| 1. |
- Bobbio, Emanuele, et al.
(författare)
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Association between central haemodynamics and renal function in advanced heart failure: a nationwide study from Sweden.
- 2022
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 9:4, s. 2654-2663
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Tidskriftsartikel (refereegranskat)abstract
- Renal dysfunction in patients with heart failure (HF) has traditionally been attributed to declining cardiac output and renal hypoperfusion. However, other central haemodynamic aberrations may contribute to impaired kidney function. This study assessed the relationship between invasive central haemodynamic measurements from right-heart catheterizations and measured glomerular filtration rate (mGFR) in advanced HF.All patients referred for heart transplantation work-up in Sweden between 1988 and 2019 were identified through the Scandiatransplant organ-exchange organization database. Invasive haemodynamic variables and mGFR were retrieved retrospectively. A total of 1001 subjects (49±13years; 24% female) were eligible for the study. Analysis of covariance adjusted for age, sex, and centre revealed that higher right atrial pressure (RAP) displayed the strongest relationship with impaired GFR [β coefficient -0.59; 95% confidence interval (CI) -0.69 to -0.48; P<0.001], followed by lower mean arterial pressure (MAP) (β coefficient 0.29; 95% CI 0.14-0.37; P<0.001), and finally reduced cardiac index (β coefficient 3.51; 95% CI 2.14-4.84; P<0.003). A combination of high RAP and low MAP was associated with markedly worse mGFR than any other RAP/MAP profile, and high renal perfusion pressure (RPP, MAP minus RAP) was associated with superior renal function irrespective of the degree of cardiac output.In patients with advanced HF, high RAP contributed more to impaired GFR than low MAP. A higher RPP was more closely related to GFR than was high cardiac index.
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| 2. |
- Erlandsson, Helen, et al.
(författare)
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Scoring of medial arterial calcification predicts cardiovascular events and mortality after kidney transplantation
- 2022
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 291:6, s. 813-823
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Tidskriftsartikel (refereegranskat)abstract
- Background Progression of vascular calcification causes cardiovascular disease, which is the most common cause of death in chronic kidney failure and after kidney transplantation (KT). The prognostic impact of the extent of medial vascular calcification at KT is unknown. Methods In this prospective cohort study, we investigated the impact of medial calcification compared to a mix of intimal and medial calcification represented by coronary artery calcification (CAC score) and aortic valve calcification in 342 patients starting on kidney failure replacement therapy. The primary outcomes were cardiovascular events (CVE) and death. The median follow-up time was 6.4 years (interquartile range 3.7-9.6 years). Exposure was CAC score and arteria epigastrica medial calcification scored as none, mild, moderate, or severe by a pathologist at time of KT (n = 200). We divided the patients according to kidney failure replacement therapy during follow-up, that is, living donor KT, deceased donor KT, or dialysis. Results Moderate to severe medial calcification in the arteria epigastrica was associated with higher mortality (p = 0.001), and the hazard ratio for CVE was 3.1 (95% confidence interval [CI] 1.12-9.02, p < 0.05) compared to no or mild medial calcification. The hazard ratio for 10-year mortality in the dialysis group was 33.6 (95% CI, 10.0-113.0, p < 0.001) compared to living donor recipients, independent of Framingham risk score and prevalent CAC. Conclusion Scoring of medial calcification in the arteria epigastrica identified living donor recipients as having 3.1 times higher risk of CVE, independent of traditional risk factors. The medial calcification score could be a reliable method to identify patients with high and low risk of CVE and mortality following KT.
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| 3. |
- Löfman, Ida, et al.
(författare)
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Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction.
- 2017
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Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 19:12, s. 1606-1614
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: As the role of chronic kidney disease (CKD) in different types of heart failure (HF) is poorly understood, our aim was to compare CKD in HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) with regard to prevalence, associations and prognostic role.METHODS AND RESULTS: Patients in the Swedish Heart Failure Registry were divided into three groups based on EF (≥50%, 40-49% and <40%). CKD was defined as an estimated glomerular filtration rate ≤60 mL/min.1.73 m(2) . Associations between covariates and CKD and between CKD and mortality were assessed with multivariable regressions. Of 40 230 patients, 8875 (22%) had HFpEF, 8374 (21%) had HFmrEF, and 22 981 (57%) had HFrEF, with a CKD prevalence of 56%, 48%, and 45%, respectively. Associations between covariates and CKD were similar in all EF groups. One-year mortality with vs. without CKD was 23% vs. 13% in HFpEF, 22% vs. 8% in HFmrEF, and 23% vs. 8% in HFrEF (P < 0.001 for all). After adjustment, CKD was more strongly associated with death in HFrEF and HFmrEF than in HFpEF [hazard ratio (HR) and 95% confidence interval (CI); 1.49 (1.42-1.56) and 1.51 (1.40-1.63) vs. 1.32 (1.24-1.42); P for interaction <0.001]. In receiver operating characteristic (ROC) analyses, CKD was also a stronger predictor of death in HFrEF and HFmrEF than in HFpEF [area under the curve (AUC) 0.699 (0.689-0.709) and 0.700 (0.683-0.716) vs. 0.629 (0.613-0.645)].CONCLUSION: CKD was associated with similar covariates regardless of EF. Although CKD was more common in HFpEF than in HFmrEF and HFrEF, it may have more of a 'bystander' role in HFpEF, being less associated with mortality and with lower prognostic discrimination.
