Why and how do elderly patients with heart failure die? Insights from the TIME‐CHF study

Rickenbacher, Peter; Pfisterer, Matthias; Burkard, Thilo; Kiowski, Wolfgang; Folláth, Ferenc; Burckhardt, D; Schindler, Ruth; Rocca, Hans‐Peter Brunner‐La

doi:10.1093/eurjhf/hfs113

Cited by 37 publications

(59 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Figure 5 Inverse relationship between prevalence of CAD and percentage non-cardiovascular deaths. Comparison of baseline burden of CAD and percentage of non-cardiovascular-related deaths (% total deaths) from similar heart failure populations (Olmsted 26 and TIME-CHF 19 ) shows an inverse relationship regardless of LVEF. HFPEF, heart failure with preserved ejection fraction; HFREF, heart failure with reduced ejection fraction.…”

Section: Fundingmentioning

confidence: 96%

“…A greater co-morbidity burden, indexed by the Charlson score, is known to be associated with reduced short-and long-term survival in heart failure regardless of LVEF. 6,19 Specifically in HFPEF, noncardiac co-morbidities have been shown to be related to increased incidence of future HFPEF, 47 reduced functional status, 48 and increased risk of hospitalizations. 49 In fact, compared with HFREF, non-cardiac co-morbidities were found to impact functional status to a greater extent in HFPEF, 48 and potentially accounts for more non-heart failure hospitalizations in HFPEF than in HFREF.…”

Section: Non-cardiac Co-morbiditiesmentioning

confidence: 99%

“…19 Analysis of COD vs. MOD in TIME-CHF showed differences in the proportions of cardiovascular-related events when classified by COD ( 40%) vs. MOD ( 66%) (Figure 3). Careful inspection of the data revealed that this difference was primarily attributed to a larger proportion of 'unknown' assignments for COD, with less 'unknown' and more frequent assignment of 'cardiovascular' for MOD, and otherwise comparable classification of noncardiovascular events by COD or MOD.…”

mentioning

confidence: 99%

See 2 more Smart Citations

How do patients with heart failure with preserved ejection fraction die?

Chan

Lam

2013

European J of Heart Fail

187

148

View full text Add to dashboard Cite

Understanding how patients with heart failure with preserved ejection fraction (HFPEF) die provides insight into the natural history and pathophysiology of this complex syndrome, thereby allowing better prediction of response to therapy in designing clinical trials. This review summarizes the current state of knowledge surrounding mortality rates, modes of death, and prognostic factors in HFPEF. Despite the lack of uniform reporting, the following conclusions may be drawn from previous studies. The mortality burden of HFPEF is substantial, ranging from 10% to 30% annually, and higher in epidemiological studies than in clinical trials. Mortality rates compared with heart failure with reduced ejection fraction (HFREF) appear to be strongly influenced by the type of study, but are clearly elevated compared with age-and co-morbidity-matched controls without heart failure. The majority of deaths in HFPEF are cardiovascular deaths, comprising 51-60% of deaths in epidemiological studies and 70% in clinical trials. Among cardiovascular deaths, sudden death and heart failure death are the leading cardiac modes of death in HFPEF clinical trials. Compared with HFREF, the proportions of cardiovascular deaths, sudden death, and heart failure deaths are lower in HFPEF. Conversely, non-cardiovascular deaths constitute a higher proportion of deaths in HFPEF than in HFREF, particularly in epidemiological studies, where this difference may be related to fewer coronary heart deaths in HFPEF. Key mortality risk factors, including age, gender, body mass index, burden of co-morbidities, and coronary artery disease, offer some explanation for the differences in mortality rates observed across studies.--

show abstract

Section: Fundingmentioning

confidence: 96%

Section: Non-cardiac Co-morbiditiesmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

How do patients with heart failure with preserved ejection fraction die?

