Naoko Ikeda

Trends and predictors of non-cardiovascular death in patients hospitalized for acute heart failure

BACKGROUND Little information is available on non-cardiovascular (CV) death in acute heart failure (AHF) patients. The present study determined the incidence, time course, and factors associated with long-term non-CV death in AHF patients in a real-world setting. METHODS The ATTEND registry, a nationwide, prospective observational multicenter cohort study, included 4842 consecutive patients hospitalized for AHF. The primary endpoint of the present study was non-CV death. RESULTS Median follow-up duration from admission was 513 (range, 385-778) days. Over the study period, 1183 patients died; 356 deaths (30.1%) were non-CV related. The proportion of non-CV deaths increased in the later follow-up phase (0-180days, 26.7%; 181-360days, 38.4%; >360days, 36.6%, p<0.001). After adjustment for all variables at baseline, age (hazard ratio [HR] 1.6 per decade, p<0.001) and non-cardiac comorbidities including chronic obstructive pulmonary disease (HR 1.58, p=0.003), history of stroke (HR 1.44, p=0.011), renal insufficiency (HR 1.07, per 10ml/min/1.73m2 decrease in estimated glomerular filtration, p=0.015), and hemoglobin (HR 1.15 per 1.0g/dl decrease, p<0.001) were strongly associated with non-CV death. Other predictors included ischemic etiology (HR 1.33, p=0.023), prior hospitalization for heart failure (HR 1.34, p=0.017), C-reactive protein (HR 1.04, p<0.001), and statin use (HR 0.70, p=0.016). CONCLUSIONS The incidence of non-CV death was high in patients with AHF, accounting for 30% of long-term mortality. Furthermore, the proportion of non-CV death increased in the later follow-up phase. Better understanding of non-CV death and more comprehensive treatment of non-CV comorbidities are vital to further improving prognosis in AHF patients.

Clinical Outcomes of Oral Tolvaptan Treatment in Patients Hospitalized with Acute Decompensated Heart Failure-Retrospective Cohort Study

was no significant difference regarding age, gender, body mass index, left ventricular function and diameters, and medication for CHF. During the follow-up of 40.3 months, the composite-endpoint occurred 22.5% in patients with DCM and DM, and 6.8% in the patients with DCM alone (p50.039). DM was associated with an increased risk of the composite-endpoint (HR: 3.05; 95% CI: 1.01 to 7.99; p50.049). The coexistent of CAD was seen more in patients with DCM and DM compared to patients with DCM alone (27.5% vs. 11.2%, p50.044). However, there was no statistical relation between the composite-endpoint and the coexistent of CAD. Conclusions: DM may contribute to the prognosis of DCM regardless of CAD.