32399
2023
eng
868-879
7
112
article
1
--
--
--
Prevalence and prognostic impact of chronic kidney disease and anaemia across ACC/AHA precursor and symptomatic heart failure stages
Background
The importance of chronic kidney disease (CKD) and anaemia has not been comprehensively studied in asymptomatic patients at risk for heart failure (HF) versus those with symptomatic HF. We analysed the prevalence, characteristics and prognostic impact of both conditions across American College of Cardiology/American Heart Association (ACC/AHA) precursor and HF stages A–D.
Methods and results
2496 participants from three non-pharmacological German Competence Network HF studies were categorized by ACC/AHA stage; stage C patients were subdivided into C1 and C2 (corresponding to NYHA classes I/II and III, respectively). Overall, patient distribution was 8.1%/35.3%/32.9% and 23.7% in ACC/AHA stages A/B/C1 and C2/D, respectively. These subgroups were stratified by the absence ( – ) or presence ( +) of CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m2) and anaemia (haemoglobin in women/men < 12/ < 13 g/dL). The primary outcome was all-cause mortality at 5-year follow-up. Prevalence increased across stages A/B/C1 and C2/D (CKD: 22.3%/23.6%/31.6%/54.7%; anaemia: 3.0%/7.9%/21.7%/33.2%, respectively), with concordant decreases in median eGFR and haemoglobin (all p < 0.001). Across all stages, hazard ratios [95% confidence intervals] for all-cause mortality were 2.1 [1.8–2.6] for CKD + , 1.7 [1.4–2.0] for anaemia, and 3.6 [2.9–4.6] for CKD + /anaemia + (all p < 0.001). Population attributable fractions (PAFs) for 5-year mortality related to CKD and/or anaemia were similar across stages A/B, C1 and C2/D (up to 33.4%, 30.8% and 34.7%, respectively).
Conclusions
Prevalence and severity of CKD and anaemia increased across ACC/AHA stages. Both conditions were individually and additively associated with increased 5-year mortality risk, with similar PAFs in asymptomatic patients and those with symptomatic HF.
Clinical Research in Cardiology
10.1007/s00392-022-02027-w
urn:nbn:de:bvb:20-opus-323990
@articleGerhardt.2023, author = Gerhardt, Louisa M. S. and Kordsmeyer, Maren and Sehner, Susanne and Güder, Gülmisal and Störk, Stefan and Edelmann, Frank and Wachter, Rolf and Pankuweit, Sabine and Prettin, Christiane and Ertl, Georg and Wanner, Christoph and Angermann, Christiane E., year = 2023, title = Prevalence and prognostic impact of chronic kidney disease and anaemia across ACC/AHA precursor and symptomatic heart failure stages, pages = 868–879, volume = 112, number = 7, journal = Clinical research in cardiology : official journal of the German Cardiac Society, doi = 10.1007/s00392-022-02027-w
md5:4e5de8f6f5b78910d93e5b7deaeacbcd
2023-08-12T09:13:03+00:00
/tmp/phpcmFGfP
bibtex
64d74d1f784180.65360981
Clinical Research in Cardiology (2023) 112:17, 868-879 DOI: 10.1007/s00392-022-02027-w
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Louisa M. S. Gerhardt
Maren Kordsmeyer
Susanne Sehner
Gülmisal Güder
Stefan Störk
Frank Edelmann
Rolf Wachter
Sabine Pankuweit
Christiane Prettin
Georg Ertl
Christoph Wanner
Christiane E. Angermann
eng
uncontrolled
anaemia
eng
uncontrolled
ACC/AHA classification
eng
uncontrolled
chronic kidney disease
eng
uncontrolled
comorbidity
eng
uncontrolled
heart failure
eng
uncontrolled
mortality
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Deutsches Zentrum für Herzinsuffizienz (DZHI)
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/32399/s00392-022-02027-w.pdf
26583
2022
eng
786-790
1
9
article
1
2022-04-05
--
--
Sex-specific bimodal clustering of left ventricular ejection fraction in patients with acute heart failure
Aims
There is an ongoing discussion whether the categorization of patients with heart failure according to left ventricular ejection fraction (LVEF) is scientifically justified and clinically relevant. Major efforts are directed towards the identification of appropriate cut-off values to correctly allocate heart failure-specific pharmacotherapy. Alternatively, an LVEF continuum without definite subgroups is discussed. This study aimed to evaluate the natural distribution of LVEF in patients presenting with acutely decompensated heart failure and to identify potential subgroups of LVEF in male and female patients.
Methods and results
We identified 470 patients (mean age 75 ± 11 years, n = 137 female) hospitalized for acute heart failure in whom LVEF could be quantified by Simpson's method in an in-hospital echocardiogram. Non-parametric modelling revealed a bimodal shape of the LVEF distribution. Parametric modelling identified two clusters suggesting two LVEF peaks with mean (variance) of 61% (9%) and 31% (10%), respectively. Sub-differentiation by sex revealed a sex-specific bimodal clustering of LVEF. The respective threshold differentiating between ‘high’ and ‘low’ LVEF was 45% in men and 52% in women.
Conclusions
In patients presenting with acute heart failure, LVEF clustered in two subgroups and exhibited profound sex-specific distributional differences. These findings might enrich the scientific process to identify distinct subgroups of heart failure patients, which might each benefit from respectively tailored (pharmaco)therapies.
ESH Heart Failure
10.1002/ehf2.13618
urn:nbn:de:bvb:20-opus-265839
publish
ESH Heart Failure (2022) 9:1, 786-790. https://doi.org/10.1002/ehf2.13618
false
true
CC BY-NC: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell 4.0 International
Carsten Henneges
Caroline Morbach
Floran Sahiti
Nina Scholz
Stefan Frantz
Georg Ertl
Christiane E. Angermann
Stefan Störk
eng
uncontrolled
heart failure
eng
uncontrolled
left ventricular ejection fraction
eng
uncontrolled
sex differences
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Deutsches Zentrum für Herzinsuffizienz (DZHI)
Förderzeitraum 2021
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/26583/ESCHeartFailure-2021-Henneges.pdf
15773
2017
eng
108
17
article
1
2018-02-19
--
--
Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort
Background:
Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation.
Methods:
Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered.
Results:
509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription.
Conclusions:
In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists.
Trial registration:
This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.
BMC Cardiovascular Disorders
10.1186/s12872-017-0543-0
urn:nbn:de:bvb:20-opus-157738
BMC Cardiovascular Disorders (2017) 17:108. DOI: 10.1186/s12872-017-0543-0
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Caroline Morbach
Martin Wagner
Stefan Güntner
Carolin Malsch
Mehmet Oezkur
David Wood
Kornelia Kotseva
Rainer Leyh
Georg Ertl
Wolfgang Karmann
Peter U Heuschmann
Stefan Störk
eng
uncontrolled
awareness
eng
uncontrolled
heart failure
eng
uncontrolled
pharmacotherapy
eng
uncontrolled
coronary artery disease
eng
uncontrolled
coronary heart disease
eng
uncontrolled
euroaspire
eng
uncontrolled
guideline adherence
eng
uncontrolled
guideline implementation
eng
uncontrolled
mineralocorticoid antagonist
eng
uncontrolled
preserved ejection fraction
Krankheiten
open_access
Klinik und Poliklinik für Thorax-, Herz- u. Thorakale Gefäßchirurgie
Medizinische Klinik und Poliklinik I
Institut für Klinische Epidemiologie und Biometrie
Förderzeitraum 2017
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/15773/Morbach_BMC_Cardiovascular_Disorders.pdf