Mode of Death in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology Pub Date : 2025-03-30 DOI:10.1001/jamacardio.2025.0860

Akshay S. Desai, Pardeep S. Jhund, Muthiah Vaduganathan, Brian L. Claggett, Jonathan W. Cunningham, Maria A. Pabon, Carolyn S. P. Lam, Michele Senni, Sanjiv Shah, Adriaan A. Voors, Faiez Zannad, Bertram Pitt, Flaviana Amarante, James Lay-Flurrie, Markus F. Scheerer, Andrea Lage, John J. V. McMurray, Scott D. Solomon

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Abstract

ImportanceThe mode of death in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) remains poorly understood and may vary by EF.ObjectiveTo evaluate the mode of death according to EF and the treatment effect of finerenone on cause-specific mortality in patients with HFmrEF/HFpEF.Design, Setting, and ParticipantsThis was a prespecified secondary analysis of the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial, which evaluated clinical outcomes in 6001 patients with HF and EF greater than or equal to 40% randomly assigned to finerenone or placebo. The mode of death in relation to baseline EF categories (&lt;50%, ≥50-&lt;60%, and ≥60%) was examined, and the effect of randomized treatment on cause-specific death in Cox regression models was assessed. Data analysis was conducted between September 2024 and January 2025.InterventionsFinerenone vs placebo.Main Outcomes and MeasuresMode of death as centrally adjudicated by a clinical end points committee.ResultsOf 1013 patients (16.9%; median [IQR] age, 76 [69-82] years; 594 male [58.6%]) who died during median (IQR) follow-up of 32 (23-36) months, mode of death was ascribed to cardiovascular causes in 502 (49.6%), noncardiovascular causes in 368 (36.3%), and undetermined cause in 143 (14.1%). Of cardiovascular deaths, 215 (42.8%) were due to sudden death, 163 (32.4%) to HF, 48 (9.6%) to stroke, 25 (5.0%) to myocardial infarction, and 51 (10.2%) to other cardiovascular causes. The proportion of all-cause, cardiovascular, and sudden death was higher in those with EF less than 50%. The proportion of deaths related to HF was similar across EF categories, and the proportion of deaths due to myocardial infarction, stroke, and other cardiovascular causes was low regardless of EF. Randomization to finerenone did not significantly reduce death or cause-specific death compared with placebo in any EF category.Conclusions and RelevanceAmong patients with HFmrEF/HFpEF in the FINEARTS-HF randomized clinical trial, higher proportions of cardiovascular and overall mortality in those with EF less than 50% were related principally to higher proportions of sudden death. A clear treatment effect of finerenone on cardiovascular or cause-specific mortality was not identified, although the trial was likely underpowered for these outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT04435626

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重要性射血分数轻度降低型心力衰竭（HFmrEF）或射血分数保留型心力衰竭（HFpEF）患者的死亡方式仍不甚明了，且可能因射血分数的不同而有所差异。设计、设置和参与者这是 "调查心衰患者非奈酮疗效和安全性优于安慰剂的非奈酮试验"（FINEARTS-HF）随机临床试验的预设二次分析，该试验评估了6001例EF大于或等于40%的高血压患者的临床结局，这些患者被随机分配到非奈酮或安慰剂治疗。该试验研究了与基线EF类别（&lt;50%、≥50-&lt;60%和≥60%）相关的死亡方式，并评估了Cox回归模型中随机治疗对特异性死因的影响。数据分析在 2024 年 9 月至 2025 年 1 月期间进行。干预菲尼酮 vs 安慰剂。主要结果和测量由临床终点委员会集中裁定的死亡方式。结果在 1013 名患者中（16.9%；中位数[IQR]年龄，76[69-82]岁；594名男性[58.6%]）中，有502人（49.6%）的死亡原因为心血管疾病，368人（36.3%）的死亡原因为非心血管疾病，143人（14.1%）的死亡原因不明。在心血管死亡病例中，215 例（42.8%）死于猝死，163 例（32.4%）死于高血压，48 例（9.6%）死于中风，25 例（5.0%）死于心肌梗死，51 例（10.2%）死于其他心血管原因。EF值低于50%的人群中，全因死亡、心血管死亡和猝死的比例较高。不同 EF 值类别中与心房颤动相关的死亡比例相似，而心肌梗死、中风和其他心血管原因导致的死亡比例较低，与 EF 值无关。在FINEARTS-HF随机临床试验的HFmrEF/HFpEF患者中，EF小于50%的患者心血管和总死亡率较高，这主要与猝死比例较高有关。尽管该试验对心血管或特定病因死亡率的治疗效果可能不足，但并未发现非格列酮对心血管或特定病因死亡率有明显的治疗效果：NCT04435626

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来源期刊

JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

45.80

自引率

1.70%

发文量

264

期刊介绍： JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.