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2. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries
- Author
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Linschoten, M, Uijl, A, Schut, A, Jakob, CEM, Romao, LR, Bell, RM, McFarlane, E, Stecher, M, Zondag, AGM, van Iperen, EPA, Hermans-van Ast, JF, Lea, NC, Schaap, J, Jewbali, LS, Smits, PC, Patel, RS, Aujayeb, A, van Smeden, M, Siebelink, HJ, Williams, S, Pilgram, L, Tieleman, RG, Williams, B, Asselbergs, FW, Al-Ali, AK, Al-Muhanna, FA, Al-Rubaish, AM, Al-Windy, NYY, Alkhalil, M, Almubarak, YA, Al Nafie, AN, Al Shahrani, M, Al Shehri, AM, Anning, C, Anthonio, RL, Badings, EA, Ball, C, Van Beek, EA, Ten Berg, JM, Von Bergwelt-Baildon, M, Bianco, M, Blagova, O, Bleijendaal, H, Bor, WL, Borgmann, S, van Boxem, AJM, van den Brink, FS, Bucciarelli-Ducci, C, Van Bussel, BCT, Byrom-Goulthorp, R, Captur, G, Caputo, M, Charlotte, N, vom Dahl, J, Dark, P, De Sutter, J, Degenhardt, C, Delsing, CE, Dolff, S, Dorman, HGR, Drost, JT, Eberwein, L, Emans, ME, Er, AG, Ferreira, JB, Forner, MJ, Friedrichs, A, Gabriel, L, Groenemeijer, BE, Groenendijk, AL, Gruener, B, Guggemos, W, Haerkens-Arends, HE, Hanses, F, Hedayat, B, Heigener, D, van der Heijden, DJ, Hellou, E, Hellwig, K, Henkens, MTHM, Hermanides, RS, Hermans, WRM, van Hessen, MWJ, Heymans, SRB, Hilt, AD, van der Horst, ICC, Hower, M, van Ierssel, SH, Isberner, N, Jensen, B, Kearney, MT, Kielstein, JT, Kietselaer, BLJH, Kochanek, M, Kolk, MZH, Koning, AMH, Kopylov, PY, Kuijper, AFM, Kwakkel-van, ERPJM, Lanznaster, J, van der Linden, MMJM, van der Lingen, ACJ, Linssen, GCM, Lomas, D, Maarse, M, Magdelijns, FJH, Magro, M, Markart, P, Martens, FMAC, Mazzilli, SG, McCann, GP, van der Meer, P, Meijs, MFL, Merle, U, Messiaen, P, Milovanovic, M, Monraats, PS, Montagna, L, Moriarty, A, Moss, AJ, Mosterd, A, Nadalin, S, Nattermann, J, Neufang, M, Nierop, PR, Offerhaus, JA, Van Ofwegen-Hanekamp, CEE, Parker, E, Persoon, AM, Piepel, C, Pinto, YM, Poorhosseini, H, Prasad, S, Raafs, AG, Raichle, C, Rauschning, D, Redon, J, Reidinga, AC, Ribeiro, MIA, Riedel, C, Rieg, S, Ripley, DP, Rommele, C, Rothfuss, K, Ruddel, J, Ruthrich, MM, Salah, R, Saneei, E, Saxena, M, Schellings, DAAM, Scholte, NTB, Schubert, J, Seelig, J, Shafiee, A, Shore, AC, Spinner, C, Stieglitz, S, Strauss, R, Sturkenboom, NH, Tessitore, E, Thomson, RJ, Timmermans, PJR, Tio, RA, Tjong, FVY, Tometten, L, Trauth, J, Van Craenenbroeck, EM, van Veen, HPAA, den Uil, CA, Vehreschild, MJGT, Veldhuis, L, Veneman, T, Verschure, DO, Voigt, I, Walter, L, vande Watering, DJ, de Vries, JK, vande Wal, RMA, Westendorp, ICD, Westendorp, PHM, Westhoff, T, Weytjens, C, Wierda, E, Wille, K, de With, K, Worm, M, Woudstra, P, Wu, KW, Zaal, R, Zaman, AG, van der Zee, PM, Zijlstra, LE, Alling, TE, Ahmed, R, Bayraktar-Verver, ECE, van Aken, K, Jimenes, Bermudez FJ, Biole, CA, Den Boer-Penning, P, Bontje, M, Bos, M, Bosch, L, Broekman, M, Broeyer, FJF, de Bruijn, EAW, Bruinsma, S, Cardoso, NM, Cosyns, B, Len, van Da DH, Dekimpe, E, Domange, J, van Doorn, JL, van DOorn, P, Dormal, F, Drost, IMJ, Dunnink, A, van Eck, JWM, Elshinawy, K, Gevers, RMM, Gognieva, DG, van der Graaf, M, Grangeon, S, Guclu, A, Habib, A, Haenen, NA, Hamilton, K, Handgraaf, S, Heidbuchel, H, Hendriks-van