ESC Heart Failure最新文献

{"title":"Considerations for drug trials in hypertrophic cardiomyopathy.","authors":"John P Farrant, Matthias Schmitt, Anna B Reid, Clifford J Garratt, William G Newman, Aneil Malhotra, Rhys Beynon, Masliza Mahmod, Betty Raman, Robert M Cooper, Dana Dawson, Thomas Green, Sanjay K Prasad, Anvesha Singh, Susanna Dodd, Hugh Watkins, Stefan Neubauer, Christopher A Miller","doi":"10.1002/ehf2.15138","DOIUrl":"https://doi.org/10.1002/ehf2.15138","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is a heterogeneous condition with potentially serious manifestations. Management has traditionally comprised therapies to palliate symptoms and implantable cardioverter-defibrillators to prevent sudden cardiac death. The need for disease-modifying therapies has been recognized for decades. More recently, an increasing number of novel and repurposed therapies hypothesized to target HCM disease pathways have been evaluated, culminating in the recent regulatory approval of mavacamten, a novel oral myosin inhibitor. HCM poses several unique challenges for clinical trials, which are important to recognize when designing trials and interpreting findings. This manuscript discusses the key considerations in the context of recent and ongoing randomized trials, including the roles of genotype, phenotype and symptom status in patient selection, the evidence base for clinical and mechanistic outcome measurements, trial duration and sample size.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of hypoxaemic burden from overnight oximetry in heart failure with preserved ejection fraction.","authors":"Sanne G J Mourmans, Jerremy Weerts, Mathias Baumert, Arantxa Barandiarán Aizpurua, Anouk Achten, Christian Knackstedt, Dominik Linz, Vanessa P M van Empel","doi":"10.1002/ehf2.15116","DOIUrl":"https://doi.org/10.1002/ehf2.15116","url":null,"abstract":"<p><strong>Aims: </strong>Nocturnal hypoxaemic burden, quantified as time spent with oxygen saturation below 90% (T90), is an established independent predictor of mortality in heart failure (HF) with reduced ejection fraction. The prognostic value of T90 in HF with preserved ejection fraction (HFpEF) is unknown. This study aims to determine the association of T90 with adverse outcomes in HFpEF.</p><p><strong>Methods and results: </strong>One hundred twenty-six patients prospectively included from our specialised HFpEF outpatient clinic underwent ambulatory home sleep monitoring to obtain oximetry data, including T90. We investigated the association between T90 and a composite endpoint of HF hospitalisations or all-cause mortality. Nocturnal hypoxaemic burden in this HFpEF population was high, with a median T90 of 13.7 min. In only 10 patients (7.9%), oxygen saturation was at no time point below 90%. After median 34 months [IQR 18.4-52.0] of follow-up, 32 patients (25%) reached the composite endpoint. T90 was significantly associated with the composite endpoint, also after adjusting for potential confounders (HR 1.004 (95% CI 1.001-1.007, P = 0.019) per 1 min T90 increase or HR 1.265 (95% CI 1.061-1.488) per 1 h T90 increase). Patients with HFpEF in the highest T90 tertile (T90 ≥ 31.4 min) had a significantly higher event rate compared to patients in the lowest two T90 tertiles, with 19 (45%) versus 13 (15%) events, respectively (P < 0.001).</p><p><strong>Conclusions: </strong>Nocturnal hypoxaemic burden is an independent prognostic marker for the composite of HF hospitalisations or all-cause mortality in HFpEF. Whether reduction of T90 improves the prognosis of patients with HFpEF warrants further research.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiograph analysis for risk assessment of heart failure with preserved ejection fraction: A deep learning model.","authors":"Zheng Gao, Yuqing Yang, Zhiqiang Yang, Xinyue Zhang, Chao Liu","doi":"10.1002/ehf2.15120","DOIUrl":"https://doi.org/10.1002/ehf2.15120","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure with preserved ejection fraction (HFpEF) requires an efficient screening method. We developed a deep learning model (DLM) to screen HFpEF risk using electrocardiograms (ECGs).