Heart Failure Resources

Abstract: Reports have shown a decline in hospitalization for emergency cardiac conditions in the United Kingdom since the onset of the COVID-19 pandemic. Researchers from the University of Bristol conducted a study to measure the impact of the pandemic on hospitalization and mortality due to acute heart failure (HF).  

In this single-center, observational trial, the investigators assessed acute HF referrals over the course of 16 weeks (January to April 2020). A total of 283 patients were included in the analysis.  

The eight weeks following the first COVID-19 death in the UK showed a statistically non-significant drop in referrals, from 164 to 119 patients. This resulted in a 27% overall reduction.  

The 30-day case fatality rate increased in the span following the first COVID-19 death: mortality was 11% in the eight weeks prior and 21% in the eight weeks after (risk ratio 1.9). After multivariate regression analysis, age and referral prior to or after pandemic onset were found to be significant predictors of mortality (age hazard ratio [HR] 1.04; referral time HR, 2.1). Increased mortality was due in part to positive COVID-19 status.  

“The study highlights the need for widespread preventative and shielding measures particularly in this group of patients especially in the light of the second wave. Longer follow-up with inclusion of data from other centers and community heart failure services will be needed,” the researchers concluded.  

Reference: Doolub G, Wong C, Hewitson L, et al. Impact of COVID-19 on inpatient referral of acute heart failure: a single-centre experience from the south-west of the UK. ESC Heart Fail. 2021 Jan 6. doi: 10.1002/ehf2.13158.  

Abstract: A new study evaluated the association between race/ethnicity and heart failure (HF) outcomes, as well as any potential factors contributing toward disparities.  

The study enrolled more than 34,000 patients diagnosed with HF between 2012 and 2016 within the Kaiser Permanente health care system. The researchers used regression with time-dependent covariates to measure the association between self-identified race/ethnicity with HF or all-cause hospitalization and mortality.  

Overall, Black patients had a higher rate of HF hospitalization than white patients (hazard ratio [HR] 1.28) but a lower rate of mortality (HR 0.78). Patients of Asian/Pacific Island ethnicity had similar rates of HF hospitalization but lower all-cause hospitalization (HR 0.89) and death (HR 0.75) than white patients. Hispanic patients had lower mortality rates than white patients (HR 0.85). 

Sensitivity analyses suggested that Black patients with reduced ejection fraction were at increased odds for hospitalization and mortality compared with white patients.  

“In a contemporary and diverse population with HF, Black patients experienced a higher rate of HF hospitalization and a lower rate of death compared with white patients. In contrast, selected outcomes for Asian/Pacific Islander and Hispanic patients were more favorable compared with white patients. The observed differences were not explained by measured potentially modifiable factors, including pharmacological treatment,” the researchers concluded.  

Reference: Savitz ST, Leong T, Sung SH, et al. Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure. J Am Heart Assoc. 2021 Jan 21:e016601. doi: 10.1161/JAHA.120.016601. Epub ahead of print.  

Abstract: A new study found that patients with acute heart failure (HF) have nearly double the risk of mortality following COVID-19 infection.  

The researchers examined referral rates and 30-day mortality for patients hospitalized with acute HF before and after the COVID-19 pandemic. They found a substantial decrease (27%) in HF admissions during the pandemic, however, 30-day mortality nearly doubled for this patient population during this time. 30-day mortality was 11% prior to the pandemic, compared with 21% during, for a relative risk of 1.9. Older age and admission during the pandemic were both found to be linked with mortality, even after adjusting for other influencing factors.  

Upon stratification of patients with and without positive COVID-19 tests, the investigators found that there was no difference in mortality before and during the pandemic for patients without COVID-19, indicating that comorbidity was related to a poorer prognosis.  

"This may suggest a direct interaction or susceptibility to worse outcomes for acute heart failure patients with superimposed COVID infection," said study lead investigator Dr. Amardeep Dastidar in a press release. "It is noteworthy that our region had very low rates of COVID infection during the study and yet a connection with higher mortality was still apparent." 

Reference: Doolub G, Wong C, Hewitson L, et al. Impact of COVID-19 on inpatient referral of acute heart failure: a single-centre experience from the south-west of the UK. ESC Heart Fail. 2021 Jan 6. doi: 10.1002/ehf2.13158.  

Abstract: A team of researchers from Zhengzhou, China, conducted a study to determine the association between lifestyle choices and risk of rehospitalization in patients with chronic heart failure (CHF).  

Data were collected on patients with CHF who were discharged between 2017 to 2018. A total of 2,697 patients were enrolled, including 1,308 (621 rehospitalizations and 687 controls) and 1,389 women (684 rehospitalizations and 705 controls). Healthy lifestyle was measured via four items: non-smoking, moderate exercise, healthy body mass index (BMI), and reasonable diet. 