Woerden, M, Hessels-Linnemeijer, BM, Hosseini, K, Huisman, J, Jacobs, TC, Jansen, SE, Janssen, A, Jourdan, K, ten Kate, GL, van Kempen, MJ, Kievit, CM, Kleikers, P, Knufman, N, van der Kooi, SE, Koole, BAS, Koole, MAC, Kui, KK, Kuipers-Elferink, L, Lemoine, I, Lensink, E, van Marrewijk, V, Meijer, EJ, Melein, AJ, Mesitskaya, DF, van Nes, CPM, Paris, FMA, Perrelli, MG, Pieterse-Rots, A, Pisters, R, Polkerman, BC, van Poppel, A, Reinders, S, Reitsma, MJ, Ruiter, AH, Selder, JL, van der Sluis, A, Sousa, AIC, Tajdini, M, Sanchez, Tercedor L, Van de Heyning, CM, Vial, H, Vlieghe, E, Vonkeman, HE, Vreugdenhil, P, de Vries, TAC, Willems, AM, Wils, AM, Zoet-Nugteren, SK, Cardiovascular Centre (CVC), Restoring Organ Function by Means of Regenerative Medicine (REGENERATE), Cardiology, Intensive Care, RS: CAPHRI - R5 - Optimising Patient Care, MUMC+: MA Medische Staf IC (9), RS: Carim - H02 Cardiomyopathy, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - V04 Surgical intervention, MUMC+: MA Intensive Care (3), UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service de cardiologie, CAPACITY-COVID Collaborative Consortium, LEOSS Study Group, Rheumatology, AII - Infectious diseases, AII - Inflammatory diseases, AMS - Musculoskeletal Health, AMS - Tissue Function & Regeneration, ACS - Heart failure & arrhythmias, General practice, Epidemiology and Data Science, Graduate School, Nuclear Medicine, and ACS - Atherosclerosis & ischemic syndromes
- Subjects
Male ,Cardiac & Cardiovascular Systems ,Epidemiology ,education ,Medizin ,Comorbidity ,AMERICAN-COLLEGE ,GUIDELINES ,DIAGNOSIS ,Cohort Studies ,Risk Factors ,MANAGEMENT ,Humans ,AcademicSubjects/MED00200 ,Hospital Mortality ,Aged ,Heart Failure ,Science & Technology ,SARS-CoV-2 ,COVID-19 ,ASSOCIATION ,Cardiovascular disease ,EUROPEAN-SOCIETY ,Hospitalization ,surgical procedures, operative ,Editorial ,Cardiovascular System & Cardiology ,behavior and behavior mechanisms ,HEART-FAILURE ,Female ,Patient registry ,Human medicine ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,psychological phenomena and processes ,TASK-FORCE - Abstract
Aims Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. Methods and results We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66–75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02–1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10–1.30; P Conclusion Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
- Published
- 2021
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3. Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction
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Bonaca, MP, Bhatt, DL, Cohen, M, Steg, PG, Storey, RF, Jensen, EC, Magnani, G, Bansilal, S, Fish, MP, Im, K, Bengtsson, O, Ophuis, TO, Budaj, A, Theroux, P, Ruda, M, Hamm, C, Goto, S, Spinar, J, Nicolau, JC, Kiss, RG, Murphy, SA, Wiviott, SD, Held, P, Braunwald, E, Sabatine, MS, Morin, S, Dantzer, E, Acquilano, D, McGuire, RL, Gannon, JB, Gershman, E, Ahlbom, AM, Boberg, B, Abola, MT, Ardissino, D, Aylward, P, Corbalan, R, Dalby, A, Diaz, R, Hu, DY, Isaza, D, Kamensky, G, Kiss, R, Kontny, F, Lopez-Sendon, J, Medina, F, Montalescot, G, Nicolau, J, Paolasso, E, Parkhomenko, A, Van De