</p><p><strong>Methods and results: </strong>A cohort study was conducted utilising data from Cohorts A and B. A convolutional neural network-long short-term memory (CNN-LSTM) DLM was employed. HFpEF risk was determined by left ventricular end-diastolic pressure (LVEDP) and clinical symptoms. The DLM was trained by ECGs. LVEDP for each patient was collected through invasive left ventricular catheterisation. Cohort A and B comprised data from individuals at high risk for HFpEF (LVEDP > 12 mmHg) and low risk for HFpEF (LVEDP ≤ 12 mmHg). The model was trained on Cohort A and prospectively validated on Cohort B.</p><p><strong>Results: </strong>A total of 238 patients underwent ECG and left ventricular catheterisation for model training in Cohort A, and 117 patients for validation in Cohort B. The DLM achieved 78% accuracy in assessing HFpEF risk in Cohort A, while in Cohort B, it demonstrated 78% accuracy, 71.9% specificity, and 71.7% sensitivity. In the validation Cohort B, the DLM-identified high-risk HFpEF group exhibited significantly higher prevalence of diabetes (22.03%-11.86%, P < 0.01), higher BMI indices (25.92-24.22 kg/cm², P < 0.01), and lower usage history of calcium channel blockers (CCB) (11.76%-28.81%, P < 0.01) compared with the DLM-identified low-risk HFpEF group. Traditional HFpEF indicators, including B-type natriuretic peptide (BNP) (22-20 pg/mL, P = 0.71) and E/E' (8.25-8.5, P = 0.66), did not exhibit significant differences between the two groups.</p><p><strong>Conclusions: </strong>The DLM offers an accurate, cost-effective tool for HFpEF risk assessment, potentially facilitating early detection and improved clinical management.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the letter regarding 'Prognostic value of left atrial reverse remodelling in patients hospitalized with ADHF'.","authors":"Sakura Nagumo, Mio Ebato, Takuya Mizukami, Yoshitaka Iso, Hiroshi Suzuki","doi":"10.1002/ehf2.15142","DOIUrl":"https://doi.org/10.1002/ehf2.15142","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Projecting the benefit of vericiguat in PARADIGM-HF and DAPA-HF populations: Insights from the VICTORIA trial.","authors":"Veraprapas Kittipibul, Robert J Mentz, Rebecca Young, Javed Butler, Justin A Ezekowitz, Carolyn S P Lam, Piotr Ponikowski, Adriaan Voors, Stefano Corda, Ciaran McMullan, Christopher M O'Connor, Kevin J Anstrom, Paul W Armstrong","doi":"10.1002/ehf2.15134","DOIUrl":"https://doi.org/10.1002/ehf2.15134","url":null,"abstract":"<p><strong>Aims: </strong>The VICTORIA trial demonstrated a significant reduction in the primary composite outcome of heart failure (HF) hospitalization or cardiovascular death with vericiguat relative to placebo in high-risk HF. This study aimed to contextualize treatment effects of vericiguat in populations with varying risk profiles simulated from the PARADIGM-HF and DAPA-HF trials.</p><p><strong>Methods: </strong>Subgroups of VICTORIA participants (n = 5050) were generated to simulate PARADIGM-HF and DAPA-HF trial populations. The PARADIGM-HF-eligible population excluded participants not meeting left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and minimal dose criteria and those with high predicted probability of run-in failure. The DAPA-HF-eligible population excluded those not meeting LVEF and eGFR criteria or with recent (<30 days) HF hospitalization. The time-to-first-event analysis was performed using an unadjusted Cox proportional hazards model.</p><p><strong>Results: </strong>A total of 1982 (39.2%) and 2543 (50.4%) VICTORIA participants were respectively deemed eligible for PARADIGM-HF and DAPA-HF. Vericiguat was associated with numerically larger reductions in the primary outcome of HF hospitalization or cardiovascular death in populations simulated from PARADIGM-HF [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.72-0.99] and DAPA-HF (HR 0.82, 95% CI 0.71-0.94) compared with the overall VICTORIA trial (HR 0.90). Significant reduction in HF hospitalization with vericiguat was also observed in the DAPA-HF-eligible population (HR 0.83, 95%CI 0.73-0.95) and with a nominal reduction in the PARADIGM-HF-eligible population (HR 0.86, 95% CI 0.74-1.01).