The investigators found that patients with these 4 healthy lifestyle behaviors had a lower risk of re-hospitalization. Men with healthy lifestyles had an overall risk (OR) of 0.34 and women with healthy lifestyles had an OR of 0.27. A combination of non-smoking and any other 2 healthy lifestyles was also associated with reduced rehospitalization risk.  

“Healthy lifestyle is associated with reduced risk of rehospitalization in patients with CHF, and the related healthy lifestyle and its combination may differ between male and female patients,” the researchers concluded.  

Reference: Cao JJ, Zhao SJ, Gao CY, et al. Association between healthy lifestyle and risk of rehospitalization in male or female patients with chronic heart failure. Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Jan 11;49(1):54-59. Chinese. doi: 10.3760/cma.j.cn112148-20201127-00940.  

Abstract: Statins may have a cardioprotective effect in women who were recently treated with chemotherapy for early-stage breast cancer, according to a new analysis in the Journal of the American Heart Association. 

Researchers assessed links between statin exposure during hospitalizations for heart failure following anthracycline- and/or trastuzumab-containing chemotherapy for breast cancer in women 66 and older.  

The five-year incidence of heart failure hospitalizations after anthracyclines was 1.2% in women exposed to statins, and 2.9% in unexposed women. For trastuzumab, the five-year cumulative incidence of heart failure hospitalizations was 2.7% in statin-exposed women compared to 3.7% in those who were not exposed. The cause-specific hazard ratio for statins in the anthracycline-treated women was 0.45. For trastuzumab, the ratio was 0.46. 

“This study does not conclusively prove statins are protective,” lead study author Husam Abdel-Qadir, MD, PhD, assistant professor of medicine at the University of Toronto. “However, this study builds on the body of evidence suggesting that they may have benefits. For women with breast cancer who meet established indications for taking a statin, they should ideally continue taking it throughout their chemotherapy treatment. Women who do not have an indication for a statin should ask their health care team if they can join a clinical trial studying the benefits of statins in protecting against heart muscle damage during chemotherapy.” 

Reference: Abdel-Qadir H, Bobrowski D, Zhou L, et al. Statin Exposure and Risk of Heart Failure After Anthracycline- or Trastuzumab-Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study. J Am Heart Assoc. 2021 Jan 6:e018393. doi: 10.1161/JAHA.119.018393.

Abstract: Women with a history of breast cancer may be at elevated risk for cardiovascular (CV) events including heart failure. A team of British researchers conducted a study to measure the prevalence of a range of CV events before and after diagnosis with breast cancer among women over the age of 65 years in the United States. 

More than 91,000 women with breast cancer were included in the study. Participant CV outcomes were compared with an age-matched cohort of more than 454,000 women without breast cancer. The effects were adjusted for time since diagnosis, race and ethnicity, prior CVD, and age. 

Survivors were found to have substantially increased risks of deep vein thrombosis and pericarditis. They also found smaller but elevated risks for cardiac arrest, and HF. The increased risk for heart failure persisted for at least five years following cancer diagnosis.  

“Our results highlight the importance of periodic cardiovascular evaluation of women diagnosed with breast cancer to ensure adequate management of cardiovascular risk,” the researchers concluded.  

Reference: Matthews AA, Peacock Hinton S, Stanway S, et al. Risk of Cardiovascular Diseases Among Older Breast Cancer Survivors in the United States: A Matched Cohort Study. J Natl Compr Canc Netw. 2021 Jan 5:1-10. doi: 10.6004/jnccn.2020.7629.  

Abstract: Ablation for atrial fibrillation (AFib) may have some benefits for patients with heart failure (HF) as well, a new analysis suggests. 

The study included data from the National Readmissions Database, with data on 749,776 patients with HF identified. Of those, 2,204 underwent ablation and 747,572 received medical therapy. The authors propensity-matched patients to balance baseline clinical characteristics, and compared 30-day readmission rates, causes, predictors, and costs of 30-day readmissions. 

According to the results, 30-day readmissions were lower for patients treated with catheter ablation in both unmatched and matched cohorts (16.8% vs. 20.1%, P<0.001) compared to those receiving medical therapy (16.8% vs. 18.8%, P=0.020). The authors reported that ablation was associated with a reduction in the risk for readmission compared to medical therapy (OR=0.86; 95% CI, 0.77 to 0.97). Among the most common causes for readmission were HF exacerbation and arrhythmias. Although ablation costs were higher during index hospitalization, they were similar to medical therapy during readmission in the matched cohort (P=0.67). Non-modifiable risk factors in both groups were predictors of readmissions. 

“Nearly one in six patients with HF are readmitted within 30‐days after undergoing catheter ablation,” the authors concluded. “In propensity matched analyses, ablation was associated with decreased rate and risk for readmission compared to medical therapy. Catheter ablation has higher index hospitalization costs, but lower readmission costs.” 

