Combined Neuro-Humoral Modulation and Outcomes in Patients with Chronic Heart Failure and Mildly Reduced or Preserved Ejection Fraction
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. NHM Prescription and Distribution
3.2. Clinical Characteristics According to NHM
3.3. NHM and Outcome
4. Discussion
4.1. NHM Prescription in HF with EF > 40%
4.2. Factors Underlying Benefits of Combined NHM in HF with LVEF > 40%
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
References
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LVEF 41–49% | All 2298 | No-Single 578 (25.1) | Double 1107 (48.2) | Triple 613 (26.7) | p Value |
---|---|---|---|---|---|
Age (mean ± SD) | 67 ± 14 | 68 ± 15 | 67 ± 13 | 67 ± 13 | 0.009 |
Age < 65 | 854 (37.2) | 181 (31.3) | 436 (39.4) | 237 (38.7) | 0.003 |
Age 65–79 | 1057 (46.0) | 285 (49.3) | 485 (43.8) | 287 (46.8) | 0.09 |
Age 80+ | 387 (16.8) | 112 (19.4) | 186 (16.8) | 89 (14.5) | 0.08 |
Female Sex | 663 (28.9) | 164 (28.4) | 320 (28.9) | 179 (29.2) | 0.95 |
Epoch 1999–2005 | 782 (34.0) | 299 (51.7) | 381 (34.4) | 102 (16.6) | <0.0001 |
Epoch 2006–2011 | 572 (24.9) | 128 (22.1) | 302 (27.3) | 142 (23.2) | 0.04 |
Epoch 2012–2018 | 944 (41.1) | 151 (26.1) | 424 (38.3) | 369 (60.2) | <0.0001 |
HF admissions (previous year) | 752 (32.7) | 195 (33.7) | 313 (28.3) | 244 (39.8) | <0.0001 |
HF history >6 months | 1396 (60.8) | 314 (54.3) | 670 (60.5) | 412 (67.2) | <0.0001 |
History of hypertension | 1349 (58.7) | 309 (53.5) | 667 (60.3) | 373 (60.9) | 0.01 |
Atrial fibrillation | 665 (28.9) | 166 (28.7) | 293 (26.5) | 206 (33.6) | 0.007 |
Ischemic etiology | 908 (39.5) | 235 (40.7) | 453 (40.9) | 220 (35.9) | 0.10 |
At least one cardiac comorbidity with an indication for NHM # | 1839 (80.0) | 456 (78.9) | 901 (81.4) | 482 (78.6) | 0.29 |
Diabetes | 665 (28.9) | 163 (28.2) | 313 (28.3) | 189 (30.8) | 0.48 |
Previous stroke/TIA | 163 (7.1) | 46 (8.0) | 82 (7.4) | 35 (5.7) | 0.27 |
Body mass index | 27.2 ± 4.8 | 26.6 ± 4.7 | 27.1 ± 4.5 | 28.1 ± 5.3 | <0.0001 |
LVEF% | 44.6 ± 2.2 | 44.9 ± 2.3 | 44.6 ± 2.1 | 44.2 ± 2.1 | <0.0001 |
Systolic blood pressure | 130 ± 20 | 133 ± 21 | 130 ± 21 | 125 ± 18 | <0.0001 |
Heart rate | 70 ± 14 | 72 ± 15 | 70 ± 14 | 69 ± 13 | <0.0001 |
NYHA class III–IV | 307 (13.4) | 103 (17.8) | 126 (11.4) | 78 (12.7) | 0.001 |
Furosemide | 1603 (69.8) | 350 (60.6) | 715 (64.6) | 538 (87.8) | <0.0001 |
Non-NHM polypharmacy | 418 (18.2) | 101 (17.5) | 187 (16.9) | 130 (21.2) | 0.07 |
LVEF ≥ 50% | All 2409 | No-Single 880 (36.5) | Double 1099 (45.6) | Triple 430 (17.9) | p Value |
---|---|---|---|---|---|
Age (mean ± SD) | 70 ± 14 | 69 ± 16 | 71 ± 14 | 72 ± 13 | 0.007 |
Age < 65 | 701 (29.1) | 281 (31.9) | 309 (28.1) | 111 (25.8) | 0.04 |
