Outcomes in ambulatory chronic systolic and diastolic heart failure: A propensity score analysis

Ahmed, Ali; Perry, Gilbert J.; Fleg, Jerome L.; Love, Thomas E.; Goff, David C.; Kitzman, Dalane W.

doi:10.1016/j.ahj.2006.06.020

Cited by 58 publications

(55 citation statements)

References 47 publications

(8 reference statements)

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“…Some studies of prognosis have been based on the presence or absence of a decreased LVEF, but there are also reports in which either almost no difference was observed or the prognosis of the preserved group was slightly better. 8,[23][24][25][26][27][28][29][30] In studies in which the results differed from ours, differences in the selection of subjects and in the criteria for the definition of LVEF may have played a role. In the present study, all cases with valvular disease were excluded from the subject group.…”

Section: Discussioncontrasting

confidence: 47%

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Long Term Prognosis of Chronic Heart Failure Reduced vs Preserved Left Ventricular Ejection Fraction

Miyagishima

Hiramitsu

Kimura

et al. 2009

Circ J

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Background Left ventricle diastolic dysfunction is attracting increasing attention of one of the etiologies of chronic heart failure (CHF). Methods and ResultsThe study sample included 560 patients with CHF who were hospitalized during the 5-year period. They were classified into 2 groups according to the left ventricular ejection fraction (LVEF): reduced group (LVEF <50%, n=431); or preserved group (LVEF ≥50%, n=129). The degree of cardiac symptoms did not differ between the 2 groups; however, no difference was found between the 2 groups in the mortality rate (P=0.898), and readmission rates (P=0.674). The results of a multivariate analysis using a Cox proportional hazards model to identify predictors of the prognosis of heart failure revealed no difference in prognosis according to the presence/absence of decreased LVEF, whereas renal dysfunction and anemia were identified as significant prognostic determinants. Also, in the reduced group, the administration of angiotensin-converting enzyme inhibitors (ACE-I) and/or angiotensin II receptor blockers (ARB), β-blockers reduced mortality. In the preserved group, ACE-I and/or ARB administration reduced mortality, whereas β-blockers did not. Conclusion In the present study, the likelihood of LVEF influencing prognosis was considered to be low, with the contribution of non-cardiac factors such as renal function and anemia concluded to be greater. (Circ J 2009; 73: 92 -99)

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Section: Discussioncontrasting

confidence: 47%

“…8,[23][24][25][26][27][28][29][30] The reasons for this include differences in the methods of selecting subjects. Many studies exclude only severe valvular disease but include moderate and mild valvular disease.…”

Section: Discussionmentioning

confidence: 99%

Long Term Prognosis of Chronic Heart Failure Reduced vs Preserved Left Ventricular Ejection Fraction

Miyagishima

Hiramitsu

Kimura

et al. 2009

Circ J

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“…Of the 30 studies (7 that did not report a table and 23 that did) that reported comparing the distribution of baseline characteristics between treated and untreated subjects, 19 used statistical significance testing, 4 used both standardized differences and significance testing, 21,38,55,58 3 relied on visual comparison, and 4 did not report what was done. Thus, no studies used only methods appropriate for matched data.…”

Section: Assessing Balance Between Treated and Untreated Subjectsmentioning

confidence: 99%

“…These studies used McNemar's test, 29,34,35 regression models estimated with generalized estimating equation methods to account for the matched-pairs nature of the sample, 43,57 Cox proportional hazards regression stratified on the matched pairs, 21,44,55,58 the signed rank test, 34 and methods that used the bootstrap. 41,60 Three additional studies used methods appropriate for correlated data for some outcomes but not for others.…”

Section: Estimating the Effect Of Treatment Or Exposure On The Outcomementioning

confidence: 99%

Primer on Statistical Interpretation or Methods Report Card on Propensity-Score Matching in the Cardiology Literature From 2004 to 2006