Reference: Lima FV, Kennedy KF, Sheikh W, et al. Thirty-day readmissions after atrial fibrillation catheter ablation in patients with heart failure. Pacing Clin Electrophysiol. 2020 Sep;43(9):930-940. doi: 10.1111/pace.14013.  

Abstract: A new study suggests that a wearable sensor powered by artificial intelligence (AI) was associated with accurate early detection of impending rehospitalization for heart failure. 

The research team for the Multisensor Non-invasive Remote Monitoring for Prediction of Heart Failure Exacerbation (LINK-HF) study enrolled 100 subjects (98% male) and monitored subjects for up to three months using a disposable multisensor patch on the chest that captured physiological data. The study results were published in Circulation: Heart Failure. 

Baseline measurements of expected physiological values were obtained after discharge using the analytical platform. The researchers estimated differences in baseline estimated vital signs and actual monitored values that triggered a clinical alert. The authors reported 35 unplanned nontrauma hospitalization events, with 24 worsening heart failure events. According to the study results, the platform was able to detect precursors of heart failure hospitalization exacerbation with 76% to 88% sensitivity and 85% specificity. The median reported time between an initial clinical alert and readmission was 6.5 days. 

Reference: Stehlik J, Schmalfuss C, Bozkurt B, et al. Continuous Wearable Monitoring Analytics Predict Heart Failure Hospitalization: The LINK-HF Multicenter Study. Circ Heart Fail. 2020 Mar;13(3):e006513. doi: 10.1161/CIRCHEARTFAILURE.119.006513. 

Abstract: Breakthroughs in genomic sequencing have helped to identify causal genetic variants for distinct subtypes of heart failure (HF), but the role of rare, high-impact variants in HF have not been systematically investigated.  

In a retrospective analysis, researchers sought to identify rare variants to all-cause HF with and without reduced left ventricular ejection fraction. Whole-exome sequencing of patients with HF was conducted. A total of 5,942 patients with HF and 13,156 controls were included. The proportion of patients with HF and controls carrying rare and presumed deleterious variants was compared, and the burden of variants of known cardiomyopathy genes were also investigated.  

About 200 patients with HF were found to have a pathogenic or likely pathogenic cardiomyopathy variant implicating 21 different genes, and 121 (60.2%) of these patients had ischemic heart disease as the clinically identified etiology for HF. Individuals with HF and preserved ejection fraction had a lower yield of implicated genes compared with individuals with midrange or reduced ejection fraction.  

“This work provides further evidence that mendelian genetic conditions may represent an important subset of complex late-onset diseases such as HF, irrespective of the clinical presentation,” the researchers concluded.  

Reference: Povysil G, Chazara O, Carss KJ, et al. Assessing the Role of Rare Genetic Variation in Patients With Heart Failure. JAMA Cardiol. 2020 Dec 16. doi: 10.1001/jamacardio.2020.6500. Epub ahead of print.  

Abstract: A study assessed trends and sec differenced in the intensity of health care and location of death among patients with heart failure (HF).  

The retrospective cohort study enrolled 396,024 decedents with HF, who died between 2004 and 2017 in Ontario, Canada. The researchers utilized population-based administrative databases to assess healthcare utilization during the last six months of life. The population was 51.5% women and 53.4% had in-hospital deaths.  

During the study timeframe, there was an overall increase in patients receiving mechanical ventilation, hemodialysis, and cardiac revascularization prior to death. Women on average spent fewer days in the hospital or in intensive care, or were less likely to receive mechanical ventilation, hemodialysis, and cardiac revascularization, compared with men. Overall, female sex was independently associated with lower odds of in-hospital death. Mean 6-month health care costs were greater for in-hospital versus out-of-hospital death.  

Reference: Van Spall HGC, Hill AD, Fu L, et al. Temporal Trends and Sex Differences in Intensity of Healthcare at the End of Life in Adults With Heart Failure. J Am Heart Assoc. 2020 Dec 16:e018495. doi: 10.1161/JAHA.120.018495. Epub ahead of print. 

Abstract: The ratio of left ventricular (LV) mass to electrocardiographic (EKG) voltage was associated with subsequent heart failure hospitalization (HHF) for patients with cardiac amyloidosis (CA), according to a study published in the International Journal of Cardiovascular Imaging. 

Researchers enrolled 85 patients with confirmed CA and comprehensive cardiovascular magnetic resonance (CMR) and EKG exams. CMR-derived LV mass was indexed according to body surface area. 

The investigators assessed EKG voltage via Sokolow, Cornell, and limb-voltage criteria and assessed the relationship between LV mass-voltage ratio and HHF using Cox proportional hazards analysis with covariate adjustment. 

At a median 3.4-year follow-up, 49% of patients had experienced HHF, and 60% had died. In unadjusted analyses, Cornell LV mass-voltage ratio was significantly associated with HHF (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02-1.09; P=0.001) and mortality (HR, 1.05; 95% CI, 1.02-1.07; P=0.001). 

