Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Abstract

Aims Low serum albumin levels are associated with poor prognosis in numerous chronic disease states but the relationship between albumin and outcomes in patients with heart failure (HF) and secondary mitral regurgitation (SMR) has not been described. Methods and results The randomized COAPT trial evaluated the safety and effectiveness of transcatheter edge‐to‐edge repair (TEER) with the MitraClipTM plus guideline‐directed medical therapy (GDMT) versus GDMT alone in patients with symptomatic HF and moderate‐to‐severe or severe SMR. Baseline serum albumin levels were measured at enrolment. Among 614 patients enrolled in COAPT, 559 (91.0%) had available baseline serum albumin levels (median 4.0 g/dl, interquartile range 3.7–4.2 g/dl). Patients with albumin <4.0 g/dl compared with ≥4.0 g/dl were older and more likely to have ischaemic cardiomyopathy and a hospitalization within the year prior to enrolment. After multivariable adjustment, patients with albumin <4.0 g/dl had higher 4‐year rates of all‐cause death (63.7% vs. 47.6%; adjusted hazard ratio 1.34, 95% confidence interval 1.02–1.74; p = 0.032), but there were no significant differences in HF hospitalizations (HFH) or all‐cause hospitalizations according to baseline serum albumin level. The relative effectiveness of TEER plus GDMT versus GDMT alone was consistent in patients with low and high albumin levels (pinteraction = 0.19 and 0.35 for death and HFH, respectively). Conclusion Low baseline serum albumin levels were independently associated with reduced 4‐year survival in patients with HF and severe SMR enrolled in the COAPT trial, but not with HFH. Patients treated with TEER derived similarly robust reductions in both death and HFH regardless of baseline albumin level.

Association between haemoglobin, albumin, lymphocytes, and platelets and mortality in patients with heart failure

“… 6 HALP is calculated from haemoglobin, albumin, lymphocytes, and platelets and reflects the patient's malnutrition, immune response, and prognosis. Previous studies have analysed the associations between haemoglobin, 24 albumin, 25 lymphocytes, 26 and platelet levels 27 and patients with heart failure. Our study investigated the relationship between combined index HALP and short‐ and long‐term mortality in patients with heart failure.…”

April 2023 at a glance: focus on diagnosis and comorbidities

“…Multiple factors may affect the outcome of patients with severe MR undergoing percutaneous treatment 31–34 . Feng et al 35 . assessed the role of serum albumin in 559 patients with baseline serum albumin levels available enrolled in the COAPT trial (median albumin level 4.0 g/dl, interquartile range 3.7–4.2 g/dl).…”

“…Multiple factors may affect the outcome of patients with severe MR undergoing percutaneous treatment. [31][32][33][34] Feng et al 35 assessed the role of serum albumin in 559 patients with baseline serum albumin levels available enrolled in the COAPT trial (median albumin level 4.0 g/dl, interquartile range 3.7-4.2 g/dl). Patients with albumin <4.0 g/dl were older, had higher 4-year rates of all-cause death, but a similar risk of HF hospitalizations or all-cause hospitalizations, compared to those with albumin ≥4.0 g/dl.…”

Hypoalbuminaemia and secondary mitral regurgitation mortality: an inevitable fate?

“…In a previous issue of the Journal, Feng et al 14 sought to assess the prevalence of hypoalbuminaemia and its impact on prognosis in patients presenting with SMR within the COAPT study. Among the 559 COAPT patients with an available baseline albumin level, only 13.6% of patients presented with hypoalbuminaemia when the conventional definition of a serum albumin level <3.5 g/dl was applied.…”

“…In a previous issue of the Journal, Feng et al 14 . sought to assess the prevalence of hypoalbuminaemia and its impact on prognosis in patients presenting with SMR within the COAPT study.…”