Cardiología

Global patterns of polypharmacy after acute heart failure hospitalization: Prevalence and outcomes from the REPORT-HF registry

2025-12-01T00:00:00Z

Global patterns of polypharmacy after acute heart failure hospitalization: Prevalence and outcomes from the REPORT-HF registry Wan Ting, Tay; Tiew-Hwa Katherine, Teng; Ouwerkerk, Wouter; John G.F., Cleland; Sean P., Collins; Christiane E., Angermann; Kenneth, Dickstein; Ulf, Dahlstrom; Anja, Schweizer; Achim, Obergfell; Kai-Hang, Yiu; Mathieu, Ghadanfar; Mahmoud, Hassanein; Qing-Wen, Ren; Wen-Li, Gu; Georg, Ertl; Sergio Víctor, Perrone; Gerasimos, Filippatos; Carolyn S.P., Lam; Jasper, Tromp Aims: Polypharmacy, defined as the concurrent use of ≥5 medications, is prevalent among older adults with heart failure (HF). While guideline-directed HF medications provide therapeutic benefits, non-HF polypharmacy, particularly involving inappropriate medications, may lead to adverse outcomes. The international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF), the largest available global acute HF registry, was used to examine the prevalence, clinical correlates, and 1-year outcome associations of non-HF polypharmacy. Methods and results: Medication counts were classified as no polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). Potentially harmful medications were identified using the 2016 American Heart Association scientific statement. Multivariable regression models examined correlates of polypharmacy and 1-year mortality. Among 18 030 patients (66 ± 14 years, 39% women), 39% had polypharmacy and 9% had hyper-polypharmacy (63% and 25%, respectively, if including HF medications). Non-HF polypharmacy was more common in older white patients from high-income countries, with preserved ejection fraction and high comorbidity burden. Patients with greater non-HF medication use were less likely to receive guideline-directed HF medications and more likely to take medications that can worsen HF. Crude hazard ratios (HRs) for 1-year mortality were 1.16 (95% confidence interval [CI] 1.08-1.25) for polypharmacy and 1.46 (95% CI 1.31-1.63) for hyper-polypharmacy versus no polypharmacy. After adjustment, hyper-polypharmacy remained associated with increased mortality (HR 1.16, 95% CI 1.01-1.33). Conclusions: Non-HF polypharmacy in HF is common worldwide, particularly in high-income regions. Its association with reduced use of guideline-directed HF medications and higher usage of medications causing or worsening HF, as well as elevated 1-year mortality, underscores the importance of addressing polypharmacy in HF.

Patent foramen ovale: is a change in the diagnostic paradigm necessary?

2025-01-01T00:00:00Z

Patent foramen ovale: is a change in the diagnostic paradigm necessary? Magariños, Eduardo; Scuteri, Antonio; Romano, Ariel; Herrera Paz, Juan José; Razzini, Sofía; Lagos, Roberto; Colombero, Darío; Pujol Lereis, Virginia Andrea; Ameriso, Sebastián Francisco The patent foramen ovale has been a well-known medical entity for a long time. With the advent of new diagnostic tools, the methodology for evaluating patients with stroke and suspected patent foramen ovale is evolving. In this article, we review the patent foramen ovale and the ultrasound methods used for its detection. Finally, we present a new paradigm for its study.

Quality of care delivery in patients with acute heart failure: insights from the international REPORT-HF registry

