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Telephonic titration of HF medications was feasible and safe and was achieved in 97% patients on ACEI/ARB and β-blockers. Medication titration was associated with significant improvement in LV function, avoiding the need for device therapy in many patients.

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Background Rheumatic immune mediated inflammatory diseases (IMIDs) are associated with high risk of acute coronary syndrome. The long‐term prognosis of acute coronary syndrome in patients with rheumatic IMIDs is not well studied. Methods and Results We identified Medicare beneficiaries admitted with a primary diagnosis of myocardial infarction (MI) from 2014 to 2019. Outcomes of patients with MI and concomitant rheumatic IMIDs including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, dermatomyositis, or psoriasis were compared with propensity matched control patients without rheumatic IMIDs. One‐to‐three propensity‐score matching was done for exact age, sex, race, ST‐segment–elevation MI, and non–ST‐segment–elevation MI variables and greedy approach on other comorbidities. The study primary outcome was all‐cause mortality. The study cohort included 1 654 862 patients with 3.6% prevalence of rheumatic IMIDs, the most common of which was rheumatoid arthritis, followed by systemic lupus erythematosus. Patients with rheumatic IMIDs were younger, more likely to be women, and more likely to present with non–ST‐segment–elevation MI. Patients with rheumatic IMIDs were less likely to undergo coronary angiography, percutaneous coronary intervention or coronary artery bypass grafting. After propensity‐score matching, at median follow up of 24 months (interquartile range 9–45), the risk of mortality (adjusted hazard ratio [HR], 1.15 [95% CI, 1.14–1.17]), heart failure (HR, 1.12 [95% CI 1.09–1.14]), recurrent MI (HR, 1.08 [95% CI 1.06–1.11]), and coronary reintervention (HR, 1.06 [95% CI, 1.01–1.13]) ( P <0.05 for all) was higher in patients with versus without rheumatic IMIDs. Conclusions Patients with MI and rheumatic IMIDs have higher risk of mortality, heart failure, recurrent MI, and need for coronary reintervention during follow‐up compared with patients without rheumatic IMIDs.

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Introduction Patients with autoimmune connective tissue diseases (CTD) have a high burden of valvular heart disease and are often thought of as high surgical risk patients. Methods Patients undergoing aortic valve replacement (AVR) were identified in the Nationwide Readmission Database (NRD) between January 2012 and December 2018. Patients with a history of systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, mixed connective tissue disease, Sjögren syndrome, polymyositis, and dermatomyositis were included in the CTD cohort. Patients undergoing coronary artery bypass grafting (CABG) concomitantly with AVR were excluded. Results A total of 569,600 hospitalizations were included, of which,16,531 (2.9%) had CTD. CTD patients were more likely to be females, with higher rates of heart failure, pulmonary hypertension, and more likely to be insured by Medicare. CTD patients had lower mortality compared to non-CTD patients (OR 0.66; 95% [CI]: 0.59-0.74); and stroke (OR 0.87; 95% [CI]: 0.79-0.97). CTD patients undergoing SAVR had lower mortality (OR 0.69; 95% [CI]: 0.60-0.80); and stroke (OR 0.86; 95% [CI]: 0.75-0.98). CTD patients undergoing TAVR had lower mortality outcomes (OR 0.67; 95% [CI]: 0.56-0.80); however, had comparable stroke outcomes (OR 0.97; 95% [CI]: 0.83-1.13, p = 0.69). Conclusions Outcomes for patients with CTD requiring AVR are not inferior to their non-CTD counterparts. A comprehensive heart team selection of patients undergoing aortic valve replacement approaches should put CTD history under consideration; however, pre-existing CTD should not be prohibitive of aortic valve replacement interventions.

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