Search

Abstract Aims This study aimed to evaluate the cumulative high‐sensitivity cardiac troponin T (hs‐cTNT) from admission to 12 months after discharge and its association with mortality after 12 months among patients with acute heart failure (HF). Methods We used data from the China Patient‐Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p‐HF Study), which enrolled patients hospitalized primarily for HF from 52 hospitals between 2016 and 2018. We included patients who survived within 12 months and had hs‐cTNT data at admission (within 48 h of admission) and 1 and 12 months after discharge. To evaluate the long‐term cumulative hs‐cTNT, we calculated cumulative hs‐cTNT levels and cumulative times of high hs‐cTNT level. Patients were divided into groups according to the quartiles of cumulative hs‐cTNT levels (Quartiles 1–4) and cumulative times of high hs‐cTNT levels (0–3 times). Multivariable Cox models were constructed to examine the association of cumulative hs‐cTNT with mortality during the follow‐up period. Results We included 1137 patients with a median age of 64 [interquartile range (IQR), 54–73] years; 406 (35.7%) were female. The median cumulative hs‐cTNT level was 150 (IQR, 91–241) ng/L*month. Based on the cumulative times of high hs‐cTNT levels, 404 (35.5%) patients were with zero time, 203 (17.9%) with one time, 174 (15.3%) with two times, and 356 (31.3%) with three times. During a median follow‐up of 4.76 (IQR, 4.25–5.07) years, 303 (26.6%) all‐cause deaths occurred. The increasing cumulative hs‐cTNT level and cumulative times of high hs‐cTNT level were independently associated with excess all‐cause mortality. Compared with Quartile 1 group, Quartile 4 had the highest hazard ratio (HR) of all‐cause mortality [4.14; 95% confidence interval (CI): 2.51–6.85], followed by Quartile 3 (HR: 3.35; 95% CI: 2.05–5.48) and Quartile 2 (HR: 2.47; 95% CI: 1.49–4.08) groups. Similarly, taking the patients with zero time of high hs‐cTNT level as the reference, the HRs were 1.60 (95% CI: 1.05–2.45), 2.61 (95% CI: 1.76–3.87), and 2.86 (95% CI: 1.98–4.14) in patients who had one, two, and three times of high hs‐cTNT level, respectively. Conclusions Elevated cumulative hs‐cTNT from admission to 12 months after discharge was independently associated with mortality after 12 months among patients with acute HF. Repeated measurements of hs‐cTNT after discharge may help monitor the cardiac damage and identify patients with high risk of death.

Background Elevated hsCRP (high‐sensitivity C‐reactive protein) level is associated with worse prognosis among patients hospitalized for heart failure. However, the prognostic value of the long‐term cumulative hsCRP remains unknown. Methods and Results We consecutively enrolled patients hospitalized for heart failure and collected their hsCRP data at admission and 1 and 12 months after discharge. Long‐term cumulative hsCRP was evaluated using 2 approaches, cumulative hsCRP level quartiles and cumulative times of high hsCRP levels. Patients were classified into 4 groups by cumulative hsCRP level quartiles and cumulative times of high hsCRP levels (0‐ to 3‐times: number of times that hsCRP levels were higher than cutoff values at admission or 1 or 12 months), respectively. Multivariable Cox models were used to assess the association of mortality with cumulative hsCRP. A total of 1281 patients were included; the median age was 64 (interquartile range, 54–73) years, and 35.4% were women. Over a 4.8‐year (interquartile range, 4.2–5.1) follow‐up, 374 (29.2%) patients died. Elevated long‐term cumulative hsCRP level was related to higher mortality. Specifically, taking the quartile 1 as the reference, the hazard ratios (HRs) were 1.29 (95% CI, 0.92–1.81) for quartile 2, 1.62 (95% CI, 1.16–2.25) for quartile 3, and 2.38 (95% CI, 1.75–3.23) for quartile 4. Similarly, compared with the patients with 0‐times (hsCRP level lower than the cutoff values in all 3 time points) of high hsCRP level, the HRs were 1.36 for 1‐time (hsCRP level higher than the cutoff value in one of the 3 time points) (95% CI, 0.92–2.01), 1.95 for 2‐times (hsCRP levels higher than the cutoff values in 2 of the 3 time points) (95% CI, 1.34–2.82), and 2.80 for 3‐times (hsCRP levels higher than the cutoff values in the 3 time points) (95% CI, 1.97–4.00). Conclusions Increasing long‐term cumulative hsCRP level was associated with worse outcomes in patients hospitalized for acute heart failure. Repeated hsCRP measurements could assist physicians in identifying patients with a high risk of death. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT 02878811.

Background Improving health status is one of the major goals in the management of heart failure (HF). However, little is known about the long‐term individual trajectories of health status in patients with acute HF after discharge. Methods and Results We enrolled 2328 patients hospitalized for HF from 51 hospitals prospectively and measured their health status via the Kansas City Cardiomyopathy Questionnaire–12 at admission and 1, 6, and 12 months after discharge, respectively. The median age of the patients included was 66 years, and 63.3% were men. Six patterns of Kansas City Cardiomyopathy Questionnaire–12 trajectories were identified by a latent class trajectory model: persistently good (34.0%), rapidly improving (35.5%), slowly improving (10.4%), moderately regressing (7.4%), severely regressing (7.5%), and persistently poor (5.3%). Advanced age, decompensated chronic HF, HF with mildly reduced ejection fraction, HF with preserved ejection fraction, depression symptoms, cognitive impairment, and each additional HF rehospitalization within 1 year of discharge were associated with unfavorable health status (moderately regressing, severely regressing, and persistently poor) (P

ObjectiveTo quantitatively characterize the pattern of systemic impairment reflected by conventional biomarkers and assess how it relates to clinical outcomes and quality of life among patients hospitalized for heart failure (HF).MethodsPatients hospitalized for HF from 52 hospitals in China were enrolled between 2016 and 2018. They were divided into developing and validating cohorts; the developing cohort was used for calculating the weights of biomarkers and constructing the multi-biomarker panel, while the validating one was used for evaluating the relationship between multi-biomarker points and outcomes. In total, five conventional biomarkers reflecting various pathophysiological processes were included in the panel: N-terminal pro-B type natriuretic peptide, high-sensitivity troponin T, hemoglobin, albumin, and creatinine. The weights of the biomarkers were defined based on their relationship with cardiovascular death, and each patient had a multi-biomarker point ranging from 0 to 12. The primary clinical outcome was cardiovascular death, and the other clinical outcomes included rehospitalization for HF, all-cause death, and all-cause rehospitalization in 1-year. The quality of life was measured using Kansas City Cardiovascular Questionnaire. Multi-variable Cox proportional hazard models were used to assess the risks of clinical outcomes, and generalized linear models were used to evaluate the quality of life.ResultsIn total, 4,693 patients hospitalized for HF were included in this analysis; the median (interquartile range, IQR) age was 67 (57–75) years old and 1,763 (37.6%) were female. The median multi-biomarker point was 5 (IQR, 2–6). There were 18.0% of patients in the low point group (6). Compared with those in the low point group, the patients in the high point group had a significantly excess risk of cardiovascular death (adjusted hazard ratio: 5.69, 95% CI, 3.33–9.70). Furthermore, patients with higher points were also more prone to worse quality of life.ConclusionSystemic impairment reflected by abnormal conventional biomarker values was common amongst patients hospitalized for HF and had substantially cumulative adverse influence on clinical outcomes and quality of life.