Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective international multi-ethnic cohort study

Lam, Carolyn S.P.; Gamble, Greg; Ling, Lieng H.; Sim, David; Leong, Kui Toh Gerard; Yeo, Poh Shuan Daniel; Ong, Hean Yee; Jaufeerally, Fazlur; Ng, Tze Pin; Cameron, Vicky A.; Poppe, Katrina; Lund, Mayanna; Devlin, Gerry; Troughton, Richard W.; Richards, A. Mark; Doughty, Robert N.

doi:10.1093/eurheartj/ehy005

Cited by 204 publications

(175 citation statements)

References 24 publications

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“…31 Conversely, in some cohort studies, female HFpEF patients represented only 48-50% of the entire HFpEF patient population. 32,33 Similarly, in our sample, there was a lower number of women (46%) enrolled, which is in contrast with the epidemiology of HFpEF in the real-world setting. Because our study differs from a complete case registration study, the proportion of female patients with HFpEF was likely lower.…”

Section: Discussionmentioning

confidence: 61%

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

et al. 2019

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Aims The objective of the study was to evaluate whether the geriatric nutritional risk index (GNRI) at discharge may be helpful in predicting the long‐term prognosis of patients hospitalized with heart failure (HF) with preserved ejection fraction (HFpEF, left ventricular ejection fraction ≥50%), a common HF phenotype in the elderly. Methods and results Overall, 110 elderly HFpEF patients (≥65 years) from the Ibaraki Cardiovascular Assessment Study‐HF ( n = 838) were enrolled. The mean age was 78.5 ± 7.2 years, and male patients accounted for 53.6% ( n = 59). All‐cause mortality was compared between the low GNRI (<92) with moderate or severe nutritional risk group and the high GNRI (≥92) with no or low nutritional risk group. Cox proportional hazard regression models were constructed to evaluate the influence of the GNRI on all‐cause death with the following covariates using forward stepwise selection: age, sex, nutritional status based on the GNRI as a categorical variable, history of HF hospitalization, haemoglobin level, estimated glomerular filtration rate, log brain natriuretic peptide levels (logBNP), history of hypertension, log C‐reactive protein levels, left ventricular ejection fraction, left ventricular mass index, and the New York Heart Association functional classification (I/II or III class). The prognostic value of the GNRI was compared with that of serum albumin using C‐statistics. The GNRI was added to the logBNP, serum albumin or the body mass index was added to the logBNP, and the C‐statistic was compared using DeLong's test. Cox regression analysis revealed that age and a low GNRI were independent predictors of all‐cause death ( P < 0.05, n = 103; hazard ratio = 1.095, 95% confidence interval = 1.031–1.163, for age, and hazard ratio = 3.075, 95% confidence interval = 1.244–7.600, for the GNRI). DeLong's test for the two correlated receiver operating characteristic curves [area under the receiver operating characteristic curve (AUROC) of serum albumin, 0.71; AUROC of the GNRI, 0.75] demonstrated significant differences between the groups ( P = 0.038). Adding the GNRI to the logBNP increased the AUROC for all‐cause death significantly (0.71 and 0.80, respectively; P = 0.040, n = 105). The addition of serum albumin or the body mass index to the logBNP did not significantly increase the AUROC for all‐cause death ( P = 0.082 and P = 0.29, respectively). Conclusions Nutritional screening using the GNRI at discharge is helpful to predict the long‐term prognosis of elderly HFpEF patients.

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Section: Discussionmentioning

confidence: 61%

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

et al. 2019

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“…The SHOP-PEOPLE study design and outcomes have been reported previously 9. In brief, the same protocol was deployed across six centres in Singapore and four centres in NZ.…”

Section: Methodsmentioning

confidence: 99%

Ethnic differences in atrial fibrillation in patients with heart failure from Asia-Pacific

