Michael Drozd

Socioeconomic deprivation and mode-specific outcomes in patients with chronic heart failure

Objective To characterise the association between socioeconomic deprivation and adverse outcomes in patients with chronic heart failure (CHF). Methods We prospectively observed 1802 patients with CHF and left ventricular ejection fraction (LVEF) ≤45%, recruited in four UK hospitals between 2006 and 2014. We assessed the association between deprivation defined by the UK Index of Multiple Deprivation (IMD) and: mode-specific mortality (mean follow-up 4 years); mode-specific hospitalisation; and the cumulative duration of hospitalisation (after 1 year). Results A 45-point difference in mean IMD score was noted between patients residing in the least and most deprived quintiles of geographical regions. Deprivation was associated with age, sex and comorbidity, but not CHF symptoms, LVEF or prescribed drug therapy. IMD score was associated with the risk of age-sex adjusted all-cause mortality (6% higher risk per 10-unit increase in IMD score; 95% CI 2% to 10%; P=0.004), and non-cardiovascular mortality (9% higher risk per 10-unit increase in IMD score; 95% CI 3% to 16%; P=0.003), but not cardiovascular mortality. All-cause, but not heart failure-specific, hospitalisation was also more common in the most deprived patients. Overall, patients spent a cumulative 3.3 days in hospital during 1 year of follow-up, with IMD score being associated with the age-sex adjusted cumulative duration of hospitalisations (4% increase in duration per 10-unit increase in IMD score; 95% CI 3% to 6%; P<0.0005). Conclusions Socioeconomic deprivation in people with CHF is linked to increased risk of death and hospitalisation due to an excess of non-cardiovascular events.

Mortality Reduction Associated With β-Adrenoceptor Inhibition in Chronic Heart Failure Is Greater in Patients With Diabetes

OBJECTIVE Diabetes increases mortality in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction. Studies have questioned the safety of β-adrenoceptor blockers (β-blockers) in some patients with diabetes and reduced left ventricular ejection fraction. We examined whether β-blockers and ACE inhibitors (ACEIs) are associated with differential effects on mortality in CHF patients with and without diabetes. RESEARCH DESIGN AND METHODS We conducted a prospective cohort study of 1,797 patients with CHF recruited between 2006 and 2014, with mean follow-up of 4 years. β-Blocker dose was expressed as the equivalent dose of bisoprolol (mg/day) and ACEI dose as the equivalent dose of ramipril (mg/day). Cox regression analysis was used to examine the interaction between diabetes and drug dose on all-cause mortality. RESULTS Patients with diabetes were prescribed larger doses of β-blockers and ACEIs than were patients without diabetes. Increasing β-blocker dose was associated with lower mortality in patients with diabetes (8.9% per mg/day; 95% CI 5–12.6) and without diabetes (3.5% per mg/day; 95% CI 0.7–6.3), although the effect was larger in people with diabetes (interaction P = 0.027). Increasing ACEI dose was associated with lower mortality in patients with diabetes (5.9% per mg/day; 95% CI 2.5–9.2) and without diabetes (5.1% per mg/day; 95% CI 2.6–7.6), with similar effect size in these groups (interaction P = 0.76). CONCLUSIONS Increasing β-blocker dose is associated with a greater prognostic advantage in CHF patients with diabetes than in CHF patients without diabetes.

Diabetes mellitus and heart failure: a deadly duo

Type 2 diabetes mellitus is alarmingly on the rise and is here to stay. There are an estimated 422 million adults living with it worldwide and the increasing prevalence is primarily due to increases in sedentary lifestyle and obesity (1). Patients with diabetes mellitus are at high risk of developing chronic heart failure (CHF) and when these conditions coexist are at a significantly increased risk of death compared to those without diabetes.

Influences of clinical experience in the quantification of morphometric sarcopaenia: a cohort study

OBJECTIVE The measurement of total psoas muscle area (TPMA) on Computed Tomography (CT) imaging is commonly made using either manual tracing or a semi-automated technique. We examined whether clinical experience influenced measurement of TPMA when utilising these two commonly used methods and describe the relationship between techniques. METHODS Pre-operative cross-sectional CT imaging of 114 consecutive patients undergoing elective EVAR were analysed. Retrospective measurements of the TPMA were performed by four independent investigators with a range of clinical experience (medical student to specialist surgical registrar) using either technique. Intra- and inter- observer differences were assessed. RESULTS There was no significant intra- or inter- observer differences when measuring the TPMA. Clinical experience also did not influence TPMA measurements recorded. Significant differences were observed between techniques when measuring TPMA (mean -65.8, 239.3SD, p=0.004). Measurement differences between techniques were highly correlated and modelled using linear regression. CONCLUSIONS Both manual tracing and semi-automated technique quantification methods of measuring TPMA are highly reproducible and independent of assessor bias and clinical experience. Advances in Knowledge: Either of the commonly used techniques to measure TPMA may be reliably used by an individual with appropriate training. We describe a relationship to facilitate comparison between these methods by which sarcopaenia may be quantified in patients with routine CT imaging.