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  • 1.
    Linde, Cecilia
    et al.
    Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden; Karolinska Inst, Stockholm, Sweden.
    Qin, Lei
    AstraZeneca, Global Hlth Econ, Gaithersburg, MD USA.
    Bakhai, Ameet
    Royal Free Hosp, Dept Cardiol, London, England.
    Furuland, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Renal Medicine.
    Evans, Marc
    Llandough Hosp, Diabet Resource Ctr, Cardiff, S Glam, Wales.
    Ayoubkhani, Daniel
    Hlth Econ & Outcomes Res Ltd, Rhymney House,Unit A Copse Walk, Cardiff, S Glam, Wales.
    Palaka, Eirini
    AstraZeneca, Global Hlth Econ, Cambridge, England.
    Bennett, Hayley
    Hlth Econ & Outcomes Res Ltd, Rhymney House,Unit A Copse Walk, Cardiff, S Glam, Wales.
    McEwan, Phil
    Hlth Econ & Outcomes Res Ltd, Rhymney House,Unit A Copse Walk, Cardiff, S Glam, Wales; Swansea Univ, Sch Human & Hlth Sci, Swansea, W Glam, Wales.
    Serum potassium and clinical outcomes in heart failure patients: results of risk calculations in 21 334 patients in the UK2019In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 6, no 2, p. 280-290Article in journal (Refereed)
    Abstract [en]

    Aims: At present, the clinical burden of hypokalaemia and hyperkalaemia among European heart failure patients, and relationships between serum potassium and adverse clinical outcomes in this population, is not well characterized. The aim of this study was to investigate associations between mortality, major adverse cardiac events, and renin–angiotensin–aldosterone system inhibitor (RAASi) discontinuation across serum potassium levels, in a UK cohort of incident heart failure patients.

    Methods and results: This was a retrospective observational cohort study of newly diagnosed heart failure patients listed in the Clinical Practice Research Datalink, with a first record of heart failure (index date) between 2006 and 2015. Hypokalaemia and hyperkalaemia episodes were defined as the number of serum potassium measurements exceeding each threshold (<3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L), without such a measurement in the preceding 7 days. Risk equations developed using Poisson generalized estimating equations were utilized to estimate adjusted incident rate ratios (IRRs) relating serum potassium and clinical outcomes (death, major adverse cardiac event, and RAASi discontinuation). Among 21,334 eligible heart failure patients, 1969 (9.2%), 7648 (35.9%), 2725 (12.8%), and 763 (3.6%) experienced episodes of serum potassium <3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L, respectively. The adjusted IRRs for mortality exhibited a U‐shaped association pattern with serum potassium. Relative to the reference category (4.5 to <5.0 mmol/L), adjusted IRRs for mortality were estimated as 1.98 (95% confidence interval: 1.69–2.33), 1.23 (1.12–1.36), 1.35 (1.14–1.60), and 3.02 (2.28–4.02), for patients with serum potassium <3.5, ≥5.0 to <5.5, ≥5.5 to <6.0, and ≥6.0 mmol/L, respectively. The adjusted IRRs for major adverse cardiac events demonstrated a non‐statistically significant relationship with serum potassium. Discontinuation of RAASi therapy exhibited a J‐shaped trend in association with serum potassium. Compared with the reference category (4.5 to <5.0 mmol/L), adjusted IRRs were estimated as 1.07 (0.89–1.28) in patients with serum potassium <3.5 mmol/L, increasing to 1.32 (1.14–1.53) and 2.19 (1.63–2.95) among those with serum potassium ≥5.5 to <6.0 and ≥6.0 mmol/L, respectively.

    Conclusions: In UK patients with new onset heart failure, both hypokalaemia and hyperkalaemia were associated with increased mortality risk, and hyperkalaemia was associated with increased likelihood of RAASi discontinuation. Our results demonstrate the potential importance of serum potassium monitoring for heart failure outcomes and management.

  • 2.
    Nordgren, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Söderlund, Anne
    Mälardalens högskola.
    Received and needed social support in relation to sociodemographic and socio‐economic factors in a population of people on sick leave due to heart failure2017In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 4, no 1, p. 46-55Article in journal (Refereed)
    Abstract [en]

    Aims

    The aim of this study was to determine differences between sociodemographic and socio‐economic factors for perceptions of received and needed social support in a population of people on sick leave due to heart failure.