Age 65–79 | 1017 (42.2) | 372 (42.3) | 458 (41.7) | 187 (43.5) | 0.81 |
Age 80+ | 691 (28.7) | 227 (25.8) | 332 (30.2) | 132 (30.7) | 0.06 |
Female Sex | 1097 (45.5) | 388 (44.1) | 511 (46.5) | 198 (46.1) | 0.55 |
Epoch 1999–2005 | 668 (27.7) | 347 (39.4) | 279 (25.4) | 42 (9.8) | <0.0001 |
Epoch 2006–2011 | 631 (26.2) | 231 (26.3) | 311 (28.3) | 89 (20.7) | 0.01 |
Epoch 2012–2018 | 1110 (46.1) | 302 (34.3) | 509 (46.3) | 299 (69.5) | <0.0001 |
HF admissions previous year | 803 (33.3) | 261 (29.7) | 366 (33.3) | 176 (40.9) | 0.0003 |
HF history >6 months | 1589 (66.0) | 562 (63.9) | 727 (66.2) | 300 (69.8) | 0.10 |
History of hypertension | 1504 (62.4) | 467 (53.1) | 730 (66.4) | 307 (71.4) | <0.0001 |
Atrial fibrillation | 986 (40.9) | 337 (38.3) | 449 (40.9) | 200 (46.5) | 0.02 |
Ischemic etiology | 513 (21.3) | 161 (18.3) | 247 (22.5) | 105 (24.4) | 0.02 |
At least one cardiac comorbidity with an indication for NHM # | 1951 (81.0) | 650 (73.9) | 929 (84.5) | 372 (86.5) | <0.0001 |
Diabetes | 624 (25.9) | 215 (24.4) | 283 (25.8) | 126 (29.3) | 0.17 |
Previous stroke/TIA | 182 (7.6) | 70 (8.0) | 87 (7.9) | 25 (5.8) | 0.32 |
Body mass index | 27.1 ± 5.0 | 26.7 ± 4.9 | 27.2 ± 4.9 | 27.5 ± 5.3 | 0.01 |
LVEF% | 57.1 ± 6.3 | 58.1 ± 6.7 | 56.8 ± 6.1 | 55.8 ± 5.6 | <0.0001 |
Systolic blood pressure | 130 ± 21 | 132 ± 21 | 130 ± 21 | 127 ± 19 | 0.001 |
Heart rate | 72 ± 15 | 72 ± 15 | 71 ± 15 | 71 ± 14 | 0.24 |
NYHA class III–IV | 473 (19.6) | 184 (20.9) | 217 (19.8) | 72 (16.7) | 0.20 |
Furosemide | 1694 (70.3) | 528 (60.0) | 781 (71.1) | 385 (89.5) | <0.0001 |
Non-NHM polypharmacy | 470 (19.5) | 161 (18.3) | 214 (19.5) | 95 (22.1) | 0.27 |
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Gori, M.; Marini, M.; Gonzini, L.; Carigi, S.; De Gennaro, L.; Gentile, P.; Leonardi, G.; Orso, F.; Tinti, D.; Lucci, D.; et al. Combined Neuro-Humoral Modulation and Outcomes in Patients with Chronic Heart Failure and Mildly Reduced or Preserved Ejection Fraction. J. Clin. Med. 2022, 11, 6627. https://doi.org/10.3390/jcm11226627
Gori M, Marini M, Gonzini L, Carigi S, De Gennaro L, Gentile P, Leonardi G, Orso F, Tinti D, Lucci D, et al. Combined Neuro-Humoral Modulation and Outcomes in Patients with Chronic Heart Failure and Mildly Reduced or Preserved Ejection Fraction. Journal of Clinical Medicine. 2022; 11(22):6627. https://doi.org/10.3390/jcm11226627
Chicago/Turabian StyleGori, Mauro, Marco Marini, Lucio Gonzini, Samuela Carigi, Luisa De Gennaro, Piero Gentile, Giuseppe Leonardi, Francesco Orso, Denitza Tinti, Donata Lucci, and et al. 2022. "Combined Neuro-Humoral Modulation and Outcomes in Patients with Chronic Heart Failure and Mildly Reduced or Preserved Ejection Fraction" Journal of Clinical Medicine 11, no. 22: 6627. https://doi.org/10.3390/jcm11226627