Werf, F, Anderson, JL, White, HD, Verheugt, FWA, Pedersen, TR, DeMets, DL, Lowe, C, Arevalo, C, Awtry, E, Berger, C, Croce, K, Desai, A, Gelfand, E, Ho, C, Leeman, D, Link, M, Norden, A, Pande, A, Rost, N, Ruberg, F, Silverman, S, Singhal, A, Vita, J, Alvarisqueta, A, De Gennaro, N, Berli, M, Roude, AE, Di Gennaro, JA, Albisu, JF, Caccavo, A, Torres, M, Cuadrado, J, Bordoni, P, Cuello, J, Aviles, A, Glenny, A, Recoaro, R, Fernandez, R, Strada, BN, Fuentealba, V, Gallo, C, Duran, RG, Garcia, C, Hominal, M, Castoldi, M, Jure, H, Pacora, FF, Lorenzatti, A, Martinez, JM, Macin, S, Cocco, N, MacKinnon, I, Bagnato, MB, Marino, J, Cusimano, S, Arias, V, Focaccia, M, Muntaner, J, Mansilla, V, Poy, C, Prado, A, Paterlini, G, Montana, O, Camino, A, Sala, J, Luciani, C, Vico, M, Morell, Y, Dumont, C, Vottero, E, Zangroniz, P, Lescano, A, Morara, P, Marquez, LL, Patron, FR, Labarta, GB, Sivila, CD, Quiroga, AR, Maffei, L, Sassone, S, Rolandi, F, Vesentini, N, Carnero, G, Del Verme, S, Hershson, A, Figal, JC, Viso, ME, Hii, C, Smith, K, Singh, B, Acampo, M, Rogers, J, ODonoghue, M, Amerena, J, Long, A, Dart, A, Kay, S, Worthley, M, Nimmo, J, Lehman, R, Morrison, H, Dick, R, Savage, C, van Gaal, W, Park, M, Blombery, P, McCarthy, C, Oqueli, E, Hill, D, Sader, M, Vrachas, D, Purnell, P, Vibert, J, Collins, N, Gordon, A, Arstall, M, Rose, J, Aroney, C, Cleave, P, Fitzpatrick, M, Mackenzie, M, Garrahy, P, Hall, C, Nelson, G, Reid, E, Lee, A, Gibbs, J, Thompson, P, Crittenden, J, Hammett, C, Hindom, L, Antonis, P, Manzoney, A, Cross, D, Pollard, C, Brieger, D, Wu, J, Whelan, A, Tulloch, G, Taylor, A, Smith, B, Horowitz, J, Black, M, Boland, J, Malmendier, D, Celen, H, Wendelen, E, Claeys, M, Pieter, M, Cools, F, Simons, N, De Maeseneire, S, De Wolf, L, Brike, C, Dubois, P, Bolado, ACY, Foading-Deffo, B, Tahon, S, Friart, A, Arend, C, Gevaert, S, Verdegem, P, Marechal, P, Gits, F, Pierard, L, Celentano, C, Pirenne, B, Bouvy, C, Renkin, J, Huyberechts, D, Sinnaeve, P, De Velder, L, Stammen, F, Casier, T, Striekwold, H, Van den Broeck, D, Thoeng, J, Goris, R, Timmermans, P, Collard, SJ, Van De Borne, P, De Clippel, M, Wollaert, B, Jacobs, C, Vankelecom, B, Daelemans, Y, Vervoort, G, Drieghe, S, Vranckx, P, Janssen, A, Vrolix, M, Simenon, I, Wijns, W, Delacroix, H, Denie, D, Schoors, D, Lemoine, I, Cornelis, K, Willems, AM, Schroder, E, Domange, J, Greque, G, Machado, H, Armaganijan, D, Del Monaco, MI, da Silva, D, Nakazone, R, Dutra, O, Vaz, R, Daher, R, Rodrigues, D, Guimaraes, A, Teixeira, A, Saraiva, J, Leaes, P, Blacher, M, Maia, L, Nakazone, MA, Manenti, E, Ruschel, K, Marin-Neto, J, Pavao, R, Preto, R, Junior, AA, Oliveira, G, Rassi, S, Sampaio, D, Rossi, PR, dos Santos, L, de Souza, J, Lino, E, Filho, PP, Zucchetti, C, Gomes, M, de Paiva, A, Sousa, AC, Almeida, A, Botelho, R, da Silva, R, Giraldez, R, Franken, M, Faludi, A, Bertolami, M, Hernandes, M, Lucas, N, Carvalho, A, Bertolami, A, Precoma, D, Geralde, L, Pereira, A, Cesar, L, Mioto, B, Marino, R, Rabelo, W, dos Santos, F, Vidotti, M, Mangione, J, Mauro, M, Kormann, A, Ultramari, F, Zimmermann, S, Michalaros, Y, Fonseca, M, Sampaio, C, Eliaschewitz, F, Barbosa, E, Drews, C, de