    Methods and results

    A cross‐sectional design was used. A postal questionnaire was distributed to all people in Sweden who had been sick listed due to heart failure during March to May 2012 (N = 1297). The questionnaire measured perceptions of received and needed social support from managers, colleagues at work, family and friends. Differences between groups were estimated with the Mann–Whitney U‐test. The sample included 414 men and 176 women aged 23 to 67 years (mean 58, median 60, SD = 6.75). Respondents with low income received significantly less support than respondents with high income and also needed significantly more support. Respondents with lower educational level needed significantly more support than people with higher education. Unmarried respondents needed significantly more support than married.

    Conclusions

    People with lower level of education, those who were unmarried and respondents with low income needed more support than they received. By identification of vulnerable patients, healthcare professionals can tailor and target supportive measures for patients who need extra social support.

  • 3.
    Pölzl, Gerhard
    et al.
    Med Univ Innsbruck, Dept Internal Med 3, Innsbruck, Austria.
    Allipour Birgani, Shadab
    Med Univ Innsbruck, Dept Internal Med 3, Innsbruck, Austria.
    Comin-Colet, Josep
    Bellvitge Univ Hosp, Dept Cardiol, Barcelona, Spain;Univ Barcelona Hosp de Llobregat, IDIBELL, Barcelona, Spain.
    Delgado, Juan F.
    CIBERCV, Univ Hosp 12 Octubre, Dept Cardiol, Madrid, Spain.
    Fedele, Francesco
    Sapienza Univ Rome, Dept Cardiovasc Resp Nephrol Anesthesiol & Geriat, Rome, Italy.
    Garcia-Gonzales, Martin Jesus
    Univ Hosp Canarias, Dept Cardiol, Tenerife, Spain.
    Gustafsson, Finn
    Copenhagen Univ Hosp, Dept Cardiol, Rigshosp, Copenhagen, Denmark.
    Masip, Josep
    Univ Barcelona, Intens Care Dept, Consorci Sanitari Integral, Barcelona, Spain;Hosp Sanitas CIMA, Cardiol Dept, Barcelona, Spain.
    Papp, Zoltan
    Univ Debrecen, Fac Med, Div Clin Physiol, Dept Cardiol, Debrecen, Hungary.
    Störk, Stefan
    Univ Hosp Wurzburg, Dept Internal Med, Wurzburg, Germany;Univ Hosp Wurzburg, Comprehens Heart Failure Ctr, Wurzburg, Germany.
    Ulmer, Hanno
    Med Univ Innsbruck, Dept Med Stat Informat & Hlth Econ, Innsbruck, Austria.
    Vrtovec, Bojan
    Univ Med Ctr Ljubljana, Dept Cardiol, Ljubljana, Slovenia.
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Altenberger, Johann
    Paracelsus Med Private Univ, Cardiac Rehabil Ctr Grossgmain, Pensionsversicherungsanstalt, Teaching Hosp, Salzburg, Austria.
    Repetitive levosimendan infusions for patients with advanced chronic heart failure in the vulnerable post-discharge period2019In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 6, no 1, p. 174-181Article in journal (Refereed)
    Abstract [en]

    Hospitalization for acute heart failure (HF) is associated with a substantial morbidity burden and with associated healthcare costs and an increased mortality risk. However, few if any major medical innovations have been witnessed in this area in recent times. Levosimendan is a first-in-class calcium sensitizer and potassium channel opener indicated for the management of acute HF. Experience in several clinical studies has indicated that administration of intravenous levosimendan in intermittent cycles may reduce hospitalization and mortality rates in patients with advanced HF; however, none of those trials were designed or powered to give conclusive insights into that possibility. This paper describes the rationale and protocol of LeoDOR (levosimendan infusions for patients with advanced chronic heart failure), a randomized, double-blind, placebo-controlled, international, multicentre trial that will explore the efficacy and safety of intermittent levosimendan therapy, in addition to optimized standard therapy, in patients following hospitalization for acute HF. Salient features of LeoDOR include the use of two treatment regimens, in order to evaluate the effects of different schedules and doses of levosimendan during a 12 week treatment phase, and the use of a global rank primary endpoint, in which all patients are ranked across three hierarchical groups ranging from time to death or urgent heart transplantation or implantation of a ventricular assist device to time to rehospitalization and, lastly, time-averaged proportional change in N-terminal pro-brain natriuretic peptide. Secondary endpoints include changes in HF symptoms and functional status at 14 weeks.

