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1. Mortality trends in an ambulatory multidisciplinary heart failure unit from 2001 to 2018.

Author

Spitaleri G, Lupón J, Domingo M, Santiago-Vacas E, Codina P, Zamora E, Cediel G, Santesmases J, Diez-Quevedo C, Troya MI, Boldo M, Altmir S, Alonso N, González B, Núñez J, and Bayes-Genis A

Subjects
Aged, Cohort Studies, Female, Heart Failure pathology, Humans, Male, Prognosis, Survival Rate, Ambulatory Care methods, Heart Failure mortality, Hospitalization statistics & numerical data, Mortality trends, Stroke Volume, Ventricular Function, Left
Abstract

To assess mortality trends at 1 and 3 years from 2001 to 2018 in a real-life cohort of HF outpatients from different etiologies with depressed and preserved LVEF. A total of 2368 consecutive patients with HF (mean age 66.4 ± 12.9 years, 71% men, 15.4% with preserved LVEF) admitted to a HF clinic from August 2001 to September 2018 were included in the study. Patients were divided into five quintiles (Q) according to the period of admission. Trends for all-cause and cardiovascular mortality from Q1 to Q5 were assessed by linear regression. Patients with LVEF < 50% had a progressive decrease in the rates of all-cause and cardiovascular death at 1 year (12.1% in Q1 to 6.5% in Q5, p = 0.003; and 8.4% in Q1 to 3.8% in Q5, p = 0.007, respectively) and 3 years (30.5% in Q1 to 17.0% in Q5, p = 0.003; and 23.9% in Q1 to 9.8% in Q5, p = 0.003, respectively). These trends remained significant after adjusting for clinical characteristics and risk. No significant trend in mortality was observed in patients with LVEF ≥ 50%. In a cohort of real-life ambulatory patients with HF, mortality progressively declined in patients with LVEF < 50%, but the same trend was not observed in patients with preserved LVEF.

Published
2021
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2. Trends in modes of death in heart failure over the last two decades: less sudden death but cancer deaths on the rise

Author

Moliner P, Lupon J, de Antonio M, Domingo M, Santiago-Vacas E, Zamora E, Cediel G, Santesmases J, Diez-Quevedo C, Troya M, Boldo M, Altmir S, Alonso N, Gonzalez B, Nunez J, and Bayes-Genis A

Subjects
Sudden death, Cardiovascular death, Heart failure, Mortality, Non-cardiovascular death, Cancer
Abstract

Aims Better management of heart failure (HF) over the past two decades has improved survival, mainly by reducing the incidence of death due to cardiovascular (CV) causes. Deaths due to non-CV causes, particularly cancer, may be increasing. This study explored the modes of death of consecutive patients who attended a HF clinic over 17 years. Methods and results A total of 935 deaths were ascertained from 2002 to 2018 among 1876 patients (mean age 65.8 +/- 12.5 years, 75% men, left ventricular ejection fraction < 50%) admitted to our HF clinic. Median follow-up was 4.2 years [1.9-7.8]. Mode of death was curated from patient health records and verified by the Catalan and Spanish health system databases. Trends for every mode of death were assessed by polynomial regression. Two trends were observed: a significant reduction in sudden death (P = 0.03) without changes in HF progression as mode of death (P = 0.26), and a significant increase in non-CV modes of death (P < 0.001). Non-CV deaths accounted for 17.4% of deaths in 2002 and 65.8% of deaths in 2018. A total 138 deaths were due to cancer (37% of non-CV deaths). A significant trend was observed towards a progressive increase in cancer deaths over time (P = 0.002). The main mode of cancer mortality was lung cancer. Conclusions The modes of death in HF have shifted over the last two decades. Patients with HF die less due to sudden death and more due to non-CV causes, mainly cancer. Whether HF triggers cancer, or cancer develops in HF survivors, deserves further insight.

Published
2019

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