10 June 2022

This week in PVD

Smoking ‘important’ modifiable risk factor for HF

Current smoking was associated with elevated risk for HF in a dose-response manner, according to a new analysis of the ARIC cohort.

“Our results strengthened the evidence that smoking is an important modifiable risk factor for HF and highlighted the importance of smoking prevention and cessation for the prevention of HF, including HF [with preserved ejection fraction],” Ning Ding, MD, ScM, data analyst at the Johns Hopkins Bloomberg School of Public Health, and colleagues wrote in the Journal of the American College of Cardiology.

Ding and colleagues analyzed 9,345 participants from the ARIC cohort (mean age, 70 years; age range, 61 to 81 years; 57% women; 21% Black) who were free from HF at baseline in 2005 to quantify the association between cigarette smoking and smoking cessation and development of HFpEF or HF with reduced ejection fraction.

In a median follow-up of 13 years, 1,215 patients developed HF. Compared with never smokers, current smokers were more likely to have a HF event (adjusted HR = 2.36; 95% CI, 1.92-2.9), a HFpEF event (aHR = 2.28; 95% CI, 1.67-3.1) or a HFrEF event (aHR = 2.16; 95% CI, 1.55-3), according to the researchers.

Sacubitril-valsartan eases PH in some heart failure patients

Sacubitril-valsartan — a combination oral therapy approved to treat heart failure — rapidly reduces pulmonary blood pressure in people with pulmonary hypertension (PH) associated with heart failure with preserved ejection fraction (HFpEF), according to data from a Phase 3 clinical trial.

Notably, these benefits were accompanied by reduced lung congestion and improved exercise capacity and quality of life, further supporting sacubitril/valsartan as a therapeutic option for people with HFpEF-associated PH (HFpEF-PH), the researchers noted.

The study, “Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension,” was published in the journal ESC Heart Failure.

In people with heart failure with reduced ejection fraction, the left side of their heart does not effectively pump blood throughout the body. However, many of these patients also have problems in the right side of the heart, which pumps blood through the vessels in the lungs, called pulmonary arteries.

Using electronic health records to predict mortality post COPD hospitalization

Several variables obtained from routine electronic health records (EHRs), including prescriptions in primary care and laboratory blood test results, are predictive of 90-day mortality following hospitalization for chronic obstructive pulmonary disease (COPD). These were among results of an analysis published in Pharmacological Research.

The researchers for the current study theorized that EHRs offer an opportunity for the development of a prognostic model representative of patients who are hospitalized with COPD, but that EHRs may not record some variables that are used in currently existing models. Although prognostic models based on EHRs can be built upon data from large numbers of patients who are treated by a broad range of health care professionals, the EHR rarely includes potentially important COPD-related information, such as patient questionnaires data related to smoking habits, severity of patients’ symptoms, and quality of life. The EHR also may not record physical examination results.

To explore the value of EHR data in predicting 90-day COPD mortality post hospitalization, the researchers conducted a retrospective cohort study among patients with an unplanned hospitalization for COPD in the NHS Greater Glasgow and Clyde area in Scotland between 2011 and 2017. The prespecified outcome of interest in the current study was all-cause mortality within 90 days of hospital discharge.

Inhaled treprostinil improves persistence, lowers risk for PAH hospitalization vs. iloprost

SAN FRANCISCO — Inhaled treprostinil significantly improved persistence, adherence and lowered risk for hospitalization compared with iloprost in patients with pulmonary arterial hypertension, researchers reported.

“For approved inhaled therapies, we have really two. Inhaled treprostinil is administered four times a day and iloprost must be administered six to nine times. The worry is that the more frequently you have to take a medication, the more difficult it is, particularly if you are having side effects such as cough or throat irritation at the time that it’s administered,” Charles D. Burger, MD, FCCP, pulmonologist in the department of medicine at Mayo Clinic in Jacksonville, Florida, told Healio during the American Thoracic Society International Conference.

Burger and colleagues conducted a retrospective, longitudinal cohort study analyzing administrative claims data from 467 adults with PAH (mean age, 64.2 years; 67.5% women) in the Optum de-identified Clinformatics Data Mart from January 2010 to September 2020. All patients were new initiators of inhaled treprostinil (United Therapeutics; n = 405) or iloprost (Bayer; n = 62) and had one or more inpatient or two or more outpatient medical claims with a pulmonary hypertension diagosnis separated by 30 days or longer.

Dysfunction of heart left ventricle linked to worse prognosis in IPAH

High scores on a measure known as H2FPEF — which reflect an increased probability of dysfunction of the left ventricle (LV) of the heart — were associated with signs of LV impairment and a worse prognosis in patients with idiopathic pulmonary arterial hypertension (IPAH), a study found.

Patients with high scores also tended to be older, obese, and male, and have worse functional abilities.

Notably, however, responses to treatment were equally positive among these patients compared with those who did not show signs of LV dysfunction, according to researchers.

“In contrast to our hypotheses, we observed favourable responses to PAH-treatment irrespective of H2FPEF-score,” the team wrote, noting that the so-called typical IPAH patient “is changing from a predominantly young female patient to an older, frequently obese patient of either sex.”

Unintended Weight Loss in outpatients with chronic obstructive pulmonary disease

In outpatients with chronic obstructive pulmonary disease (COPD), a high prevalence of unintended weight loss (UWL) has been reported, with nutrition impact symptoms (NIS) and reduced food intake (RFI) reported as UWL-associated characteristics, according to the results of a recent analysis published in the journal Clinical Nutrition ESPEN.

“Malnutrition is commonly seen in [COPD] and has been associated with negative outcomes,” noted authors of the current study. Because unintended weight loss is a potential indicator of COPD-related malnutrition, study investigators conducted a cross-sectional study to identify the prevalence of UWL and its associated characteristics in outpatients with COPD. Data from all patients who visited a COPD outpatient clinic at a Danish University Hospital between November 2020 and May 2021 were obtained via medical records and a patient questionnaire administered by the researchers.

Study inclusion criteria were age ≥18 years and the willingness to sign an informed consent after written and oral information was presented in Danish or English. Any patients who did not wish to be weighed and measured, and had not had their weight measured within the past week and their height measured within the past year, were excluded from the study.

Low sodium, need for vasopressors among PAH mortality risk factors

Despite recent advances in care, mortality while in the intensive care unit (ICU) and up to one year thereafter remains high among people with pulmonary arterial hypertension (PAH), a new study reports.

Risk factors for mortality one year after ICU discharge included low blood sodium, raised pro-B-type natriuretic peptide (proBNP; a heart disease marker), total bilirubin — a liver function marker — treatment with vasopressors/inotropes, mechanical ventilation, and kidney replacement therapy. Inotropes typically increase the ability of the heart muscle to contract and vasopressors narrow blood vessels, which increases blood pressure.

The study, “Causes and outcomes of ICU hospitalisations in patients with pulmonary arterial hypertension,” was published in ERJ Open Research.

PAH is still associated with high hospital admissions and mortality rates regardless of improvements in medical care and treatments. Although right heart failure has been identified as the leading cause of hospitalizations and mortality in PAH, the other risk factors involved are poorly characterized.

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