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7. Implications of peripheral oedema in heart failure with preserved ejection fraction: a heart failure network analysis

Author

Fudim, Marat, primary, Ashur, Nicolas, additional, Jones, Aaron D., additional, Ambrosy, Andrew P., additional, Bart, Bradley A., additional, Butler, Javed, additional, Chen, Horng H., additional, Greene, Stephen J., additional, Reddy, Yogesh, additional, Redfield, Margaret M., additional, Sharma, Abhinav, additional, Hernandez, Adrian F., additional, Felker, Gary Michael, additional, Borlaug, Barry A., additional, and Mentz, Robert J., additional

Published
2020
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8. Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI

Author

Marquis-Gravel, Guillaume, primary, Dalgaard, Frederik, additional, Jones, Aaron D., additional, Lokhnygina, Yuliya, additional, James, Stefan K., additional, Harrington, Robert A., additional, Wallentin, Lars, additional, Steg, Philippe Gabriel, additional, Lopes, Renato D., additional, Storey, Robert F., additional, Goodman, Shaun G., additional, Mahaffey, Kenneth W., additional, Tricoci, Pierluigi, additional, White, Harvey D., additional, Armstrong, Paul W., additional, Ohman, E. Magnus, additional, Alexander, John H., additional, and Roe, Matthew T., additional

Published
2020
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9. Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI

Author

Marquis-Gravel, Guillaume, Dalgaard, Frederik, Jones, Aaron D., Lokhnygina, Yuliya, James, Stefan, Harrington, Robert A., Wallentin, Lars, Steg, Philippe Gabriel, Lopes, Renato D., Storey, Robert F., Goodman, Shaun G., Mahaffey, Kenneth W., Tricoci, Pierluigi, White, Harvey D., Armstrong, Paul W., Ohman, E. Magnus, Alexander, John H., Roe, Matthew T., Marquis-Gravel, Guillaume, Dalgaard, Frederik, Jones, Aaron D., Lokhnygina, Yuliya, James, Stefan, Harrington, Robert A., Wallentin, Lars, Steg, Philippe Gabriel, Lopes, Renato D., Storey, Robert F., Goodman, Shaun G., Mahaffey, Kenneth W., Tricoci, Pierluigi, White, Harvey D., Armstrong, Paul W., Ohman, E. Magnus, Alexander, John H., and Roe, Matthew T.

Abstract

BACKGROUND The long-term prognostic impact of post-discharge bleeding in the unique population of patients with acute coronary syndrome (ACS) treated without percutaneous coronary intervention (PCI) remains unexplored. OBJECTIVES The aim of this study was to assess the association between post-discharge bleeding and subsequent mortality after ACS according to index strategy (PCI or no PCI) and to contrast with the association between post-discharge myocardial infarction (MI) and subsequent mortality. METHODS In a harmonized dataset of 4 multicenter randomized trials (APPRAISE-2 [Apixaban for Prevention of Acute Ischemic Events-2], PLATO [Study of Platelet Inhibition and Patient Outcomes], TRACER [Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome], and TRILOGY ACS [Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes]), the association between post-discharge noncoronary artery bypass graft-related GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) moderate, severe, or life-threatening bleeding (landmark 7 days post-ACS) and subsequent all-cause mortality was evaluated in a time-updated Cox proportional hazards analysis. Interaction with index treatment strategy was assessed. Results were contrasted with risk for mortality following post-discharge MI. RESULTS Among 45,011 participants, 1,133 experienced post-discharge bleeding events (2.6 per 100 patient-years), and 2,149 died during follow-up. The risk for mortality was significantly higher <30 days (adjusted hazard ratio: 15.7; 95% confidence interval: 12.3 to 20.0) and 30 days to 12 months (adjusted hazard ratio: 2.7; 95% confidence interval: 2.1 to 3.4) after bleeding, and this association was consistent in participants treated with or without PCI for their index ACS (p for interaction = 0.240). The time-related association between post-discharge bleeding and mortality was similar to the association between MI and su

Published
2020
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10. Implications of peripheral oedema in heart failure with preserved ejection fraction: a heart failure network analysis.

Author

Fudim, Marat, Ashur, Nicolas, Jones, Aaron D., Ambrosy, Andrew P., Bart, Bradley A., Butler, Javed, Chen, Horng H., Greene, Stephen J., Reddy, Yogesh, Redfield, Margaret M., Sharma, Abhinav, Hernandez, Adrian F., Felker, Gary Michael, Borlaug, Barry A., and Mentz, Robert J.