Austin

2008

Circ: Cardiovascular Quality and Outcomes

140

126

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Background-Propensity-score matching is frequently used in the cardiology literature. Recent systematic reviews have found that this method is, in general, poorly implemented in the medical literature. The study objective was to examine the quality of the implementation of propensity-score matching in the general cardiology literature. Methods and Results-A total of 44 articles published in the American Heart Journal, the American Journal of Cardiology, Circulation, the European Heart Journal, Heart, the International Journal of Cardiology, and the Journal of the American College of Cardiology between January 1, 2004, and December 31, 2006, were examined. Twenty of the 44 studies did not provide adequate information on how the propensity-score-matched pairs were formed. Fourteen studies did not report whether matching on the propensity score balanced baseline characteristics between treated and untreated subjects in the matched sample. Only 4 studies explicitly used statistical methods appropriate for matched studies to compare baseline characteristics between treated and untreated subjects. Only 11 (25%) of the 44 studies explicitly used statistical methods appropriate for the analysis of matched data when estimating the effect of treatment on the outcomes. Only 2 studies described the matching method used, assessed balance in baseline covariates by appropriate methods, and used appropriate statistical methods to estimate the treatment effect and its significance.

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“…Because of significant imbalance in baseline covariates between patients with NYHA class I-II and III-IV symptoms (Table 1), we calculated propensity scores for NYHA III-IV symptoms for 4036 patients using a non-parsimonious multivariable logistic regression model, adjusting for all available baseline covariates, and incorporating significant two-way interaction terms in the model (Ahmed, et al, 2006b;Ahmed, et al, 2006c;Ahmed, et al, 2006d;Rosenbaum and Rubin, 1983;Rubin, 1997;Rubin, 2001). Covariates in the model included age, sex, race, body mass index, duration of HF, etiology of HF (ischemic versus other causes), prior myocardial infarction, current angina, hypertension, diabetes, diuretic, potassium-sparing diuretics, potassium supplement, angiotensin-converting enzyme (ACE) inhibitors, combined use of hydralazine and nitrates, and pre-trial use of digoxin, dyspnea at rest, dyspnea on exertion, third heart sound, elevated jugular venous pressure, pulmonary râles, lower extremity edema, pulmonary congestion, cardiothoracic ratio >0.5, serum creatinine and potassium levels, and LVEFE.…”

Section: Estimation Of Propensity Scoresmentioning

confidence: 99%

A propensity-matched study of the association of physical function and outcomes in geriatric heart failure

Ahmed¹,

Aronow²

2008

Archives of Gerontology and Geriatrics

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Most heart failure (HF) patients are older adults. However, the association of functional status and outcomes in ambulatory older adults with chronic HF has not been well studied. Of the 7788 Digitalis Investigation Group (DIG) trial participants, 4036 were ≥65 years. Of these, 1369 (34%) had New York Heart Association (NYHA) class III-IV symptoms. We calculated propensity scores for NYHA III-IV symptoms for all 4036 patients using a non-parsimonious logistic regression model. We used propensity scores to match 1010 (74% of 1369) NYHA III-IV patients with 1010 of NYHA I-II patients. Kaplan-Meier and matched Cox proportion hazard analyses were used to estimate associations of NYHA class III-IV with mortality and hospitalizations. Patients had a mean age of 73 years, 31% were female, and 11% were nonwhites. All-cause mortality occurred in 394 (rate, 1385/10000 person-years) NYHA I-II and 452 (rate, 1654/10000 person-years) NYHA III-IV patients, respectively, during 2967 and 2733 years of follow up (hazard ratio {HR}, 1.28; 95% confidence interval {CI}, 1.09-1.50; P=0.002). NYHA III-IV class was associated with increased cardiovascular (HR, 1.25, 95% CI, 1.04-1.49, P=0.016) and HF mortality (HR, 1.51, 95% CI, 1.16-1.97, P=0.002). NYHA III-IV class was not significantly associated with hospitalizations due to all causes (HR, 1.10; 95% CI, 0.96-1.25; P=0.165), cardiovascular causes (HR, 1.11; 95% CI, 0.96-1.29; P=0.150), or worsening HF (HR, 1.09, 95% CI, 0.92-1.30; P=0.330). Baseline NYHA functional class was associated with mortality but not with hospitalization in ambulatory older adults with chronic HF.

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Outcomes in ambulatory chronic systolic and diastolic heart failure: A propensity score analysis

Cited by 58 publications

References 47 publications

Long Term Prognosis of Chronic Heart Failure Reduced vs Preserved Left Ventricular Ejection Fraction

Long Term Prognosis of Chronic Heart Failure Reduced vs Preserved Left Ventricular Ejection Fraction

Primer on Statistical Interpretation or Methods Report Card on Propensity-Score Matching in the Cardiology Literature From 2004 to 2006

A propensity-matched study of the association of physical function and outcomes in geriatric heart failure

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