AimsVitamin D deficiency is a highly prevalent, global phenomenon. The prevalence in heart failure (HF) patients and its effect on outcome are less clear. We evaluated vitamin D levels and vitamin D supplementation in patients with HF and its effect on mortality. Methods and results 25- ConclusionsVitamin D deficiency is highly prevalent in HF patients and is a significant predictor of reduced survival. Vitamin D supplementation was associated with improved outcome.--
Aims Thyroid dysfunction is known to effect cardiac function and is a risk factor for developing heart failure (HF). Data regarding the clinical significance of thyroid‐stimulating hormone (TSH) levels alone as a predictor of outcome in patients with HF is sparse. We evaluated the significance of TSH on clinical outcome in a large cohort of patients with chronic HF. Methods and results Patients with a diagnosis of HF at a Health Maintenance Organization (n = 5599) were followed for cardiac‐related hospitalizations and death. Median TSH levels were 2.2 mIU/L (interquartile range 1.4–3.5). We divided patients into quartiles based on TSH levels. Median follow‐up time was 434 days and the overall mortality rate was 13.2%. Both a high and a low TSH level was associated with an increased mortality rate. Cox regression analysis after adjustment for other significant predictors demonstrated that the highest TSH quartile was associated with increased mortality compared with those with the lowest mortality [second quartile: TSH 1.4–2.2 mIU/L, hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.08–1.71, P = 0.01]. TSH was also an independent predictor of death and cardiac‐related hospitalization. Analysis of patients not on levothyroxine treatment (78%) demonstrated that TSH was an even stronger predictor of mortality (HR 1.54, 95% CI 1.17–2.03, P = 0.002). Additional analysis based on accepted clinical cut‐offs of TSH demonstrated that increasing TSH levels above normal were independently associated with increased mortality and cardiac‐related hospitalizations. Conclusions Increased TSH levels are associated with worse clinical outcome in patients with HF. Thyroid imbalance confers significant risk in HF and warrants attention.
Background Low serum albumin is common in patients with chronic heart failure (HF). Hypothesis Albumin may have an impact on clinical outcome in HF. We evaluated the effect of albumin levels on clinical outcome in a real‐world cohort of patients with HF. Methods All patients with HF at a health maintenance organization were followed for cardiac‐related hospitalizations and death. Results A total of 5779 HF patients were included in the study; mean follow‐up was 576 days; median serum albumin was 4.0 g/dL (interquartile range 3.7‐4.2), and 12% of the patients had hypoalbuminemia (albumin<3.5 g/dL). Low albumin was associated with increasing age, higher urea and C‐reactive protein, lower sodium, hemoglobin, iron, less treatment with angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, reduced right ventricular function, and pulmonary hypertension. Cox regression analysis after adjustment for significant predictors demonstrated that decreasing quartiles of albumin was significantly associated with mortality: Lowest quartile compared to highest: hazard ratio (HR) 5.74, 95% confidence interval (CI) 4.08 to 8.07, P < 0.001. Cox regression analysis of albumin as a continuous parameter using restricted cubic splines after adjustment for significant parameters demonstrated that reduced albumin levels were directly associated with increased mortality ( P < 0.001 for the adjusted model). Decreasing quartiles of albumin were also a significant predictor of increased cardiac‐related hospitalizations. A decrease in albumin on follow‐up was an independent predictor of increased mortality by Cox regression analysis: HR 2.58, 95% CI 2.12 to 3.14, P < 0.001. Conclusions Low albumin provides important information regarding several detrimental processes in HF and is a significant predictor of a worse outcome in these patients.
Aims The characteristics of heart failure (HF) patients of different ethnic backgrounds in Israel are unknown. The purpose of the present study was to evaluate the clinical characteristics of Arab vs. Jewish patients with chronic HF. Methods and results Patients with a diagnosis of HF at a health maintenance organization in Jerusalem, Israel were evaluated. All patients were followed for cardiac‐related hospitalizations and death. The study cohort included 6773 HF patients; 4991 (74%) were Jewish and 1735 (26%) were Arab. The overall prevalence of HF in the Jewish vs. Arab population was similar (women, 4.3% vs. 4.7%, respectively, P = 0.06; men, 5.3% vs. 5.2%, P = 0.61). The prevalence of HF was significantly higher in Arab subjects of younger age groups (50–70 years). Arabs developed HF on average 10 years earlier and had a significantly higher rate of diabetes and obesity. Standard of care based on prescribed medications was similar between the ethnic groups. Glucose and cholesterol levels were higher in the Arab cohort. Mortality was similar between the groups at median follow‐up (576 days), with the exception of cardiovascular hospitalizations and death that were higher in Arab men. Conclusions Arab subjects develop HF at a much younger age compared with their Jewish counterparts and have a higher prevalence of diabetes and obesity. Standard of care and clinical outcome are comparable. Implementation of prevention programmes to reduce risk factors, particularly diabetes and obesity, may help reduce the disparity between Arabs and Jews.
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