The determined optimal cutoff value for Cornell LV mass-voltage ratio to predict HHF was 6.7 gm/m2/mV. After adjusting for covariates, a Cornell LV mass-voltage ratio greater than 6.7 gm/m2/mV was significantly associated with HHF (HR, 2.25; 95% CI, 1.09-4.61; P= 0.03), though not mortality. 

Reference: Slivnick JA, Wallner AL, Vallakati A, et al. Indexed left ventricular mass to QRS voltage ratio is associated with heart failure hospitalizations in patients with cardiac amyloidosis. Int J Cardiovasc Imaging. 2020 Oct 17. doi: 10.1007/s10554-020-02059-1. Epub ahead of print.  

Abstract: Sotagliflozin is a beneficial treatment for patients with type 2 diabetes with recent worsening heart failure (HF), according to a study published in the New England Journal of Medicine. 

In this study, researchers randomly assigned 1,222 patients with type 2 diabetes mellitus who were hospitalized for worsening HF to either sotagliflozin or placebo. Patients were followed up for a median of 9 months. The primary endpoint was total number of deaths from cardiovascular causes and hospitalizations or urgent visits for heart failure.  

A total of 600 primary endpoint events occurred: 245 in the sotagliflozin group and 355 in the placebo group. The overall rate of these events was lower for the sotagliflozin group. The rates of death from cardiovascular causes and death from any cause were lower in the treatment group as well. The trial ended early due to COVID-19-related loss of funding. 

“In patients with diabetes and recent worsening heart failure, sotagliflozin therapy, initiated before or shortly after discharge, resulted in a significantly lower total number of deaths from cardiovascular causes and hospitalizations and urgent visits for heart failure than placebo,” the researchers concluded. 

References: Bhatt DL, Szarek M, Steg PG, et al. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 2020 Nov 16. doi: 10.1056/NEJMoa2030183. Epub ahead of print. PMID: 33200892. 

Abstract: Women are at increased risk for heart failure and death after first-time myocardial infarction (MI), according to a study published online in Circulation. 

Researchers from the University of Alberta in Edmonton, Canada examined the incidence, angiographic findings, treatment, and clinical outcomes of 45,064 patients (30.8%  women) hospitalized with a primary diagnosis of first-time MI between 2002 and 2016 (54.9% non-ST-segment elevation MI [NSTEMI] and 45.1% ST-segment elevation MI [STEMI]). 

The researchers found that compared with men, women were older, had more comorbidities, and had lower rates of diagnostic angiography. Among patients with STEMI and NSTEMI, women had a higher unadjusted rate of in-hospital mortality than men (STEMI, 9.4% versus 4.5%; NSTEMI, 4.7% versus 2.9%). The difference remained significant after adjustment in STEMI patients (adjusted OR=1.42; 95%, 1.24 to 1.64) but not in NSTEMI patients (adjusted OR=0.97; 95% CI, 0.83 to 1.13). After discharge more women than men developed heart failure after STEMI (22.5 versus 14.9 percent) and NSTEMI (23.2% versus 15.7%). Across the years, these differences remained similar. 

“There are gaps across diagnosis, access, quality of care, and follow-up for all patients, so we need to be vigilant, pay attention to our own biases and to those most vulnerable to ensure that we have done everything possible in providing the best treatment,” a coauthor said in a statement. 

Reference: Ezekowitz JA, Savu A, Welsh RC, et al. Is There a Sex Gap in Surviving an Acute Coronary Syndrome or Subsequent Development of Heart Failure? Circulation. 2020 Nov 30. doi: 10.1161/CIRCULATIONAHA.120.048015.  

Abstract: The use of a smartphone app to manage and record symptoms was found to improve quality of life (QoL) in patients with heart failure (HF), according to a study published in JMIR Nursing. 

The research team conducted a randomized, controlled clinical trial of 120 patients with HF who were hospitalized in cardiac care unites. Participants were randomized to either routine care or, in the intervention group, routine care plus daily use of a smartphone-based app for a 3-month period.  

The interactive Android-based app was designed to provide daily reminders, educational content, pharmacy guides, frequently asked questions, and daily recording of physical and psychological symptoms and vital signs. App usage was evaluated by patients and their health care providers. 

There were no statistically significant differences between the two groups at the start of the study. QoL and health data were collected from medical records, interviews, and the Minnesota Living with Heart Failure Questionnaire, the most common assessment of QoL in patients living with HF. The score range was between 0 and 105, with a high score indicating a poor QoL. 

At baseline, mean QoL scores in the intervention and control groups were 42.91 vs. 47.42, respectively. After 3 months of intervention, mean QoL scores were 26.03 and 50.13, respectively. These findings were statistically significant (P<0.001). 