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| 4. |
- Löfman, Ida, et al.
(författare)
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Prevalence and prognostic impact of kidney disease on heart failure patients.
- 2016
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Ingår i: Open heart. - : BMJ Publishing Group Ltd. - 2053-3624. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim was to determine the prevalence of different degrees of kidney dysfunction and to examine their association with short-term and long-term outcomes in a large unselected contemporary heart failure population and some of its subgroups. We examined to what extent the different cardiac conditions and their severity contribute to the prognostic value of kidney dysfunction in heart failure.DESIGN: We studied 47 716 patients in the Swedish Heart Failure Registry. Patients were divided into five renal function strata based on estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation. The adjusted association between kidney function and outcome was examined by Cox regression.RESULTS: 51% of the patients had eGFR <60 mL/min/1.73 m(2) and 11% had eGFR <30. There was increasing mortality with decreasing kidney function regardless of age, presence of diabetes, New York Heart Association NYHA class, duration of heart failure and haemoglobin levels. The risk HR (95% CI) persisted after adjusting for differences in baseline characteristics, severity of heart disease, and medical treatment: eGFR 60-89: 0.86 (0.79 to 0.95); eGFR 30-59: 1.13 (1.03 to 1.24); eGFR 15-29: 1.85 (1.67 to 2.07); and eGFR <15: 2.96 ([2.53 to -3.47)], compared with eGFR ≥90.CONCLUSIONS: Kidney dysfunction is common and strongly associated with short-term and long-term outcomes in patients with heart failure. This strong association was evident in all age groups, regardless of NYHA class, duration of heart failure, haemoglobin level, and presence/absence of diabetes mellitus. After adjusting for differences in baseline data, aetiology and severity of heart disease and treatment, the strong association remained.
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| 5. |
- Löfman, Ida
(författare)
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Renal dysfunction in heart failure : insights on prevalence and prognosis
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Kidney disease is common in heart failure (HF) and has been found to be associated with worse outcomes. The impact of different degrees of chronic kidney disease (CKD) in HF, as well as the link to, and impact of CKD in HF with reduced (HFrEF), the newly defined mid-range (HFmrEF) and preserved ejection fraction (HFpEF) have been uncertain. Studies of worsening renal function (WRF) in the various EF groups are lacking. HF treatment of HFrEF is well defined, while we lack knowledge of the effect of heart failure treatment in HFpEF, HFmrEF and in patients with HF and CKD. Aims: 1. To examine prevalence and prognostic impact of different degrees of kidney dysfunction in unselected HF patients; 2. To perform a comprehensive comparison of CKD in HF with HFpEF, HFmrEF and HFrEF with regards to prevalence, clinical correlates and prognosis; 3. To examine the risk for and impact of WRF in HFpEF, HFmrEF and HFrEF; 4. To analyze the association between mineralocorticoid receptor antagonist (MRA) treatment and outcome in patients with myocardial infarction (MI) and HF in relation to EF groups and CKD. Prevalence and prognostic impact of kidney disease in heart failure: We studied 47,716 patients in the Swedish Heart Failure Registry (SwedeHF) 2000-2013. Patients were divided into five renal function strata based on estimated glomerular filtration rate (eGFR). 