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07. Syncope and Bradycardia
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Predictors of major adverse cardiovascular events in patients with heart failure – insights from a real-world population followed in a regional hospital
Session:
Sessão de Posters 18 - Insuficiência cardíaca - Fatores preditores
Speaker:
Adriana da Fonseca Vazão
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Adriana Vazão; Carolina Gonçalves; André Martins; Mariana Carvalho; Margarida Cabral; João Carvalho; Célia Domingues; Joana Correia; João Morais
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Introduction: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Heart failure (HF) is a major global cause of cardiovascular morbi-mortality. Some HF patients (pts) undergo accelerated disease course marked by frequent exacerbations which are known to be associated with worse prognosis. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Objective: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Identify predictors of major adverse cardiovascular events (MACE) in pts with HF with ejection fraction (EF) <50% followed in an HF clinic at a regional hospital in Portugal.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Methods: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Retrospective single-center cohort study of adult pts followed up for ≥6 months from 2018 to 2022. Data regarding clinical characteristics, cardiac procedures and HF characterization was obtained. Expanded MACE over 18-month period were defined as all-cause mortality, cardiovascular (CV) mortality, myocardial infarction, coronary revascularization, stroke and HF hospitalization. Pts who suffered MACE (group 1) were compared with those who did not (group 2). </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Results: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">209 pts were included (mean age 68±12yrs, 84% male), of which 33 (16%) had MACE (group 1). Group 1 pts were older (72±10 vs 67±12yrs,p=0.041), more frequently had diabetes (DM) (55vs30%,p=0.007), dyslipidemia (85vs65%,p=0.026), chronic kidney disease (30 vs 12%,p=0.013) and chronic obstructive pulmonary disease (COPD) (27 vs 7%,p<0.001). There were no differences in procedures - percutaneous coronary intervention (27vs24%), coronary artery bypass graft (12vs8%), implantable cardiac defibrillator (6vs12%) or cardiac resynchronization therapy-defibrillator (12vs10%) (p>0.05). Regarding HF characterization, the majority of pts had EF<40% (91vs 94%,p=0.751) and ischemic cause was numerically more frequent in group 1 (49vs 39%,p=0.290). Group 1 had lower prescription of angiotensin receptor-neprilysin inhibitor (ARNI) (64 vs 86%,p=0.002) but higher of furosemide (79vs61%,p=0.049) and metolazone (12vs1%,p=0.002). The primary driver of 18-month MACE was HF hospitalizations (70%) </span></span></span><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">followed by all-cause mortality (27%). After multivariate logistic regression, DM </span></span></span><span style="font-size:10.5pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">(OR </span></span></span><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:black">3.07, CI 95% 1.35-6.99), </span></span></span><span style="font-size:10.5pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">COPD (OR </span></span></span><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:black">4.34, CI 95% 1.45-12.98) and medication with metolazone (OR 13.01, CI 95% 1.03-165.02)</span></span></span> <span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">remained independent predictors of MACE in this population. Medication with ARNI </span></span></span><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:black">appears to be a protective factor for MACE </span></span></span><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">(OR 0.296, CI 95% 0.118-0.746). </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">Conclusion: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:"PT Serif",serif"><span style="color:#222222">In this HF population,<strong> </strong>predominantly with reduced EF,<strong> </strong>18-months MACE occurred in 16% of pts. DM, COPD and medication with metolazone were found to be independent predictors of MACE and medication with ARNI appeared to be protective. </span></span></span></span></span></span></p>
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