  • 4.
    Stenemo, Markus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ganna, Andrea
    Massachusetts Gen Hosp, Analyt & Translat Genet Unit, Boston, MA 02114 USA ; Broad Inst MIT & Harvard, Program Med & Populat Genet, Cambridge, MA 02142 USA ; Broad Inst MIT & Harvard, Stanley Ctr Psychiat Res, Cambridge, MA 02142 USA ; Karolinska Inst, Dept Med Epidemiol & Biostat MEB, Stockholm, Sweden.
    Salihovic, Samira
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Nowak, Christoph
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Family Med & Primary Care, Stockholm, Sweden.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. George Inst Global Hlth, Sydney, NSW, Australia.
    Giedraitis, Vilmantas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Broeckling, Corey
    Colorado State Univ, Prote & Metabol Facil, Ft Collins, CO 80523 USA.
    Prenni, Jessica
    Colorado State Univ, Prote & Metabol Facil, Ft Collins, CO 80523 USA ; Colorado State Univ, Dept Hort & Landscape Architecture, Ft Collins, CO 80523 USA.
    Svensson, Per
    Karolinska Inst, Dept Clin Sci & Educ, Dept Cardiol, Sodersjukhuset, Stockholm, Sweden.
    Magnusson, Patrik
    Karolinska Inst, Dept Med Epidemiol & Biostat MEB, Stockholm, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Stanford Univ, Sch Med, Dept Med, Div Cardiovasc Med, Stanford, CA 94305 USA ; Stanford Univ, Stanford Cardiovasc Inst, Stanford, CA 94305 USA ; Stanford Univ, Stanford Diabet Res Ctr, Stanford, CA 94305 USA.
    Ärnlöv, Johan
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Family Med & Primary Care, Stockholm, Sweden ; Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    The metabolites urobilin and sphingomyelin (30:1) are associated with incident heart failure in the general population2019In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 6, no 4, p. 764-773Article in journal (Refereed)
    Abstract [en]

    Aims: We aimed to investigate whether metabolomic profiling of blood can lead to novel insights into heart failure pathogenesis or improved risk prediction.

    Methods: Mass spectrometry-based metabolomic profiling was performed in plasma or serum samples from three community-based cohorts without heart failure at baseline (total n=3,924; 341 incident heart failure events, median follow-up ranging from 4.6 to 13.9 years). Cox proportional hazards models were applied to assess the association of each of the 206 identified metabolites with incident heart failure in the discovery cohorts Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, n=920) and Uppsala Longitudinal Study of Adult Men (ULSAM, n=1,121). Replication was undertaken in the independent cohort TwinGene (n=1,797). We also assessed whether metabolites could improve the prediction of heart failure beyond established risk factors (age, sex, body mass index, low-density lipoprotein- and high-density lipoprotein-cholesterol, triglycerides, lipid medication, diabetes, systolic and diastolic blood pressure, blood pressure medication, glomerular filtration rate, smoking status, and myocardial infarction prior to or during follow-up).

    Results: Higher circulating urobilin and lower sphingomyelin (30:1) were associated with incident heart failure in age- and sex-adjusted models in the discovery and replication sample. The hazard ratio (HR) for urobilin in the replication cohort was estimated to 1.29 per SD unit, 95% confidence interval (CI) 1.03-1.63) and for sphingomyelin (30:1) to 0.72 (95% CI 0.58-0.89). Results remained similar after further adjustment for established heart failure risk factors in meta-analyses of all three cohorts. Urobilin concentrations were inversely associated with left ventricular ejection fraction at baseline in the PIVUS cohort (β= -0.70 (95% CI -1.03-(-0.38)). No improvement in risk prediction was observed when adding the two top metabolites (C-index 0.787 (95% CI 0.752-0.823)) or nine Lasso-selected metabolites (0.790 (95% CI 0.754-0.826)) to a modified Atherosclerosis Risk in Communities (ARIC) heart failure risk score model (0.780 (95% CI 0.745-0.816)).

    Conclusions: Our metabolomics study identified associations of circulating levels of the heme breakdown product urobilin, and sphingomyelin (30:1), a cell membrane component involved in signal transduction and apoptosis, with incident heart failure.

1 - 4 of 4
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