51% of the patients had eGFR < 60 ml/min/1.73 m2 and 11% had eGFR < 30 ml/min/1.73 m2. The mortality risk increased with decreasing eGFR and persisted after adjusting for differences in baseline characteristics, severity of heart disease and medical treatment. Associations with and prognostic impact of CKD in HFpEF, HFmrEF and HFrEF: Of 40,230 patients with measured EF in SwedeHF, 22% had HFpEF, 21% had HFmrEF, and 57% had HFrEF, with a CKD prevalence of 56%, 48%, and 45%, respectively. Associations between covariates and CKD were similar in all EF groups. There was higher mortality in all EF groups in patients with CKD. After adjustment, CKD was more strongly associated with death in HFrEF and HFmrEF than in HFpEF. WRF in different EF categories: After merging the SwedeHF registry with the laboratory data in Stockholm Creatinine Measurement (SCREAM) database, 7,154 patients in Stockholm between 2006-2010 were studied. After discharge, the risk for WRF was higher in HFpEF than in HFmrEF and HFrEF. Variables related to more severe HF were predictive of WRF. WRF within year one after the index-HF event was strongly associated with long-term mortality, but in HFpEF only with the most severe WRF. Outcome in MI patients with HF with or without MRA treatment: Patients with MI and HF registered in the Swedish national myocardial infarction registry, SWEDEHEART, between 2005-2014, were studied. Of 45,071 patients with MI and HF, 10% were treated with MRA. Patients with reduced EF < 40% were more often treated with MRA compared to mid-range EF 40-49% and normal EF > 50%. Of patients with CKD, 9% received MRA. After adjustment, MRA use was associated with a lower mortality in patients with EF < 40% but not with EF > 50% while the association between MRA use and outcome was similar regardless of presence or not of CKD. Conclusions: In unselected HF patients, half of the patients have at least moderate renal dysfunction. There is a strong graded association between renal dysfunction and both short- and long-term outcome. CKD is slightly more common in patients with HFpEF but is associated with similar covariates regardless of EF. CKD is strongly associated with mortality regardless of EF group, although less strongly in HFpEF than in HFmrEF and HFrEF. The long-term risk of WRF is high in HF and especially in HFpEF. WRF within one year of discharge is a strong negative prognostic factor in all EF groups during long term follow-up, although in HFpEF only in those with the most severe WRF. In patients with MI and HF, MRA treatment is associated with better long-term survival in patients with reduced but not with preserved EF, while the association between MRA use and outcome seems to be similar regardless of presence or not of CKD.
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| 6. |
- Savarese, Gianluigi, et al.
(författare)
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Comorbidities and cause-specific outcomes in heart failure across the ejection fraction spectrum : A blueprint for clinical trial design
- 2020
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 313, s. 76-82
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundComorbidities may differently affect treatment response and cause-specific outcomes in heart failure (HF) with preserved (HFpEF) vs. mid-range/mildly-reduced (HFmrEF) vs. reduced (HFrEF) ejection fraction (EF), complicating trial design. In patients with HF, we performed a comprehensive analysis of type 2 diabetes (T2DM), atrial fibrillation (AF) chronic kidney disease (CKD), and cause-specific outcomes.Methods and resultsOf 42,583 patients from the Swedish HF registry (23% HFpEF, 21% HFmrEF, 56% HFrEF), 24% had T2DM, 51% CKD, 56% AF, and 8% all three comorbidities. HFpEF had higher prevalence of CKD and AF, HFmrEF had intermediate prevalence of AF, and prevalence of T2DM was similar across the EF spectrum. Patients with T2DM, AF and/or CKD were more likely to have also other comorbidities and more severe HF. Risk of cardiovascular (CV) events was highest in HFrEF vs. HFpEF and HFmrEF; non-CV risk was highest in HFpEF vs. HFmrEF vs. HFrEF. T2DM increased CV and non-CV events similarly but less so in HFpEF. CKD increased CV events somewhat more than non-CV events and less so in HFpEF. AF increased CV events considerably more than non-CV events and more so in HFpEF and HFmrEF.ConclusionHFpEF is distinguished from HFmrEF and HFrEF by more comorbidities, non-CV events, but lower effect of T2DM and CKD on events. CV events are most frequent in HFrEF. To enrich for CV vs. non-CV events, trialists should not exclude patients with lower EF, AF and/or CKD, who report higher CV risk.
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| 7. |
- Söfteland, John M., 1977, et al.