Lorenzo, A, Barros, C, Cancado, G, Neuesnchwander, F, Zimmermann, E, Chompalova, B, Denchev, S, Gocheva, N, Mihov, A, Mincheva, V, Gelev, V, Tisheva, S, Todorov, G, Goudev, A, Parvanova, Z, Todorova, M, Mitkova, M, Smilov, L, Yakovova, S, Milanova, K, Aleksov, N, Mollov, M, Shishmanova, D, Hristova, K, Uzunangelov, Y, Peltegov, V, Karamitev, G, Benov, H, Vasileva, D, Parishev, G, Milcheva, N, Avramov, D, Miteva, B, Stoyanovski, V, Pencheva, G, Nikolova, L, Stancheva, N, Nyagina, M, Markov, D, Spirova, D, Peneva, Y, Peshkov, O, Mitkova, L, Mandzhukova, S, Rangelova, V, Ivanov, K, Krusheva, B, Raycheva, V, Gergova, V, Goranov, K, Stoykov, A, Staleva, M, Rashkova, V, Postadzhian, A, Krancheva, V, Lulova, E, Delchev, G, Cantor, W, Constance, C, Gosselin, G, Marr, D, Pandey, A, Pesant, Y, Pouliot, J, Gladstone, P, McPherson, T, Rupka, D, Saw, J, St-Amour, E, Syan, G, Syan, R, Rosenbloom, A, Vizel, S, Della Siega, A, Halperin, F, Nigro, F, Chehayeb, R, Fell, D, Labonte, R, Nawaz, S, Gupta, M, Ma, P, Glanz, A, Kouz, S, Bhargava, R, Dion, D, Dupuis, R, Grondin, F, Wong, B, Sabbah, E, Hui, W, Belisle, P, Tymchak, W, Montigny, M, Lonn, E, Bose, S, Kincade, D, Gallo, R, Lamy, A, Bell, A, Lemay, M, Bata, I, Kostuk, W, Cheung, S, Petrella, R, Lubelsky, B, Berlingieri, J, Fortin, C, DeYoung, J, Babapulle, M, Landry, D, Gupta, A, Bertrand, O, Jadin, M, Robbins, K, Gauthier, MF, Masson, C, Reyes, V, O'Blenis, G, Clarus, S, Sardin, V, Marquette, S, Bozek, B, Spurrell, D, Thiessen, S, Fox, R, Tremblay, I, Singh, J, Samms, S, Ross, B, Solomon, P, Nelson, S, Roberts, P, Forsyth, C, Lepage, C, McPherson, C, Dewar, C, Dela Cruz, C, Louch, D, Vilag, C, Roy, M, Stata, C, Morissette, A, Ouimet, F, Bilodeau, N, Chausse, I, Kvill, L, Chartrand, MJ, Harris, L, Bolduc, H, Magi, A, Jule, P, Valley, S, Morrissette, J, Power, P, Kailey, P, Thomas, A, Wright, D, Carr, S, Cleveland, T, Dihel, C, Coldwell, J, Schellenberg, S, Viau, C, Watt, M, Corke, R, Shea-Landry, G, Gandhi, A, Tishler, S, Prieto, JC, Noriega, V, Cobos, L, Obreque, C, Potthof, S, Zapata, J, Lucero, F, Luque, M, Pincetti, C, Torres, G, Yanez, M, Vasquez, C, Manriquez, L, Espinoza, MJ, Yovaniniz, P, Grandon, M, Castro, P, Llevaneras, S, Lanas, F, Hidalgo, J, Arriagada, G, Villan, C, Florenzano, F, Chacon, MV, Rodriguez, M, Barreda, B, Raffo, C, Reyes, T, Hu, D, Liu, W, Tan, N, Feng, Y, Dong, Y, Yang, D, Liao, Y, Wei, F, Wei, M, Yan, M, Yan, X, Wang, S, Li, Y, Yuan, Z, Xiong, Y, Zhu, J, Li, S, Ma, G, Chen, L, Li, Z, Liu, Y, Xiong, W, Pang, W, Chen, Y, Lu, G, Chen, Z, Zhao, S, Zhou, H, Huang, J, Gang, Y, Chai, Y, Yang, X, Zhang, Z, Mu, Z, Hernandez, E, Mora, C, Maria, E, Catalan, Y, Reynales, H, Huertas, D, Molina, D, Rendon, N, Sanchez, G, Tellez, R, Botero, R, Salazar, P, Vesga, B, Delgado, P, Herrera, M, Perez, D, Jaramillo, N, Toloza, R, Orozco, A, Bustamante, Y, Jaramillo, C, Garces, G, Saaibi, J, Castillo, J, Arana, C, Gonzalez, M, Urina, M, Ramirez, N, Manzur, F, Rosales, D, Quintero, A, Gonzalez, E, Accini, J, Reyes, M, Elbl, L, Malecha, J, Stanek, L, Jerabek, O, Lubanda, H, Kos, P, Zidkova, E, Vlckova, D, Naplava, R, Ludka, O, Ludkova, A, Soucek, M, Kuchar, J, Poloczek, M, Wasserburger, B, Panovsky, R, Linhart, A, Rihacek, I, Macha, J, Grunfeldova, H, Spinarova, L, Zanova, M, Bren, J, Zarembova, J, Cermak, O, Sembera, Z, Svobodova, I, Monhart, Z, Pleva, L, Sipula, J, Polasek, R, Kolmas, P, Dedek, V, Janota, T, Stipal, R, Kucera, D, Bednarova, J, Broulova, P