</p><p><strong>Conclusions: </strong>A trend towards enhanced efficacy of vericiguat in populations simulated from PARADIGM-HF and DAPA-HF was observed. These findings support further exploration of vericiguat in lower-risk HF populations as is being investigated in the ongoing VICTOR (a study of vericiguat in participants with chronic heart failure with reduced ejection fraction) trial.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urine chloride trajectory and relationship with diuretic response in acute heart failure.","authors":"Mateusz Guzik, Robert Zymliński, Piotr Ponikowski, Jan Biegus","doi":"10.1002/ehf2.15054","DOIUrl":"https://doi.org/10.1002/ehf2.15054","url":null,"abstract":"<p><strong>Aims: </strong>Sodium excretion is a well-defined marker used to assess diuretic response in acute heart failure (AHF). Despite a strong pathophysiological background, the role of urine chloride excretion has not been described and established yet. We aimed to evaluate chloride trajectory during intensive diuretic treatment in AHF patients and examine its potential role in predicting poor diuretic response.</p><p><strong>Methods: </strong>The study was conducted on 50 AHF patients. Participants were included within the first 36 h of hospitalization. They received furosemide dose adjusted for body weight (half in bolus, half in 2 h infusion). Post-diuretic hourly urine collection with biochemical analysis was performed.</p><p><strong>Results: </strong>In general, the concentrations of urine chloride (uCl^-) and sodium (uNa⁺) at the baseline samples exhibited a comparable level (71 ± 39 vs. 70 ± 44 mmol/L, respectively; P = 0.99), but across all post-furosemide study timepoints, uCl^- remained significantly higher than uNa⁺ since 1 to 6 h of the study. In this course, both ions (uCl^- and uNa⁺) reached peak values in 2 h (114 ± 28 vs. 97 ± 34 mmol/L, respectively; P < 0.01). The pattern of uCl^- dominance over uNa⁺ concentration was also observed in separate analyses of patients naïve to furosemide and those chronically exposed to furosemide. Regardless of these patterns, naïve to furosemide individuals excreted more ions (both uCl^- and uNa⁺) than chronically exposed patients at all timepoints. Additionally, a strong, linear correlation between uCl^- and uNa⁺ was observed in each post-furosemide timepoint (the strongest in 1 h r = 0.87; P < 0.001). Both interdependent ions concentration was almost parallel when analysed in chronic furosemide users and those naïve to furosemide separately [uCl^- = 0.85 * uNa⁺ + 28.82, P < 0.001, R² = 0.83 for chronic furosemide users, and uCl^- = 0.72 * uNa⁺ + 41.55, P < 0.001, R² = 0.65 for naïves to furosemide (linear regression model)]. Moreover, uCl^- (with cutoff point: 72 mmol/L) was a satisfactory predictive factor for poor diuretic response (<100 mL/h in 6 h since the beginning of furosemide infusion) [odds ratio (OR) 95% confidence interval (CI): 39.0 (3.8-405.00)]. It presented those properties also after adjusting for urine creatinine [cutoff point: 0.296 mmol/mg-OR (95% CI): 81.0 (8.0-816.0)].</p><p><strong>Conclusions: </strong>Urine chloride and sodium are highly interrelated during decongestion of AHF patients. The uCl^- (cutoff 72 mmol/L) exhibits better prognostic abilities to identify poor diuretic response than uNa⁺.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning tool for identifying newly diagnosed heart failure in individuals with known diabetes in primary care.","authors":"Per Wändell, Axel C Carlsson, Julia Eriksson, Caroline Wachtler, Toralph Ruge","doi":"10.1002/ehf2.15115","DOIUrl":"https://doi.org/10.1002/ehf2.15115","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to create a predictive model utilizing machine learning (ML) to identify new cases of congestive heart failure (CHF) in individuals with diabetes in primary health care (PHC) through the analysis of diagnostic data.</p><p><strong>Methods: </strong>We used a sex- and age-matched case-control design. Cases of new CHF were identified across all outpatient care settings 2015-2022 (n = 9098). We included individuals 30 years and above, by sex and age groups of 30-65 years and >65 years. The controls (five per case) were sampled from the individuals in 2015-2022 without CHF at any time between 2010 and 2022, in total 45 490. From the stochastic gradient boosting (SGB) technique model, we obtained a rank of the 10 most important factors related to newly diagnosed CHF in individuals with diabetes, with the normalized relative influence (NRI) score and a corresponding odds ratio of marginal effects (OR_ME). Area under curve (AUC) was calculated.