Chan

Lam

2013

European J of Heart Fail

187

148

View full text Add to dashboard Cite

show abstract

“…Although heart failure mortality is a very large proportion of total mortality in people with heart failure, the proportion varies somewhat with age (with a higher proportion of non-heart failure mortality in older people with heart failure). 158 However, although we have not annualised the estimate of absolute benefit, the mean duration of treatment in the trials from which the RR estimate is derived was 35 months, meaning that the assumptions underlying annualisation are more likely to be reasonable. This emphasises that the plausibility of the assumptions required to use absolute benefit in practice are at least partly context dependent.…”

Section: Using More Realistic Estimates Of Baseline Riskmentioning

confidence: 97%

Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling

Guthrie

Thompson

Dumbreck

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 11/2003/27. The contractual start date was in October 2012. The final report began editorial review in July 2015 and was accepted for publication in November 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Hea...

show abstract

“…Cause of death was predominantly cardiovascular. 19 A total of 254 patients (50.9%) experienced the disease-specific end point of HF hospitalization or death and 379 patients (76.0%) experienced the end point of all-cause hospitalization or death with a median follow-up of 26 months (interquartile range, 16-41).…”

Section: Long-term Outcomementioning

confidence: 99%

Long-Term Results of Intensified, N-Terminal-Pro-B-Type Natriuretic Peptide–Guided Versus Symptom-Guided Treatment in Elderly Patients With Heart Failure

Wijk

Maeder

Nietlispach

et al. 2014

Circ: Heart Failure

Self Cite

View full text Add to dashboard Cite

Background— Therapy guided by N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels may improve outcomes in patients with chronic heart failure (HF), especially in younger patients with reduced left ventricular ejection fraction. It remains unclear whether treatment effects persist after discontinuation of the NT-proBNP–guided treatment strategy. Methods and Results— Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure randomized 499 patients with HF aged ≥60 years with left ventricular ejection fraction ≤45% to intensified, NT-proBNP–guided versus standard, symptom-guided therapy into prespecified age groups (60–74 and ≥75 years) during 18 months. A total of 329 patients (92%) alive at 18 months agreed to long-term follow-up. HF medication was intensified to a larger extent in the NT-proBNP–guided group. During long-term, NT-proBNP–guided therapy did not improve hospital-free (primary end point: hazard ratio, 0.87; 95% confidence interval, 0.71–1.06; P =0.16) or overall survival (hazard ratio, 0.85; 95% confidence interval, 0.64–1.13; P =0.25) but did improve HF hospitalization-free survival (hazard ratio, 0.70; 95% confidence interval, 0.55–0.90; P =0.005). Patients aged 60 to 74 years had benefit from NT-proBNP–guided therapy on the primary end point and HF hospitalization-free survival, whereas patients aged ≥75 years did not ( P <0.10 for interaction). In landmark analysis, there was no regression to the mean after cessation of the NT-proBNP–guided strategy. More intensified HF medication at month 12 was associated with better long-term HF hospitalization-free and overall survival. Conclusions— Intensified, NT-proBNP–guided therapy did not improve the primary end point compared with symptom-guided therapy but did improve HF hospitalization-free survival. Within the subgroup of patients aged 60 to 74 years, it improved clinical outcome including the primary end point. These effects did not disappear after cessation of the NT-proBNP–guided strategy on the long-term. This is possibly attributable to a more intensified HF medical therapy in the NT-proBNP–guided group. Clinical Trial Registration— URL: http://www.isrctn.org . Unique identifier: ISRCTN43596477.

show abstract

Why and how do elderly patients with heart failure die? Insights from the TIME‐CHF study

Cited by 37 publications

References 43 publications

How do patients with heart failure with preserved ejection fraction die?

How do patients with heart failure with preserved ejection fraction die?

Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling

Long-Term Results of Intensified, N-Terminal-Pro-B-Type Natriuretic Peptide–Guided Versus Symptom-Guided Treatment in Elderly Patients With Heart Failure

Contact Info

Product

Resources

About