized from Russia and Georgia compared with the 1767 enrolled from the United States, Canada, Brazil, and Argentina (the Americas). Methods and Results— To better understand this regional difference in clinical outcomes, demographic characteristics of these populations and their responses to spironolactone were explored. Patients from Russia/Georgia were younger, had less atrial fibrillation and diabetes mellitus, but were more likely to have had prior myocardial infarction or a hospitalization for heart failure. Russia/Georgia patients also had lower left ventricular ejection fraction and creatinine but higher diastolic blood pressure (all P <0.001). Hyperkalemia and doubling of creatinine were more likely and hypokalemia was less likely in patients receiving spironolactone in the Americas with no significant treatment effects in Russia/Georgia. All clinical event rates were markedly lower in Russia/Georgia, and there was no detectable impact of spironolactone on any outcomes. In contrast, in the Americas, the rates of the primary outcome, cardiovascular death, and hospitalization for heart failure were significantly reduced by spironolactone. Conclusions— This post hoc analysis demonstrated greater potassium and creatinine changes and possible clinical benefits with spironolactone in patients with heart failure and preserved ejection fraction from the Americas. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00094302.

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“…13,14,15,16,17,18,19,20,21,22,23,24,25 Some studies have shown heart failure patients face a similar magnitude of risk regardless of ejection fraction 13,14,19 , while others have demonstrated lower event rates in patients with HFpEF compared to HFrEF. 16,17,18,22,23,24 This disparate finding regarding the effect of ejection fraction on event rates is also seen when the studies are grouped into acute heart failure, 13,14,15,16,17 versus chronic, prevalent heart failure.…”

Section: Discussionmentioning

confidence: 99%

Influence of Previous Heart Failure Hospitalization on Cardiovascular Events in Patients With Reduced and Preserved Ejection Fraction

Bello

Claggett

Desai

et al. 2014

Circ: Heart Failure

132

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Background Hospitalization for acute heart failure (HF) is associated with high rates of subsequent mortality and readmission. We assessed the influence of the time interval between prior HF hospitalization and randomization in the CHARM trials on clinical outcomes in patients with both reduced and preserved ejection fraction. Methods and Results CHARM enrolled 7,599 patients with NYHA class II-IV heart failure, of whom 5,426 had a history of prior HF hospitalization. Cox proportional hazards regression models were utilized to assess the association between time from prior HF hospitalization and randomization and the primary outcome of cardiovascular death or unplanned admission to hospital for the management of worsening HF over a median of 36.6 months. For patients with HF and reduced (HFrEF) or preserved (HFpEF) ejection fraction, rates of CV mortality and HF hospitalization were higher among patients with prior HF hospitalization than those without. The risk for mortality and hospitalization varied inversely with the time interval between hospitalization and randomization. Rates were higher for HFrEF patients within each category. Event rates for those with HFpEF and a HF hospitalization in the 6 months prior to randomization were comparable to the rate in HFrEF patients with no prior HF hospitalization. Conclusions Rates of CV death or HF hospitalization are greatest in those who have been previously hospitalized for HF. Independent of EF, rates of death and readmission decline as time from HF hospitalization to trial enrollment increased. Recent HF hospitalization identifies a high risk population for future clinical trials in HFrEF and HFpEF. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00634400.

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Heart Failure and Preserved Left Ventricular Function: Long Term Clinical Outcome

Cited by 15 publications

References 22 publications

Long-term survival following acute heart failure: The Acute Heart Failure Database Main registry (AHEAD Main)

Long-term survival following acute heart failure: The Acute Heart Failure Database Main registry (AHEAD Main)

Regional Variation in Patients and Outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial

Influence of Previous Heart Failure Hospitalization on Cardiovascular Events in Patients With Reduced and Preserved Ejection Fraction

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