</p><p><strong>Results: </strong>For women 30-65 years and >65 years, we identified 488 and 3240 new cases of CHF, respectively, and men 30-65 years and >65 years 1196 and 4174 new cases. Among the 10 most important factors in the four groups (divided by sex and lower and higher age) for newly diagnosed CHF, we found the number of visits 12 months before diagnosis (NRI 44.3%-55.9%), coronary artery disease (NRI 2.9%-7.8%), atrial fibrillation and flutter (NRI 6.6%-12.2%) and 'abnormalities of breathing' (ICD-10 code R06) (NRI 2.6%-4.4%) were predictive in all groups. For younger women, a diagnosis of COPD (NRI 2.7%) contributed to the predictive effect, while for older women, oedema (NRI 3.1%) and number of years with diabetes (NRI 3.5%) contributed to the predictive effect. For men in both age groups, chronic renal disease had predictive effect (NRI 3.9%-5.1%) The model prediction of CHF among patients with diabetes was high, AUC around 0.85 for the four groups, and with sensitivity over 0.783 and specificity over 0.708 for all four groups.</p><p><strong>Conclusions: </strong>An SGB model using routinely collected data about diagnoses and number of visits in primary care, can accurately predict risk for diagnosis of heart failure in individuals with diabetes. Age and sex difference in predictive factors warrant further examination.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Win ratio analysis of transvenous phrenic nerve stimulation to treat central sleep apnoea in heart failure.","authors":"William T Abraham, Olaf Oldenburg, Mitja Lainscak, Rami Khayat, Jerryll Asin, Piotr Ponikowski, Robin Germany, Scott McKane, Maria Rosa Costanzo","doi":"10.1002/ehf2.15074","DOIUrl":"https://doi.org/10.1002/ehf2.15074","url":null,"abstract":"<p><strong>Aims: </strong>Central sleep apnoea (CSA) is present in 20-40% of heart failure (HF) patients and is associated with poor clinical outcomes and health status. Transvenous phrenic nerve stimulation (TPNS) is an available treatment for CSA in HF patients. The impact on HF outcomes is incompletely understood. The win ratio (WR) allows inclusion of multiple endpoint components, considers the relative severity of each component, and permits assessment of recurrent events in evaluation of clinical benefit.</p><p><strong>Methods and results: </strong>A WR hierarchy was pre-defined for analysis of the HF subgroup of the remedē® System Pivotal Trial. The analysis used three hierarchical components to compare all treated to all control subjects: longest survival, lowest HF hospitalization rate, and ≥2-category difference in Patient Global Assessment at 6 months. Sensitivity analyses were performed substituting Epworth Sleepiness Scale and 4% oxygen desaturation index for the third component, and a 4-component WR hierarchy was also evaluated. Ninety-one HF subjects, 43 receiving TPNS and 48 in the control group, provided 2064 pairwise comparisons. More patients treated with TPNS experienced clinical benefit compared with control (WR 4.92, 95% confidence interval 2.27-10.63, P < 0.0001). There were 1111 (53.83%) winning pairwise comparisons for the treatment group and 226 (10.95%) for the control group. Similarly, large WRs were observed for all additional WR hierarchies.</p><p><strong>Conclusions: </strong>This WR analysis of the remedē® System Pivotal Trial suggests that TPNS may be superior to untreated CSA in HF patients with CSA using a hierarchical clinical benefit endpoint composed of mortality, HF hospitalization, and health status.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions.","authors":"Alexander Liu, Raheel Ahmed, Mansimran Singh Dulay, Joseph Okafor, Alessia Azzu, Kamleshun Ramphul, Rui Shi, Gerald Ballo, John Arun Baksi, Kshama Wechalekar, Rajdeep Khattar, Peter Collins, Athol Umfrey Wells, Vasilis Kouranos, Rakesh Sharma","doi":"10.1002/ehf2.15113","DOIUrl":"https://doi.org/10.1002/ehf2.15113","url":null,"abstract":"<p><strong>Aims: </strong>In cardiac sarcoidosis (CS) patients, the benefit of cardiac resynchronization therapy (CRT) remains unclear. We sought to assess the short-term and long-term effects of CRT in CS patients with a range of left ventricular (LV) ejection fractions (LVEFs).