Reference: Davoudi M, Najafi Ghezeljeh T, Vakilian Aghouee F. Effect of a Smartphone-Based App on the Quality of Life of Patients With Heart Failure: Randomized Controlled Trial. JMIR Nursing. 2020;3(1):e20747. doi: 10.2196/20747 

Abstract: Older women who spend more time in sedentary behaviors, such as sitting or lying down, have an increased risk of heart failure, according to new research. 

Investigators examined records of almost 81,000 postmenopausal women who self-reported amount of time spent daily during waking hours either sitting, lying down, or being physically active. No participants had been diagnosed with heart failure at the beginning of the study. 

At a median 9 years of follow-up, 1,402 women were hospitalized due to heart failure. Compared with women who spent less than 6.5 hours per day sitting or lying down, the risk of heart failure hospitalization was 15% higher in women reporting 6.6-9.5 sedentary hours daily, and 42% higher in women reporting more than 9.5 sedentary hours daily.  

The association remained after adjusting for known heart failure risk factors such as high blood pressure, diabetes, obesity, and previous heart attack.  

"Our message is simple: sit less and move more. Historically, we have emphasized promoting a physically active lifestyle for heart health - and we should continue to do so! However, our study clearly shows that we also need to increase efforts to reduce daily sedentary time and encourage adults to frequently interrupt their sedentary time," said lead author Michael J. LaMonte, PhD, MPH, associate professor of epidemiology in the School of Public Health and Health Professions at the University at Buffalo in Buffalo, New York, in a press release 

References: 

• American Heart Association, Inc. (2020, November 24) Less sedentary time reduces heart failure risk for older women [Press release]. https://newsroom.heart.org/news/less-sedentary-time-reduces-heart-failure-risk-for-older-women?preview=1fd0 

• LaMonte MJ, Larson JC, Manson JE, et al. Association of Sedentary Time and Incident Heart Failure Hospitalization in Postmenopausal Women. Circ Heart Fail. 2020 Nov 24:CIRCHEARTFAILURE120007508. doi: 10.1161/CIRCHEARTFAILURE.120.007508.  

Abstract: Adherence to healthy sleep patterns was found to be associated with a lower risk for heart failure. 

Investigators from Tulane University conducted a prospective investigation on the association between a validated healthy sleep pattern, incorporating five different sleep behaviors, with the risk for heart failure in a cohort of 408,802 participants aged 37 to 73 years. Chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness were combined to create a healthy sleep score. 

The researchers identified 5,221 cases of heart failure during a median follow-up of 10.1 years. Across three Fine-Gray subdistribution hazard models, there was an inverse association for the healthy sleep score with the incidence of heart failure. For a 1-point increase in the healthy sleep score, the hazard ratio for heart failure was 0.85. The hazard ratio for heart failure was 0.58 for those with a healthy sleep score of 5 versus a score of 0 or 1. In the multivariable-adjusted model, when analyzing each binary component of the healthy sleep pattern and the risk for heart failure, early chronotype, sleeping seven to eight hours per day, no frequent insomnia, and no frequent daytime sleepiness were each independently associated with a lower risk for heart failure (8, 12, 17, and 34 percent, respectively). 

Reference: Li X, Xue Q, Wang M, et al. Adherence to a Healthy Sleep Pattern and Incident Heart Failure: A Prospective Study of 408802 UK Biobank Participants. Circulation. 2020 Nov 16. doi: 10.1161/CIRCULATIONAHA.120.050792.

Abstract: Dapagliflozin appears safe and effective across different diuretic subgroups of heart failure patients, a new analysis confirmed. 

This substudy of patients in the DAPA-HF trial, which looked at the SGLT2 inhibitor dapaglifozin for the risk of worsening heart failure, included 4,616 analyzable patients. Of those, 736 were on no diuretic, 1,311 were taking a diuretic dose equivalent to <40 mg furosemide, and 1,402 were taking 40 mg at baseline. The primary study endpoint was a composite of cardiovascular death or a worsening heart failure event, as well as its components, plus all-cause death and symptoms. 

According to the results, dapagliflozin was shown to reduce the risk of the primary composite endpoint in each subgroup. For those taking no diuretic, the hazard ratio was 0.57. In those taking the equivalent to <40 mg furosemide, the hazard ratio was 0.83. Those taking 40 mg had a hazard ratio of 0.77, and those taking more than 40 mg had a hazard ratio of 0.78. Those taking any diuretic had a hazard ratio of 0.78. The researchers reported consistency across the subgroups in terms of toleration and improved symptoms. Diuretic dose changes were infrequent during follow-up and mean diuretic dose did not differ between the treatment arm and placebo group. 

Reference: Jackson AM, Dewan P, Anand IS, et al. Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF. Circulation. 2020 Sep 15;142(11):1040-1054. doi: 10.1161/CIRCULATIONAHA.120.047077.  