Tan

Tay

Teng

et al. 2019

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ObjectiveEthnic differences in the prevalence of atrial fibrillation (AF) in heart failure (HF) remain unclear. We compared the prevalence and clinical correlates of AF among different ethnicities in an Asian-Pacific population with HF.MethodsPatients with validated HF were prospectively studied across Singapore and New Zealand (NZ).ResultsAmong 1746 patients with HF (62% Asian, 26% women, mean age 66 (SD 13) years, mean ejection fraction (EF) 37 (SD 16%), 39% had AF. The prevalence of AF was markedly lower in Singapore-Asians than NZ-Europeans (24% vs 63%; p<0.001), even after adjusting for age, clinical and echocardiographic covariates, regardless of EF group (pinteraction for EF=0.39). Patients with AF were older, had higher body mass index and were more likely to have a history of hypertension, stroke, peripheral vascular disease, renal disease, chronic respiratory disease and increased alcohol intake, but less likely to have diabetes. Clinical correlates were similar for Asians and NZ-Europeans, except diabetes: Asian diabetic patients with HF had less AF compared with Asian patients without diabetes (OR 0.66, 95% CI 0.50 to 0.88), whereas among NZ-Europeans there was no significant association between diabetes and AF (OR 1.22, 95% CI 0.85 to 1.75) (pinteraction for ethnicity=0.01). AF was associated with a higher crude composite outcome of mortality and HF hospitalisations at 2 years (HR 1.19, 95% CI 1.02 to 1.38).ConclusionThere is a strikingly lower prevalence of AF among Asian compared with NZ-European patients with HF. The underlying mechanisms for the lower prevalence of AF among Asians, particularly in the presence of diabetes, deserve further study.Trial registration numberACTRN12610000374066.

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“…4 In HF with preserved EF (EF ≥ 50%, HFpEF), there is conflicting evidence of the prognostic importance of IHD, 2,3,5 and HF with mid-range EF (EF 40-49%, HFmrEF) is less explored in this regard, even though often described as an intermediate group with a higher prevalence of cardiovascular disease but otherwise with co-morbidities and all-cause mortality resembling that of HFpEF. 6,7 In the past decades, we have witnessed a gradual decline in the incidence of, and death by, myocardial infarction [8][9][10] likely due to more effective pharmacotherapies such as dual antiplatelet therapies, 11 anticoagulants, 12,13 lipid-lowering treatment, 14 possibly more effective invasive techniques, 15 and stent development, 16 as well as widespread use of early revascularization strategies in acute myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact over time of ischaemic heart disease vs. non‐ischaemic heart disease in heart failure

et al. 2020

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Aims The aim of this study is to investigate the prognostic impact of ischaemic heart disease (IHD) in heart failure (HF) and its association to age, sex, left ventricular ejection fraction (EF), and HF duration, and furthermore, to evaluate if the impact of IHD has changed over time, in light of improved therapy. Methods and results We studied 30 946 patients with non‐valvular HF, by accessing the Swedish Heart Failure Registry, from years 2000 to 2012. The mortality in 17 778 patients with clinical IHD was compared with 13 168 patients without IHD (non‐IHD). There was a significantly worse outcome in IHD, with the crude mortality of 41.1% and the event rate per 100 person‐years [95% confidence interval (CI)] of 14.8 (14.4–15.1), compared with 28.2% and 9.7 (9.4–10.0) in non‐IHD. After multivariable adjustment, the hazard ratio (HR) (95% CI) for mortality, IHD vs. non‐IHD, was 1.16 (1.11–1.22; P < 0.0001). Subgroup analyses showed significantly increased mortality in IHD, in all age subgroups, in all subgroups with EF < 50%, in both men and women, and regardless of heart failure duration more or less than 6 months. Analyses for the combination of age and EF showed the highest HR for time to death in the youngest with the lowest EF, HR (95% CI) 2.05 (1.59–2.64) for patients <60 years of age with EF < 30%. Although a numerical reduction of the HR for mortality was seen over time, the risk for mortality in IHD, compared with the non‐IHD group, was greater throughout the study period. Conclusions In non‐valvular heart failure, IHD was associated with significantly increased mortality, compared with non‐IHD, in groups of EF below 50%, in all age groups, and regardless of sex or HF duration. The risk increase associated with EF reduction diminished with increasing age. The mortality in IHD, compared with non‐IHD, remained significantly higher throughout the 13 year study period.

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Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective international multi-ethnic cohort study

Abstract: Australian New Zealand Clinical Trial Registry (ACTRN12610000374066).

Cited by 204 publications

References 24 publications

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

Ethnic differences in atrial fibrillation in patients with heart failure from Asia-Pacific

Prognostic impact over time of ischaemic heart disease vs. non‐ischaemic heart disease in heart failure

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