, Lukac, M, Hanak, P, Reichert, P, Bouchal, P, Turkova, N, Krocova, E, Petrova, I, Matyasek, I, Brychta, T, Machova, V, Marusincova, I, Sperlingova, B, Macquin-Mavier, T, Khalife, K, Galley, D, Elhadad, S, Decoulx, E, Cottin, Y, Coisne, D, Bonnet, JL, Ferrari, E, Range, G, Cayla, G, Goralski, M, Furber, A, Elbaz, M, Aboyans, V, Poulard, JE, Zemour, G, Labeque, JN, Hirsch, JL, Vaquette, B, Livarek, B, Igigabel, P, Lafitte, S, Oudghiri, M, Bertin, B, Beitar, T, Merkling, D, Beltra, C, Maubert, A, El Jarroudi, M, Bichat, F, Berger, N, Fiacchetti, C, Douillet, M, Laure, C, Leperchois-Jacquey, C, Miran, S, Cornet, C, Rosolin, N, Pradel, V, Leparree, S, Doux, N, Mais, C, Sevilla, J, Laurencon, V, Georges, J, Gilard, V, Duprat, C, Giannitsis, E, Schenkenberger, I, Appel, KF, Toursarkissian, N, Bott, J, Nischik, R, Schmidt, E, Jung, T, Steiner, S, Khariouzov, A, Heuer, H, Kadel, C, Hanefeld, M, Weil, J, Koenig, W, Horacek, T, Muenzel, T, Brachmann, J, Weber, D, Wittlich, N, Stellbrink, C, Dungen, HD, Leschke, M, Zeymer, U, Dorsel, T, Voehringer, HF, Dissmann, M, Vom Dahl, J, Derwahl, KM, Trenk, D, Frey, N, Schroeder, T, Foerster, A, Bartels, R, Kisselbach, C, Deigentasch, H, Dreykluft, K, Becker, P, Scheuren, A, Erdas, M, Wipper, J, Schmidt, A, Henzler, A, Winter, K, Fischer, S, Kopf, S, Laschewski, B, Rahn, G, Schrapel, C, Miodek, M, Hildenbrand, S, Fink, P, Gebel, G, Goebel, U, Siepmann, C, Drexler, A, Maiwald, A, Blaich, B, Baumann, S, Iselt, M, Gebhardt, S, Kazcmarek, N, Krug-Hoeren, B, Traubler, B, Nicula, D, Reichenbach, D, Langer, C, Kiroglu, K, Riedel, S, Schulte, M, Borst, M, Katona, A, Vertes, A, Merkely, B, Ungi, I, Kiraly, C, Zolyomi, S, Horvath, I, Lupkovics, G, Edes, I, Simon, E, Czuriga, I, Laszlo, Z, Kancz, S, Takacs, J, Papp, A, 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G, Russo, G, Rizzotti, D, Orsini, E, Saponetti, LS, Babbolin, M, De Divitiis, M, Patti, G, Monti, F, Silvestri, N, Valbusa, A, Lazzarotti, M, Puccetti, L, Grikstaite, E, Patrizi, G, Bosco, B, Marchegiano, R, Takenaka, T, Ono, M, Suzuki, M, Hasegawa, K, Domae, H, Fukui, K, Iseki, H, Aoyama, T, Suzuki, C, Sakai, R, Hashimoto, T, Inoko, M, Sasaki, T, Kataoka, T, Okutsu, M, Yasaka, Y, Miyamoto, T, Tomobuchi, Y, Tamura, R, Hosokawa, S, Komura, Y, Takahashi, N, Mima, T, Sadamatsu, K, Fujimoto, K, Matsumura, T, Koide, S, Himi, T, Hashimoto, Y, Yamasaki, M, Okubo, M, Takase, H, Morii, I, Utsu, N, Higashino, Y, Shigematsu, S, Nakagawa, T, Ota, T, Takahashi, W, Kakishita, M, Hayashi, Y, Momiyama, Y, Baden, M, Saeki, T, Hiroi, S, Wada, A, Nakata, A, Nishi, Y, Hirasawa, S, Shibata, Y, Fukuzawa, S, Machida, M, Takama, N, Teranishi, J, Sakuma, K, Abe, Y, Suzuki, A, Yamazaki, A, Nakachi, T, Nagayama, H, Fujino, S, Tsurukai, A, Nojima, S, Ishiguchi, Y, Hada, K, Nakatani, K, Yamamoto, K, Matsuo, A, 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- Abstract
BACKGROUND The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y(12) receptor antagonist with established efficacy after an acute coronary syndrome, in this context. METHODS We randomly assigned, in a double-blind 1: 1: 1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. RESULTS The two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan-Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P = 0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P = 0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P < 0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively. CONCLUSIONS In patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding. (Funded by AstraZeneca; PEGASUS-TIMI 54 ClinicalTrials.gov number, NCT01225562.)