</p><p><strong>Methods: </strong>Consecutive CS patients with heart failure with reduced ejection fraction (HFrEF; LVEF ≤ 40%), mildly reduced ejection fraction (HFmrEF; LVEF 41%-49%) and preserved ejection fraction (HFpEF; LVEF ≥ 50) treated with CRT under the care of a tertiary UK centre between 2008 and 2023 were reviewed. CRT response was defined by >5% improvement in serial LVEF. The primary endpoint was a composite of all-cause mortality, cardiac transplantation or unplanned hospitalization for decompensated heart failure. The secondary endpoint included ventricular arrhythmic events.</p><p><strong>Results: </strong>Of the 100 patients enrolled (age 58 ± 10 years; 71% male), 63 had HFrEF, 17 had HFmrEF and 20 had HFpEF. After short-term follow-up (9.8 ± 5.4 months), HFrEF patients demonstrated significant LVEF response (P < 0.01). On Kaplan-Meier analysis (follow-up 38 ± 32 months), HFrEF non-responders had significantly worse event-free survival compared with HFrEF responders for the primary (P < 0.001) and secondary (P = 0.001) endpoints. Despite short-term LV function improvement, CRT responders still had worse event-free survival compared with HFmrEF/HFpEF patients for the primary endpoint (P < 0.001). On multivariable Cox analysis, age [hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.01-1.10, P = 0.008] and HFrEF CRT non-response (HR 12.33, 95% CI 2.45-61.87, P = 0.002) were associated with the primary endpoint.</p><p><strong>Conclusions: </strong>In CS patients with HFrEF, CRT response is associated with a better long-term prognosis than non-response. However, HFrEF CRT responders still have worse long-term prognosis than HFmrEF/HFpEF patients.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between clinician team segregation, receipt of cardiovascular care and outcomes in valvular heart diseases.","authors":"Ikeoluwapo Kendra Bolakale-Rufai, Shannon M Knapp, Janina Quintero Bisono, Adedoyin Johnson, Wanda Moore, Ekow Yankah, Ryan Yee, Dalancee Trabue, Brahmajee Nallamothu, John M Hollingsworth, Stephen Watty, Francesca Williamson, Natalie Pool, Megan Hebdon, Nneamaka Ezema, Quinn Capers, Courtland Blount, Nia Kimbrough, Denee Johnson, Jalynn Evans, Brandi Foree, Anastacia Holman, Karen Lightbourne, David Brown, Brownsyne Tucker Edmonds, Khadijah Breathett","doi":"10.1002/ehf2.15078","DOIUrl":"https://doi.org/10.1002/ehf2.15078","url":null,"abstract":"<p><strong>Aims: </strong>Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30-day readmission and 1-year survival.</p><p><strong>Methods and results: </strong>Using Optum's Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0-1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67-82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58-1.08), P = 0.14; Medium SG aOR: 0.86 (95% CI: 0.60-1.25), P = 0.43; High SG aOR: 1.07 (95% CI: 0.68-1.69), P = 0.76]. Among those that received care from a cardiologist, there was no difference in the 30-day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83-1.31), P = 0.70; Medium SG aOR: 1.22 (95% CI: 0.92-1.61), P = 0.17; High SG aOR: 0.81 (95% CI: 0.57-1.17), P = 0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30-day readmission compared to White patients [aOR: 2.74 (95%CI:1.38-5.43), P < 0.01]. Odds of 1-year survival were similar across race for all SG irrespective of receipt of care from a cardiologist [seen by a cardiologist: Low SG aOR: 1.13 (95% CI: 0.86-1.48), P = 0.38; Medium SG aOR: 0.83 (95% CI: 0.59-1.17), P = 0.29; High SG aOR: 1.01 (95% CI: 0.66-1.52), P = 0.98; not seen by a cardiologist: Low SG aOR: 0.56 (95% CI: 0.23-1.34), P = 0.19; Medium SG aOR: 0.81 (95% CI: 0.28-2.37), P = 0.70; High SG aOR: 0.63 (95% CI: 0.23-1.74), P = 0.37].</p><p><strong>Conclusions: </strong>Among an insured population, race was not associated with care by a cardiologist for VHD or survival. Black patients not seen by cardiologists had higher odds of 30-day readmission in low clinician SG.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}