Subjects
EDEMA, HEART failure patients, VENTRICULAR ejection fraction
Abstract

Aims: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous condition, and tissue congestion manifested by oedema is not present in all patients. We compared clinical characteristics, exercise capacity, and outcomes in patients with HFpEF with and without oedema. Methods and results: This study was a post hoc analysis of pooled data of patients with left ventricular ejection fraction of ≥50% enrolled in the DOSE, CARRESS‐HF, RELAX, ATHENA, ROSE, INDIE, and NEAT trials. Patients were dichotomized by the severity of oedema. Cox proportional hazard regression and generalized linear regression models were used to assess associations between oedema, symptoms, and clinical outcomes. The ambulatory cohort included 393 patients (228 with and 165 without oedema), and the hospitalized cohort included 338 patients (249 with ≥moderate oedema and 89 with mild or none). Among ambulatory patients, patients with oedema had a higher body mass index (35.2 kg/m2 [inter‐quartile range, IQR 30.5, 41.6] vs. 31.6 kg/m2 [IQR 27.9, 36.3], P < 0.001), greater burden of co‐morbidities, higher intravascular pressures estimated on physical examination (elevated jugular venous pressure: 50% vs. 24.7%, P < 0.001), poorer renal function (creatinine: 1.2 mg/dL [IQR 0.9, 1.5] vs. 1 mg/dL [IQR 0.8, 1.3], P = 0.003), and lower peak VO2 (adjusted mean difference −1.04 mL/kg/min, 95% confidence interval [−1.71, −0.37], P < 0.003). Among hospitalized patients, despite greater in‐hospital fluid/weight loss in the ≥moderate oedema group, there was no difference in the improvement in dyspnoea by the visual analogue scale or well‐being visual analogue scale from baseline to 3–4 days and no statistically significant difference in the rate of 60 day rehospitalization/death (adjusted hazard ratio 1.44, 95% confidence interval [0.87, 2.39], P = 0.156). Conclusions: Patients with HFpEF and oedema display higher body mass, greater burden of co‐morbidities, and more severe exercise intolerance, but clinical responses to treatment appear similar. Further research is required to better understand the nature of volume distribution in different HFpEF phenotypes. [ABSTRACT FROM AUTHOR]

Published
2021
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14. Abstract 12881: The Importance of Non-Cardiac Comorbidities in Hospitalized Heart Failure With Preserved Ejection Fraction - A Secondary Analysis of Heart Failure Network Trials

Author

Reddy, Yogesh N, Obokata, Masaru, Jones, Aaron D, AbouEzzedine, Omar, Fudim, Marat, Alhanti, Brooke, Stevenson, Lynne W, Redfield, Margaret M, and Borlaug, Barry A

Abstract

Introduction:It is widely appreciated that Heart Failure (HF) with preserved Ejection Fraction (HFpEF) is a heterogeneous syndrome. Some patients develop elevated filling pressures exclusively during exercise and never require hospitalization, whereas others periodically develop marked congestion at rest that requires inpatient treatment. It is unknown what distinguishes these cohorts.Hypothesis:We hypothesized that worsening functional capacity and increasing comorbidity burden, particularly renal dysfunction, would be greater in patients with history of HF hospitalization compared to ambulatory patients without prior HF hospitalization.Methods:We performed a secondary analysis of 3 NIH sponsored multicenter trials of definite ambulatory HFpEF (EF?50%) including RELAX, NEAT and INDIE. Patients were stratified by HF hospitalization as never hospitalized (HFpEFNH) and prior hospitalized (HFpEFPH). Pre-randomization cardiac structure, biomarkers, clinical characteristics and outcomes were contrasted between groups.Results:Those with HFpEFPH(n=109) displayed lower activity levels and poorer exercise capacity (6 minute walk distance and peak exercise capacity) as compared to HFpEFNH(n=280). Comorbidity burden, specifically anemia, lung disease and renal dysfunction, was significantly greater in patients with HFpEFPHas compared to HFpEFNH, and this was associated with higher adjusted rates of HF hospitalization or death (Table).Conclusions:Greater comorbidity burden, functional impairment and renal dysfunction distinguish patients with HFpEF and a history of HF hospitalization from those without. Continued optimization of non-cardiac organ function may be helpful to reduce risk of hospitalization in HFpEF, given the likely bidirectional relationship between HFpEF and systemic comorbidity burden.

Published
2019
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