Impact of mitral regurgitation on cardiovascular hospitalization and death in newly diagnosed heart failure patients

Abstract

Aims Heart failure (HF) carries a poor prognosis, and the impact of concomitant mitral regurgitation (MR) is not well understood. This analysis aimed to estimate the incremental effect of MR in patients newly diagnosed with HF. Methods and results Data from the IBM® MarketScan® Research Databases were analysed. Included patients had at least one inpatient or two outpatient HF claims. A 6 month post-period after HF index was used to capture MR diagnosis and severity. HF patients were separated into three cohorts: without MR (no MR), not clinically significant MR (nsMR), and significant MR (sMR). Time-to-event analyses were modelled to estimate the clinical burden of disease. The primary outcome was a composite endpoint of death or cardiovascular (CV)-related admission. Secondary outcomes were death and CV hospitalization alone. All models controlled for baseline demographics and co-morbidities. Patients with sMR were at significantly higher risk of either death or CV admission compared with patients with no MR [hazard ratio (HR) 1.26; 95% confidence interval (CI) 1.15-1.39]. When evaluating death alone, patients with sMR had significantly higher risk of death (HR 1.24; 95% CI 1.08-1.43) compared with patients with no MR. When evaluating CV admission alone, patients with MR were at higher risk of hospital admission vs. patients with no MR, and the magnitude was dependent upon the MR severity: sMR (HR 1.55; 95% CI 1.38-1.74) and nsMR (HR 1.23; 95% CI 1.08-1.40). Conclusions Evidence of MR in retrospective claims significantly increases the clinical burden of incident HF patients. Time to death and CV hospitalizations are increased when MR is clinically significant.

The Prognostic Role of Mitral Valve Regurgitation Severity and Left Ventricle Function in Acute Heart Failure

“…Our study, which evaluated almost 7000 contemporary patients admitted with AHF, reinforces the notion that MR severity is associated with all-cause mortality and extends the current understanding by demonstrating in a large group of patients that mortality is mainly mediated by the baseline LV function [ 10 , 21 , 22 , 23 , 24 , 25 ].…”

Pathophysiology and Therapeutic Approaches to Acute Decompensated Heart Failure

“… 21 Moderate and severe mitral regurgitation are well known to worsen clinical outcomes in patients with HFrEF. 22 – 24 …”

Embracing secondary mitral regurgitation with Carillon: past, present, and future

“…Mitral regurgitation (MR) is a highly prevalent valvular heart disease 1 . Several national and international reports have identified MR as a frequent clinical condition in patients with heart failure (HF) 2–4 . In many cases, MR is moderate to severe and associated with high mortality and frequent hospitalizations 4–6 .…”

“…1 Several national and international reports have identified MR as a frequent clinical condition in patients with heart failure (HF). [2][3][4] In many cases, MR is moderate to severe and associated with high mortality and frequent hospitalizations. [4][5][6] For optimal patient management, it is essential to distinguish between primary and secondary MR, as patient management and interventions differ significantly.…”

“…[2][3][4] In many cases, MR is moderate to severe and associated with high mortality and frequent hospitalizations. [4][5][6] For optimal patient management, it is essential to distinguish between primary and secondary MR, as patient management and interventions differ significantly. 1 Secondary MR is a disease of the left heart.…”