(författare)
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COVID-19 in solid organ transplant recipients : A national cohort study from Sweden
- 2021
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Ingår i: American Journal of Transplantation. - : John Wiley & Sons. - 1600-6135 .- 1600-6143. ; 21:8, s. 2762-2773
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Tidskriftsartikel (refereegranskat)abstract
- Solid organ transplant (SOT) recipients run a high risk for adverse outcomes from COVID-19, with reported mortality around 19%. We retrospectively reviewed all known Swedish SOT recipients with RT-PCR confirmed COVID-19 between March 1 and November 20, 2020 and analyzed patient characteristics, management, and outcome. We identified 230 patients with a median age of 54.0 years (13.2), who were predominantly male (64%). Most patients were hospitalized (64%), but 36% remained outpatients. Age >50 and male sex were among predictors of transition from outpatient to inpatient status. National early warning Score 2 (NEWS2) at presentation was higher in non-survivors. Thirty-day all-cause mortality was 9.6% (15.0% for inpatients), increased with age and BMI, and was higher in men. Renal function decreased during COVID-19 but recovered in most patients. SARS-CoV-2 antibodies were identified in 78% of patients at 1-2 months post-infection. Nucleocapsid-specific antibodies decreased to 38% after 6-7 months, while spike-specific antibody responses were more durable. Seroprevalence in 559 asymptomatic patients was 1.4%. Many patients can be managed on an outpatient basis aided by risk stratification with age, sex, and NEWS2 score. Factors associated with adverse outcomes include older age, male sex, greater BMI, and a higher NEWS2 score.
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| 8. |
- Welfordsson, Paul, et al.
(författare)
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Feasibility of alcohol interventions in cardiology: A qualitative study of clinician perspectives in Sweden
- 2024
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford Academic. - 1474-5151 .- 1873-1953.
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Tidskriftsartikel (refereegranskat)abstract
- Aim:To identify barriers and facilitators to implementing alcohol screening and brief interventions (SBI) in cardiology services.Methods and results:Qualitative study. Individual, semi-structured interviews were conducted with 24 clinical cardiology staff (doctors, nurses, assistant nurses) of varying experience levels, and from various clinical settings (high dependency unit, ward, outpatient clinic), in three regions of Sweden. Reflexive thematic analysis was used, with deductive coding applying the Capability, Opportunity, Motivation (COM-B) theoretical framework. A total of 41 barriers and facilitators were identified, including twelve related to capability, nine to opportunity, and 20 to motivation. Four themes were developed: 1. Uncharted territory, where clinicians expressed a need to address alcohol use but lacked knowledge and a roadmap for implementing SBI; 2. Cardiology as a cardiovascular specialty, where tasks were prioritized according to established roles; 3. Alcohol stigma, where alcohol was reported to be a sensitive topic that staff avoid discussing with patients; 4. Window of opportunity, where staff expressed potential for implementing SBI in routine cardiology care.Conclusion:Findings suggest that opportunities exist for early identification and follow-up of hazardous alcohol use within routine cardiology care. Several barriers, including low knowledge, stigma, a lack of ownership, and a greater focus on other risk factors must be addressed prior to the implementation of SBI in cardiology. To meet current clinical guidelines, there is a need to increase awareness and to improve pathways to addiction care. In addition, there may be a need for clinicians dedicated to alcohol interventions within cardiology services.
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| 9. |
- Welfordsson, Paul, et al.
(författare)
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Mixed messages? Exposure to reports about alcohol’s suggested cardiovascular effects and hazardous alcohol use : a cross-sectional study of patients in cardiology care
- 2024
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hazardous alcohol use is a leading risk factor for disability and death, yet observational studies have also reported reduced cardiovascular disease mortality among regular, low-level drinkers. Such findings are refuted by more recent research, yet have received significant media coverage. We aimed to explore: (1) how patients with cardiovascular diseases access health information about moderate drinking and cardiovascular health; (2) the perceived messages these sources convey, and (3) associations with own level of alcohol use.Methods: We conducted a cross-sectional survey of patients in cardiology services at three hospitals in Sweden. The study outcome was hazardous alcohol use, assessed using the AUDIT-C questionnaire and defined as ≥ 3 in women and ≥ 4 in men. The exposure was accessing information sources suggesting that moderate alcohol consumption can be good for the heart, as opposed to accessing information that alcohol is bad for the heart. Health information sources were described using descriptive statistics. Gender, age and education were adjusted for in multiple logistic regression analyses.Results: A total of 330 (66.3%) of 498 patients (mean age 70.5 years, 65% males) who had heard that drinking moderately can affect the heart described being exposed to reports that moderate alcohol use can be good for the heart, and 108 (21.7%) met criteria for hazardous alcohol use. Health information sources included newspapers (32.9%), television (29.2%), healthcare staff (13.4%), friends/family (11.8%), social media (8.9%) and websites (3.7%). Participants indicated that most reports (77.9%) conveyed mixed messages about the cardiovascular effects of moderate drinking. Exposure to reports of healthy heart effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use (OR = 1.67, 95%CI = 1.02–2.74).Conclusions: This study suggests that many patients in cardiology care access health information about alcohol from media sources, which convey mixed messages about the cardiovascular effects of alcohol. Exposure to reports that moderate drinking has protective cardiovascular effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use. Findings highlight a need for clear and consistent messages about the health effects of alcohol.
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