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- 2015
4. Serial cardiac biomarkers, pulmonary artery pressures and traditional parameters of fluid status in relation to prognosis in patients with chronic heart failure: Design and rationale of the BioMEMS study.
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Allach Y, Barry-Loncq de Jong M, Clephas PRD, van Gent MWF, Brunner-La Rocca HP, Szymanski MK, van Halm VP, Handoko ML, Kok WEM, Asselbergs FW, van Kimmenade RRJ, Manintveld OC, van Mieghem NMDA, Beeres SLMA, Rienstra M, Post MC, van Heerebeek L, Borleffs CJW, Tukkie R, Mosterd A, Linssen GCM, Spee RF, Emans ME, Smilde TDJ, van Ramshorst J, Kirchhof CJHJ, Feenema-Aardema MW, da Fonseca CA, van den Heuvel M, Hazeleger R, van Eck JWM, Boersma E, Kardys I, de Boer RA, and Brugts JJ
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- Humans, Prognosis, Female, Male, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Aged, Pulmonary Wedge Pressure physiology, Chronic Disease, Middle Aged, Heart Failure physiopathology, Heart Failure blood, Biomarkers blood, Pulmonary Artery physiopathology
- Abstract
Aims: Heart failure (HF), a global pandemic affecting millions of individuals, calls for adequate predictive guidance for improved therapy. Congestion, a key factor in HF-related hospitalizations, further underscores the need for timely interventions. Proactive monitoring of intracardiac pressures, guided by pulmonary artery (PA) pressure, offers opportunities for efficient early-stage intervention, since haemodynamic congestion precedes clinical symptoms., Methods: The BioMEMS study, a substudy of the MONITOR-HF trial, proposes a multifaceted approach integrating blood biobank data with traditional and novel HF parameters. Two additional blood samples from 340 active participants in the MONITOR-HF trial were collected at baseline, 3-, 6-, and 12-month visits and stored for the BioMEMS biobank. The main aims are to identify the relationship between temporal biomarker patterns and PA pressures derived from the CardioMEMS-HF system, and to identify the biomarker profile(s) associated with the risk of HF events and cardiovascular death., Conclusion: Since the prognostic value of single baseline measurements of biomarkers like N-terminal pro-B-type natriuretic peptide is limited, with the BioMEMS study we advocate a dynamic, serial approach to better capture HF progression. We will substantiate this by relating repeated biomarker measurements to PA pressures. This design rationale presents a comprehensive review on cardiac biomarkers in HF, and aims to contribute valuable insights into personalized HF therapy and patient risk assessment, advancing our ability to address the evolving nature of HF effectively., (© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2024
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5. Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study.