Heart Failure History Linked to Adverse Outcomes in COVID-19 

Abstract: History of heart failure is associated with an increased risk for mechanical ventilation and mortality among patients hospitalized with COVID-19, according to a study published in the Journal of the American College of Cardiology. 

Researchers from the Icahn School of Medicine at Mount Sinai conducted a retrospective analysis of 6,439 patients admitted for COVID-19 at one of five Mount Sinai Health System hospitals between Feb. 27 and June 26, 2020, to describe the clinical profile and associated outcomes among patients with heart failure. 

The researchers found that patients with previous heart failure had longer length of stay (eight versus six days), increased risk for mechanical ventilation (22.8 versus 11.9 percent; adjusted odds ratio, 3.64), and an increased risk for mortality (40.0 versus 24.9 percent; adjusted odds ratio, 1.88) compared with patients without heart failure. Patients with heart failure had similar outcomes, irrespective of left ventricular ejection fraction or renin-angiotensin-aldosterone inhibitor use. 

“At the beginning of the pandemic, some heart failure drugs were believed to lead to increased risk of worse outcomes for COVID-19 patients, but our analysis shows no association between heart failure drugs, specifically angiotensin inhibitors, and worse prognosis,” Alvarez-Garcia said in a statement. “This study reinforces that these medications should be maintained unless health care providers recommend stopping them in specific cases.” 

Reference: Alvarez-Garcia J, Lee S, Gupta A, et al. Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19. J Am Coll Cardiol. 2020 Nov 17;76(20):2334-2348. doi: 10.1016/j.jacc.2020.09.549. Epub 2020 Oct 28.  

Abstract: History of heart failure is associated with an increased risk for mechanical ventilation and mortality among patients hospitalized with COVID-19, according to a study published in the Journal of the American College of Cardiology. 

Researchers from the Icahn School of Medicine at Mount Sinai conducted a retrospective analysis of 6,439 patients admitted for COVID-19 at one of five Mount Sinai Health System hospitals between Feb. 27 and June 26, 2020, to describe the clinical profile and associated outcomes among patients with heart failure. 

The researchers found that patients with previous heart failure had longer length of stay (eight versus six days), increased risk for mechanical ventilation (22.8 versus 11.9 percent; adjusted odds ratio, 3.64), and an increased risk for mortality (40.0 versus 24.9 percent; adjusted odds ratio, 1.88) compared with patients without heart failure. Patients with heart failure had similar outcomes, irrespective of left ventricular ejection fraction or renin-angiotensin-aldosterone inhibitor use. 

“At the beginning of the pandemic, some heart failure drugs were believed to lead to increased risk of worse outcomes for COVID-19 patients, but our analysis shows no association between heart failure drugs, specifically angiotensin inhibitors, and worse prognosis,” Alvarez-Garcia said in a statement. “This study reinforces that these medications should be maintained unless health care providers recommend stopping them in specific cases.” 

Reference: Alvarez-Garcia J, Lee S, Gupta A, et al. Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19. J Am Coll Cardiol. 2020 Nov 17;76(20):2334-2348. doi: 10.1016/j.jacc.2020.09.549. Epub 2020 Oct 28.  

Abstract: Results from a new randomized study suggest that exposure to classical music is associated with improved quality of life in patients with heart failure (HF) in a home-care setting. 

The multicenter, randomized controlled trial included 159 patients with HF randomized 1:1 into two study groups. The first group was the intervention group (exposed to music) and a control, and the patients were evaluated at 30 days, 60 days, 90 days, and at six months. The authors assigned the intervention group to listen to music from a selected playlist for 30 minutes per day on an MP3 player plus standard care and assigned the control group to standard care alone. Using specified scales, the researchers evaluated HF-specific quality of life, generic quality of life, self-care, somatic perception of symptoms, sleep quality, anxiety, and depression. 

The authors reported that on average, patients in the music intervention group saw greater improvements in their heart failure-specific quality of life (P<0.001), generic quality of life (P=0.05), sleep quality (P=0.007), anxiety/depression levels (P<0.001 for both), and also cognitive performance (P=0.003). 

“Listening to recorded classical music is a feasible, noninvasive, safe, and inexpensive intervention, able to improve quality of life in patients with HF in the home-care setting,” the authors wrote in their study. “This emphasizes the importance of complementary nonpharmacologic treatments in patients with HF.” 

Reference: Burrai F, Sanna GD, Moccia E, et al. Beneficial Effects of Listening to Classical Music in Patients With Heart Failure: A Randomized Controlled Trial. J Card Fail. 2020 Jul;26(7):541-549. doi: 10.1016/j.cardfail.2019.12.005.  

Abstract: Obstructive sleep apnea (OSA) is not uncommon in hospitalized patients with heart failure and is an independent risk factor for readmission. But it is unclear what the association is between undiagnosed OSA in these patients and costs for a healthcare system. A study found that previously undiagnosed OSA in hospitalized patients with heart failure resulted in increased readmissions and costs at three and six months. 

