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Aims Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF. ..................................................................................................................................................................... Methods and results The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1–Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 ( < 5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1=1.28 [95% confidence intervals (1.09–1.50), P =0.003], cardiovascular death [1.44 (1.11–1.77), P =0.001], HF hospitalization [1.37 (1.11–1.70), P =0.004], and all-cause mortality [1.36 (1.13–1.64), P =0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17–0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. ..................................................................................................................................................................... Conclusion Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA.

Objectives: This study sought to assess safety and effectiveness of low-dose aspirin in heart failure (HF) not complicated by atrial fibrillation. Background: Despite lack of evidence, low-dose aspirin is widely used in patients with HF and sinus rhythm with and without prior ischemic heart disease. Methods: The study included 12,277 patients with new-onset HF during 2007 to 2012 who had no history of atrial fibrillation. Of 5,450 patients using low-dose aspirin at baseline, 3,840 were propensity matched to non-aspirin users in a 1:1 ratio. Propensity-matched Cox models were calculated with respect to the primary composite outcome of all-cause mortality, myocardial infarction, and stroke and the secondary outcomes of bleeding and HF readmission. Results: The composite outcome occurred in 1,554 (40.5%) patients in the aspirin group and 1,604 (41.8%) patients in the non-aspirin group. Aspirin use was not associated with an altered risk of composite outcome (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.91 to 1.05), but it was associated with an increased risk of myocardial infarction (HR: 1.34; 95% CI: 1.08 to 1.67), whereas no differences were observed in all-cause mortality and stroke. An increased risk of HF readmission was observed in the aspirin group (HR: 1.25; 95% CI: 1.17 to 1.33). No difference in bleeding was observed. In subgroup analyses on the basis of a history of ischemic heart disease, the results were similar to the main result. Conclusions: No association was detected between low-dose aspirin use and the composite outcome of all-cause mortality, admission for myocardial infarction, and admission for stroke in patients with HF with no history of atrial fibrillation. Aspirin use was associated with an increased risk of readmission for HF.

Background: Employment status at time of first heart failure (HF) hospitalization may be an indicator of both self-perceived and objective health status. In this study, we examined the association between employment status and the risk of all-cause mortality and recurrent HF hospitalization in a nationwide cohort of patients with HF. \ud Methods and Results: We identified all patients of working age (18-60 years) with a first HF hospitalisation in the period 1997-2015 in Denmark, categorized according to whether or not they were part of the workforce at time of the index admission. The primary outcome was death from any cause and the secondary outcome was readmission for HF. Cumulative incidence curves, binomial regression and Cox regression models were used to assess outcomes. Of 25571 patients with a first hospitalization for HF, 15428 (60%) were part of the workforce at baseline. Patients in the workforce were significantly younger (53 vs. 55 years) more likely to be male (75% vs 64%) and less likely to have diabetes (13% vs 22%) and chronic obstructive pulmonary disease (5% vs 10%), all p-values

Background: Heart failure (HF) has a major impact on a patient’s quality of life and functional\ud status. This impact may be sufficiently profound to prevent independent living although how\ud often this is the case is unknown. We examined the need for domiciliary assistance and admission\ud to a nursing home following first HF hospitalization.\ud Methods: In nationwide Danish registries, we identified a cohort of patients discharged alive\ud after a first-time HF hospitalization in the period 2008–2014 who were matched 1:5 with comparison\ud subjects based on age and sex and followed for 5 years.\ud Results: We included 37,547 patients (69% men) discharged after a first-time HF-hospitalization\ud and 187,735 comparison subjects. The 5-year incidence of initiation of domiciliary care was\ud 24.1% [23.7%–24.6%] among HF patients and 9.2% [9.1%–9.4%] among the comparison\ud cohort and yielded a corresponding adjusted HR of 2.02 [1.96–2.09]. Covariates associated with\ud initiation of domiciliary support included older age (HR 1.08 [1.07–1.08] per 1 year increase\ud in age), living alone (HR 2.09 [2.04–2.15]) and comorbidities. The 5-year incidence of nursing\ud home admission was 3.9% [3.7%–4.0%] among HF patients and 1.7% [1.7%–1.8%] among the\ud comparison cohort and this resulted in an adjusted HR of 1.91 [1.77–2.06]. Covariates associated\ud with nursing home admission included older age (HR 1.10 [1.10–1.11]), living alone (HR\ud 2.15 [2.02–2.28]) and history of stroke (HR 2.71 [2.53–2.90]).\ud Conclusion: Hospitalization for HF is associated with increased need for domiciliary support\ud and nursing home admissions. Older age, living alone, and comorbidities were associated with\ud higher risk of both outcomes.

Objectives:\ud This study investigated the association between the use of evidence-based medicine (EBM) for heart failure (HF) and risk of workforce detachment.\ud \ud Background:\ud The ability to work can be a marker of functional capacity and quality of life.\ud \ud Methods:\ud We examined a nationwide cohort of patients in the workforce 1 year after first hospitalization for HF. EBM was defined as treatment with β-blockers and renin angiotensin system inhibitors. The fraction of target dose (0-1) for each drug was calculated. The sum of the fractions gave each patient a score between 0 and 2. Patients were stratified into 4 groups according to this score: group 4 score = 2 (target dose of both drugs); group 3 score 1; group 2 score ≤1 to >0.5; and group 1 score ≤0.5. The risk of subsequent workforce detachment was estimated in cause specific Cox regression models.\ud \ud Results:\ud One year after first HF hospitalization, 10,185 patients were part of the workforce, and 7,561 (74%) were in treatment with at least 1 of the components of EBM. During a median follow-up of 727 days, 2,698 individuals (36%) became detached from the workforce. Patients receiving more EBM had a significantly lower risk of workforce detachment compared with those receiving less EBM (group 4 hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; group 3 HR: 0.85; 95% CI: 0.77 to 0.94; and group 2 HR 0.92; 95% CI: 0.83 to 1.02), all compared to group 1.\ud \ud Conclusions:\ud Patients in the workforce 1 year after first HF hospitalization and treated with target or near-target doses of EBM were associated with a significantly lower risk of subsequent workforce detachment.