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Malgie J, Wilde MI, Clephas PRD, Emans ME, Koudstaal S, Schaap J, Mosterd A, van Ramshorst J, Wardeh AJ, van Wijk S, van den Heuvel M, Wierda E, Borleffs CJW, Saraber C, Beeres SLMA, van Kimmenade R, Jansen Klomp W, Denham R, da Fonseca CA, Klip IT, Manintveld OC, van der Boon RMA, van Ofwegen CEE, Yilmaz A, Pisters R, Linssen GCM, Faber N, van Heerebeek L, van de Swaluw JEC, Bouhuijzen LJ, Post MC, Kuijper AFM, Wu KW, van Beek EA, Hesselink T, Kleijn L, Kurvers MJM, Tio RA, Langerveld J, van Dalen BM, van Eck JWM, Handoko ML, Hermans WRM, Koornstra-Wortel HJJ, Szymanski MK, Rooker D, Tandjung K, Eijsbouts SCM, Asselbergs FW, van der Meer P, Brunner-La Rocca HP, de Boer RA, and Brugts JJ
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- Humans, Female, Male, Aged, Middle Aged, Netherlands, Practice Guidelines as Topic, Prospective Studies, Chronic Disease, Adrenergic beta-Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Cardiovascular Agents therapeutic use, Drug Therapy, Combination, Heart Failure drug therapy, Heart Failure physiopathology, Stroke Volume physiology, Registries, Disease Progression
- Abstract
Aims: Despite clear guideline recommendations for initiating four drug classes in all patients with heart failure (HF) with reduced ejection fraction (HFrEF) and the availability of rapid titration schemes, information on real-world implementation lags behind. Closely following the 2021 ESC HF guidelines and 2023 focused update, the TITRATE-HF study started to prospectively investigate the use, sequencing, and titration of guideline-directed medical therapy (GDMT) in HF patients, including the identification of implementation barriers., Methods and Results: TITRATE-HF is an ongoing long-term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63-78), 29% were female, and median ejection fraction was 35% (IQR 25-40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non-use in HFrEF patients was related to side-effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF., Conclusion: This first analysis of the TITRATE-HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management., (© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
- Published
- 2024
- Full Text
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6. Colchicine in Patients With Chronic Coronary Disease in Relation to Prior Acute Coronary Syndrome.
- Author
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Opstal TSJ, Fiolet ATL, van Broekhoven A, Mosterd A, Eikelboom JW, Nidorf SM, Thompson PL, Duyvendak M, van Eck JWM, van Beek EA, den Hartog F, Budgeon CA, Bax WA, Tijssen JGP, El Messaoudi S, and Cornel JH
- Subjects
- Dose-Response Relationship, Drug, Double-Blind Method, Drug Monitoring, Female, Gout Suppressants administration & dosage, Gout Suppressants adverse effects, Humans, Incidence, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction etiology, Outcome Assessment, Health Care, Risk Assessment, Secondary Prevention methods, Stroke diagnosis, Stroke etiology, Time-to-Treatment, Acute Coronary Syndrome complications, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome drug therapy, Colchicine administration & dosage, Colchicine adverse effects
- Abstract
Background: Colchicine reduces risk of cardiovascular events in patients post-myocardial infarction and in patients with chronic coronary disease. It remains unclear whether this effect is related to the time of onset of treatment following an acute coronary syndrome (ACS)., Objectives: This study investigates risk for major adverse cardiovascular events in relation to history and timing of prior ACS, to determine whether the benefits of colchicine are consistent independent of prior ACS status., Methods: The LoDoCo2 (Low-Dose Colchicine 2) trial randomly allocated patients with chronic coronary disease to colchicine 0.5 mg once daily or placebo. The rate of the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization was compared between patients with no prior, recent (6-24 months), remote (2-7 years), or very remote (>7 years) ACS; interaction between ACS status and colchicine treatment effect was assessed., Results: In 5,522 randomized patients, risk of the primary endpoint was independent of prior ACS status. Colchicine consistently reduced