Hospitalized patients with heart failure who underwent inpatient sleep testing during the index hospitalization (n=1,547) were eligible for inclusion. Cost, number of readmissions, and vitals were tracked post-discharge. A total of 716 patients had OSA, and 393 had no sleep disordered breathing (SDB). 

The OSA group, compared with the no SDB group, had higher rates of three- (27.1% vs. 20.4%; P=0.01) and six-month readmission (36.9% vs. 27.7%; P=0.002). 

In adjusted analyses, among patients who required readmission, at three months, the estimated cumulative costs of readmissions were $9,792 for the OSA group compared with $5,846 for the no SBD group (P=0.03). At six months, the estimated cumulative costs were $16,180 and $8,719 in the OSA and no SBD groups, respectively (P<0.001). 

“Healthcare systems attempting to identify high prevalence and high-cost patient populations for targeted readmission reduction efforts can consider interventions in previously undiagnosed OSA patients during decompensated heart failure admissions,” the study authors stated. 

Reference: Patel N, Porter K, Englert J, Khayat R. OSA Is Associated With Increased Costs of Heart Failure Readmissions. CHEST. 2020 Oct1;158(4): A2326. doi: 10.1016/j.chest.2020.08.1491

Abstract: Patients with acute decompensated heart failure and concomitant peripheral artery disease (PAD) have a higher burden of cardiovascular comorbidities and acute decompensated heart failure readmission, according to a study in the Journal of the American Heart Association. 

The study included 1,418 patients hospitalized with acute decompensated heart failure between 2005 and 2016. About 14% of those patients had a diagnosis of PAD (and were more often men, smokers, with a greater prevalence of coronary artery disease). Chronic obstructive pulmonary disease was also more prevalent with PAD, as was a history of myocardial infarction and history of stroke or transient ischemic attack.  

The maximum number of recurrent acute decompensated heart failure readmissions per patient within 30 days of hospital discharge ranged between zero and two for both groups of patients, but the likelihood of being admitted at least once was disproportionately higher in the PAD group. PAD was linked with a higher likelihood of 30-day readmission for acute decompensated heart failure after adjustment for demographics and comorbidities. 

“Patients with acute decompensated heart failure and concomitant PAD have a greater cardiovascular comorbidity burden and higher likelihood of acute decompensated heart failure readmission,” the researchers concluded. “The association is stronger among patients with heart failure with reduced ejection fraction, who may represent a high‐risk group suitable for targeted intervention.” 

Reference: Chunawala Z, Chang PP, DeFilippis AP, et al. Recurrent Admissions for Acute Decompensated Heart Failure Among Patients With and Without Peripheral Artery Disease: The ARIC Study. J Am Heart Assoc. 2020 Nov 3;9(21):e017174. doi: 10.1161/JAHA.120.017174. Epub 2020 Oct 26. PMID: 33100106. 

Abstract: Older adults with gout may be at risk for heart failure (HF), according to a study published in Arthritis Research & Therapy. 

The study included 5,713 adults aged 65.5 years or older with no prior history of HF, coronary heart disease (CHD), or stroke. Patients were followed for HF hospitalization, CHD, stroke, and all-cause mortality. The researchers replicated analyses in a random sample of 839,059 patients aged 65.5 years or older. 

Mean age at baseline was 72.6 years; 3.3% had gout. Median follow-up was 10 years, during which time incidence rates per 1,000 person-years among patients with and without gout were 13.1 and 4.4 for HF hospitalization, 16.0 and 9.3 for CHD, 9.3 and 8.2 for stroke, and 55.0 and 37.1 for all-cause mortality, respectively. The adjusted hazard ratio (HR) for patients with versus without gout for HF hospitalization was 1.97. The HR for CHD was 1.21, for stroke was 0.83, and for all-cause mortality was 1.08. Upon multivariable-adjusted analysis, the HR for HF hospitalization with reduced and preserved left ventricular ejection fraction in patients with versus without gout was 1.77 and 2.32, respectively.  

The researchers concluded that older patients with gout are at risk for incident HF, which was consistent across sex- and race-related analyses. 

Reference: Colantonio LD, Saag KG, Singh JA, et al. Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study. Arthritis Res Ther. 2020 Apr 16;22(1):86. doi: 10.1186/s13075-020-02175-2. 

Abstract: Diabetes mellitus is an independent predictor for heart failure, according to the findings of a study published in Mayo Clinic Proceedings. 

In this study, using the Rochester Epidemiology Project, researchers assessed the long-term impact of diabetes on the development of heart failure by including 116 study subjects with diabetes, who were matched 1:2 based on age, hypertension, sex, coronary artery disease and diastolic with 232 participants without diabetes. The researchers also looked at mortality rates in the study population while controlling for hypertension, coronary artery disease and diastolic function. 