2025-01-10T00:00:00Z

Quality of care delivery in patients with acute heart failure: insights from the international REPORT-HF registry Tay, Wan Ting; Katherine, Teng Tiew-Hwa; Ouwerkerk, Wouter; Angermann, Christiane E.; Dickstein, Kenneth; Cleland, John G. F.; Dahlstrom, Ulf; Ertl, Georg; Hassanein, Mahmoud; Perrone, Sergio Víctor; Ghadanfar, Mathieu; Schweizer, Anja; Obergfell, Achim; Collins, Sean P.; Filippatos, Gerasimos; Lam, Carolyn S. P.; Tromp, Jasper Background: Heart Failure (HF) quality of care (QoC) is associated with clinical outcomes. Therefore, we investigated differences in HF QoC across worldwide regions (with differing national income) and the association of quality indicators with outcomes. Methods: We examined the quality of care (QoC) in acute heart failure (HF) patients across different regions using quality indicators (QIs) from the European Society of Cardiology (ESC) and the American Heart Association (AHA) to evaluate QoC. The analysis included 17,632 patients enrolled from 358 medical centres in 44 countries between 23 July 2014 and 24 March 2017, all part of the prospective REPORT-HF cohort study. We investigated how QoC varied by region and its relationship with mortality rates at 30 days and 1 year after hospital discharge. For each QI, percentage attainment of QI among eligible patients was calculated and compared across regions. Findings: Among 17,632 patients (median age: 67 years; 61% women) followed up for a median of two years, we assessed 16 QIs. QIs that were least often achieved included measurement of natriuretic peptides, performance of echocardiography, treatment with guideline medical therapy, and a scheduled follow-up consultation after discharge. QI achievement was significantly lower in lower-than higher-income countries. Higher (≥50% vs. <50%) achievement of cumulative QIs was associated with lower 30-day (hazard ratio [HR] 0.58, 95% Confidence Interval [CI] 0.40-0.83; p < 0.001), and 1-year mortality (HR 0.58, 95% CI 0.50-0.68; p < 0.001). Interpretation: QoC is lower in lower-than higher-income countries and lower QoC is associated with worse outcomes. Improving QoC by addressing structural barriers and quality improvement programs may improve the outcomes of patients with HF.

Prognostic Implications and Global Perspectives of Atrial Fibrillation in Patients Hospitalized for Heart Failure

2025-02-05T00:00:00Z

Prognostic Implications and Global Perspectives of Atrial Fibrillation in Patients Hospitalized for Heart Failure Chyou, Janice Y.; Tay, Wan Ting; Tromp, Jasper; Ouwerkerk, Wouter; Hang Yiu, Kai; Cleland, John G. F.; Collins, Sean P.; Angermann, Christiane E.; Ertl, Georg; Dahlström, Ulf; Dickstein, Kenneth; Perrone, Sergio Víctor; Ghadanfar, Mathieu; Schweizer, Anja; Obergfell, Achim; Filippatos, Gerasimos; Lam, Carolyn S. P. Background: Atrial fibrillation (AF) and heart failure (HF) each contributes to global disease burden and can coexist. The interplay of prior HF, prior AF, and presenting rhythm have not previously been jointly considered in prognostic implication. Objectives: The authors sought to assess 1-year all-cause mortality according to permutations of prior HF, prior AF, and AF as presenting rhythm, in a global cohort of patients hospitalized for HF. Methods: REPORT-HF enrolled patients during hospitalization for acute HF from 44 countries over 6 continents. Cox proportional hazard models were used to compute HRs for the primary outcome of 1-year all-cause mortality. Results: Of 13,401 participants (median age 67 years, 61% men), 58% had prior HF. AF prevalence (prior or newly detected) at HF admission was 39%, varying by left ventricular ejection fraction and race subgroups. Compared with patients with no prior HF, no prior AF, and presenting in sinus rhythm, 1-year all-cause mortality was elevated in patients with prior HF, prior AF, and presenting in AF (adjusted HR: 1.54 [95% CI: 1.34-1.78]; P < 0.001) and in patients with prior HF, no prior AF, and presenting in AF (adjusted HR: 1.51 [95% CI: 1.20-1.90]; P < 0.001), but not in patients with no prior HF and with prior AF or presenting in AF. These results were conserved across left ventricular ejection fraction and race subgroups. Conclusions: In a global cohort of patients hospitalized for HF, permutations of prior HF, prior AF, and AF as presenting rhythm differentiate outcome. History of prior HF influences the prognostic implications of AF in patients hospitalized for HF. (Global Noninterventional Heart Failure Disease Registry [REPORT-HF]; NCT02595814).