the primary endpoint in patients with no prior ACS (incidence: 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.52-1.27), recent ACS (incidence: 2.4 vs 3.3 events per 100 person-years; HR: 0.75; 95% CI: 0.51-1.10), remote ACS (incidence: 1.8 vs 3.2 events per 100 person-years, HR: 0.55; 95% CI: 0.37-0.82), and very remote ACS (incidence: 3.0 vs 4.3 events per 100 person-years, HR: 0.70; 95% CI: 0.51-0.96) (P for interaction = 0.59)., Conclusions: The benefits of colchicine are consistent irrespective of history and timing of prior ACS. (The LoDoCo2 Trial: Low Dose Colchicine for secondary prevention of cardiovascular disease [LoDoCo2] ACTRN12614000093684)., Competing Interests: Funding Support and Author Disclosures This trial was supported by the National Health Medical Research Council of Australia; a grant from the Sir Charles Gairdner Research Advisory Committee; the Withering Foundation (the Netherlands); the Netherlands Heart Foundation; the Netherlands Organization for Health Research and Development; and a consortium of Teva, Disphar, and Tiofarma in the Netherlands. The funders did not have any role in the design or conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. Dr Mosterd has received grants from Novartis; and has received personal fees from Amarin, Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Merck Sharp and Dohme, and Pfizer. Dr Eikelboom has received consulting/honoraria support from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Pfizer, Janssen, Sanofi, and Servier; and has received grants and/or in-kind support from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Pfizer, Janssen, and Sanofi. Dr Thompson has received grants, travel support, and honoraria from Amarin, Amgen, AstraZeneca, Bristol Myers Squibb, Merck, and Pfizer. Dr Cornel has served on the advisory board for Amgen and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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7. Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF).
- Author
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Damman K, Beusekamp JC, Boorsma EM, Swart HP, Smilde TDJ, Elvan A, van Eck JWM, Heerspink HJL, and Voors AA
- Subjects
- Aged, Double-Blind Method, Female, Humans, Male, Natriuretic Peptide, Brain, Peptide Fragments, Pilot Projects, Treatment Outcome, Benzhydryl Compounds therapeutic use, Glucosides therapeutic use, Heart Failure drug therapy
- Abstract
Aims: Inhibition of sodium-glucose co-transporter 2 (SGLT2) reduces the risk of death and heart failure (HF) admissions in patients with chronic HF. However, safety and clinical efficacy of SGLT2 inhibitors in patients with acute decompensated HF are unknown., Methods and Results: In this randomized, placebo-controlled, double-blind, parallel group, multicentre pilot study, we randomized 80 acute HF patients with and without diabetes to either empagliflozin 10 mg/day or placebo for 30 days. The primary outcomes were change in visual analogue scale (VAS) dyspnoea score, diuretic response (weight change per 40 mg furosemide), change in N-terminal pro brain natriuretic peptide (NT-proBNP), and length of stay. Secondary outcomes included safety and clinical endpoints. Mean age was 76 years, 33% were female, 47% had de novo HF and median NT-proBNP was 5236 pg/mL. No difference was observed in VAS dyspnoea score, diuretic response, length of stay, or change in NT-proBNP between empagliflozin and placebo. Empagliflozin reduced a combined endpoint of in-hospital worsening HF, rehospitalization for HF or death at 60 days compared with placebo [4 (10%) vs. 13 (33%); P = 0.014]. Urinary output up until day 4 was significantly greater with empagliflozin vs. placebo [difference 3449 (95% confidence interval 578-6321) mL; P < 0.01]. Empagliflozin was safe, well tolerated, and had no adverse effects on blood pressure or renal function., Conclusions: In patients with acute HF, treatment with empagliflozin had no effect on change in VAS dyspnoea, diuretic response, NT-proBNP, and length of hospital stay, but was safe, increased urinary output and reduced a combined endpoint of worsening HF, rehospitalization for HF or death at 60 days., (© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
- Published
- 2020
- Full Text
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