Following analysis, the results showed that that diabetes is an independent risk factor for the development of heart failure. Over the duration of 10 years, 21% of participants with diabetes developed heart failure, independent of other causes. The researchers observed that by comparison, only 12% of patients without diabetes developed heart failure. They also found that cardiac death, heart attack and stroke were not statistically different in the study between the two groups. 

This research builds upon previous findings and demonstrates that even without a known cardiac abnormality and with a healthy ejection fraction, diabetic patients still incur an increased risk of heart failure compared to those without the disease. 

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Reference: Klajda MD, Scott CG, Rodeheffer RJ, Chen HH. Diabetes Mellitus Is an Independent Predictor for the Development of Heart Failure: A Population Study. Mayo Clin Proc. 2020 Jan;95(1):124-133. doi: 10.1016/j.mayocp.2019.07.008. 

Abstract: Poor health literacy is associated with worse heart failure outcomes, according to a review published in JACC: Heart Failure. 

Matteo Fabbri, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a systematic literature review to evaluate associations between health literacy and health-related outcomes in patients with heart failure. 

Based on 15 studies, the researchers found that an average of 24 percent of patients with heart failure had inadequate or marginal health literacy. There was an association between inadequate health literacy and higher unadjusted risk for mortality (risk ratio [RR], 1.67), hospitalizations (RR, 1.19), and emergency department visits (RR, 1.17). In an adjusted analysis, findings remained statistically significant for an association between health literacy and mortality (RR, 1.41) and hospitalizations (RR, 1.12). Two of four interventional studies effectively improved outcomes among patients with inadequate health literacy. 

“These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes,” the authors write. 

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Reference: Fabbri M, Murad MH, Wennberg AM, et al. Health Literacy and Outcomes Among Patients With Heart Failure: A Systematic Review and Meta-Analysis. JACC Heart Fail. 2020 Jun;8(6):451-460. doi: 10.1016/j.jchf.2019.11.007. 

Abstract: A study published in the Journal of Cardiac Failure indicates that mental stress may have physical effects that affect the heart, and heart failure in particular. 

The study assessed 24 heart failure patients with ischemic cardiomyopathy and reduced ejection fraction (HFrEF) who completed daily assessments of perceived anger, stress, and other negative emotions for a period of seven days. Patients then underwent a laboratory mental stress protocol, receiving 2D Doppler electrocardiography testing to assess indices of diastolic function while at rest and during sequential anger arithmetic tasks.  

According to the study results, 14 patients (63.6%) experienced stress-induced increases in diastolic function. Changes in baseline to stress were driven by decreases in left ventricular relaxation. The authors also reported that age-adjusted linear regression revealed a link between seven-day anger and baseline diastolic function, and that patients who reported greater anger in the prior week to mental stress showed higher resting left ventricular pressure. 

“We have evidence that patients who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events. Clarifying the relevant behavioral and physiological pathways is especially important in the era of COVID-19 when the typical stressors of heart failure may be further compounded by pandemic-related stressors,” said lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale University. 

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Reference: Harris KM, Gottdiener JS, Gottlieb SS, et al. Impact of Mental Stress and Anger on Indices of Diastolic Function in Patients With Heart Failure. J Card Fail. 2020 Aug 1:S1071-9164(20)30890-3. doi: 10.1016/j.cardfail.2020.07.008. Epub ahead of print.  

Abstract: A study published in Circulation: Heart Failure suggests that when a woman experiences cardiogenic shock following an in-hospital heart attack, she is more likely to receive less aggressive treatment than men. 

The retrospective study included data on more than 90,000 individual patient admissions, of which 26% were women. from the National Inpatient Sample, between 2000 to 2017. Patients had in-hospital heart attacks complicated by cardiogenic shock. 

Women were found to be less likely than men to receive coronary angiography (78% vs. 81.4%, respectively). There was also a large discrepancy in angiographies performed on day of hospital admission (49.2% vs. 54.1%, respectively). Women were also less likely than men to be treated with stents or balloons (59.2% vs. 64%, respectively). Women were also less likely to have their heart function temporarily supplemented with a mechanical pump (50.3% vs. 59.2%, respectively). 

The authors also reported disparities in who suffered cardiogenic shock after heart attack, reporting that black women suffered heart attacks followed by shock more frequently than white men or white women. Women were also more likely to be from low-income families with low incomes and low education levels. The authors cited non-randomization as among the limitations of the study. 

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Reference: Vallabhajosyula S, Ya'Qoub L, Singh M, et al. Sex Disparities in the Management and Outcomes of Cardiogenic Shock Complicating Acute Myocardial Infarction in the Young. Circ Heart Fail. 2020 Oct;13(10):e007154. doi: 10.1161/CIRCHEARTFAILURE.120.007154. Epub 2020 Sep 29.