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Comorbidities and c...
Comorbidities and cause-specific outcomes in heart failure across the ejection fraction spectrum : A blueprint for clinical trial design
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- Savarese, Gianluigi (author)
- Karolinska Institutet
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- Settergren, Camilla (author)
- Karolinska Institutet
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- Schrage, Benedikt (author)
- Karolinska Institutet
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- Thorvaldsen, Tonje (author)
- Karolinska Institutet
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- Löfman, Ida (author)
- Karolinska Inst, Div Cardiol, Dept Med, SE-17176 Stockholm, Sweden
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- Sartipy, Ulrik (author)
- Karolinska Institutet
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- Mellbin, Linda (author)
- Karolinska Institutet
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- Meyers, Andrea (author)
- Boehringer Ingelheim Pharmaceut, Ridgefield, CT USA
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- Farsani, Soulmaz Fazeli (author)
- Boehringer Ingelheim Int GmbH, Ingelheim, Germany
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- Brueckmann, Martina (author)
- Boehringer Ingelheim Int GmbH, Ingelheim, Germany; Heidelberg Univ, Fac Med Mannheim, Mannheim, Germany
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- Brodovicz, Kimberly G. (author)
- Boehringer Ingelheim Pharmaceut, Ridgefield, CT USA
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- Vedin, Ola (author)
- Uppsala universitet,Kardiologi,Boehringer Ingelheim AB, Stockholm, Sweden,Boehringer Ingelheim AB, Sweden; Uppsala Univ, Sweden
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- Asselbergs, Folkert W. (author)
- Univ Utrecht, Univ Med Ctr Utrecht, Div Heart & Lungs, Dept Cardiol, Utrecht, Netherlands; UCL, Fac Populat Hlth Sci, Inst Cardiovasc Sci, London, England; UCL, Hlth Data Res UK, London, England; UCL, Inst Hlth Informat, London, England
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- Dahlström, Ulf (author)
- Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Cosentino, Francesco (author)
- Karolinska Institutet
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- Lund, Lars H. (author)
- Karolinska Institutet
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(creator_code:org_t)
- Elsevier BV, 2020
- 2020
- English.
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 313, s. 76-82
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Type 2 diabetes mellitus
- Chronic kidney disease
- Atrial fibrillation
- Heart failure
- Ejection fraction
- Trial design
Publication and Content Type
- ref (subject category)
- art (subject category)
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Savarese, Gianlu ...
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Settergren, Cami ...
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Schrage, Benedik ...
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Thorvaldsen, Ton ...
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Löfman, Ida
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Sartipy, Ulrik
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Mellbin, Linda
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Meyers, Andrea
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Farsani, Soulmaz ...
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Brueckmann, Mart ...
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Brodovicz, Kimbe ...
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Vedin, Ola
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Asselbergs, Folk ...
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Dahlström, Ulf
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Cosentino, Franc ...
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Lund, Lars H.
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Linköping University
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Karolinska Institutet