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Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany

AIMS: Whereas syncopal episodes are a frequent complication of cardiovascular disorders, including heart failure (HF), little is known whether syncopes impact the prognosis of patients with HF. We aimed to assess the impact of a history of syncope (HoS) on overall and hospitalization‐free survival o...

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Autores principales: Hashemi, Djawid, Blum, Moritz, Mende, Meinhard, Störk, Stefan, Angermann, Christiane E., Pankuweit, Sabine, Tahirovic, Elvis, Wachter, Rolf, Pieske, Burkert, Edelmann, Frank, Düngen, Hans‐Dirk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261586/
https://www.ncbi.nlm.nih.gov/pubmed/32003157
http://dx.doi.org/10.1002/ehf2.12605
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author Hashemi, Djawid
Blum, Moritz
Mende, Meinhard
Störk, Stefan
Angermann, Christiane E.
Pankuweit, Sabine
Tahirovic, Elvis
Wachter, Rolf
Pieske, Burkert
Edelmann, Frank
Düngen, Hans‐Dirk
author_facet Hashemi, Djawid
Blum, Moritz
Mende, Meinhard
Störk, Stefan
Angermann, Christiane E.
Pankuweit, Sabine
Tahirovic, Elvis
Wachter, Rolf
Pieske, Burkert
Edelmann, Frank
Düngen, Hans‐Dirk
author_sort Hashemi, Djawid
collection PubMed
description AIMS: Whereas syncopal episodes are a frequent complication of cardiovascular disorders, including heart failure (HF), little is known whether syncopes impact the prognosis of patients with HF. We aimed to assess the impact of a history of syncope (HoS) on overall and hospitalization‐free survival of these patients. METHODS AND RESULTS: We pooled the data of prospective, nationwide, multicentre studies conducted within the framework of the German Competence Network for Heart Failure including 11 335 subjects. Excluding studies with follow‐up periods <10 years, we assessed 5318 subjects. We excluded a study focusing on cardiac changes in patients with an HIV infection because of possible confounding factors and 849 patients due to either missing key parameters or missing follow‐up data, resulting in 3594 eligible subjects, including 2130 patients with HF [1564 patients with heart failure with reduced ejection fraction (HFrEF), 314 patients with heart failure with mid‐range ejection fraction, and 252 patients with heart failure with preserved ejection fraction (HFpEF)] and 1464 subjects without HF considered as controls. HoS was more frequent in the overall cohort of patients with HF compared with controls (P < 0.001)—mainly driven by the HFpEF subgroup (HFpEF vs. controls: 25.0% vs. 12.8%, P < 0.001). Of all the subjects, 14.6% reported a HoS. Patients with HFrEF in our pooled cohort showed more often syncopes than subjects without HF (15.0% vs. 12.8%, P = 0.082). Subjects with HoS showed worse overall survival [42.4% vs. 37.9%, hazard ratio (HR) = 1.21, 99% confidence interval (0.99, 1.46), P = 0.04] and less days alive out of hospital [HR = 1.39, 99% confidence interval (1.18, 1.64), P < 0.001] compared with all subjects without HoS. Patients with HFrEF with HoS died earlier [30.3% vs. 41.6%, HR = 1.40, 99% confidence interval (1.12, 1.74), P < 0.001] and lived fewer days out of hospital than those without HoS. We could not find these changes in mortality and hospital‐free survival in the heart failure with mid‐range ejection fraction and HFpEF cohorts. HoS represented a clinically high‐risk profile within the HFrEF group—combining different risk factors. Further analyses showed that among patients with HFrEF with HoS, known cardiovascular risk factors (e.g. age, male sex, diabetes mellitus, and anaemia) were more prevalent. These constellations of the risk factors explained the effect of HoS in a multivariable Cox regression models. CONCLUSIONS: In a large cohort of patients with HF, HoS was found to be a clinically and easily accessible predictor of both overall and hospitalization‐free survival in patients with HFrEF and should thus routinely be assessed.
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spelling pubmed-72615862020-06-01 Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany Hashemi, Djawid Blum, Moritz Mende, Meinhard Störk, Stefan Angermann, Christiane E. Pankuweit, Sabine Tahirovic, Elvis Wachter, Rolf Pieske, Burkert Edelmann, Frank Düngen, Hans‐Dirk ESC Heart Fail Original Research Articles AIMS: Whereas syncopal episodes are a frequent complication of cardiovascular disorders, including heart failure (HF), little is known whether syncopes impact the prognosis of patients with HF. We aimed to assess the impact of a history of syncope (HoS) on overall and hospitalization‐free survival of these patients. METHODS AND RESULTS: We pooled the data of prospective, nationwide, multicentre studies conducted within the framework of the German Competence Network for Heart Failure including 11 335 subjects. Excluding studies with follow‐up periods <10 years, we assessed 5318 subjects. We excluded a study focusing on cardiac changes in patients with an HIV infection because of possible confounding factors and 849 patients due to either missing key parameters or missing follow‐up data, resulting in 3594 eligible subjects, including 2130 patients with HF [1564 patients with heart failure with reduced ejection fraction (HFrEF), 314 patients with heart failure with mid‐range ejection fraction, and 252 patients with heart failure with preserved ejection fraction (HFpEF)] and 1464 subjects without HF considered as controls. HoS was more frequent in the overall cohort of patients with HF compared with controls (P < 0.001)—mainly driven by the HFpEF subgroup (HFpEF vs. controls: 25.0% vs. 12.8%, P < 0.001). Of all the subjects, 14.6% reported a HoS. Patients with HFrEF in our pooled cohort showed more often syncopes than subjects without HF (15.0% vs. 12.8%, P = 0.082). Subjects with HoS showed worse overall survival [42.4% vs. 37.9%, hazard ratio (HR) = 1.21, 99% confidence interval (0.99, 1.46), P = 0.04] and less days alive out of hospital [HR = 1.39, 99% confidence interval (1.18, 1.64), P < 0.001] compared with all subjects without HoS. Patients with HFrEF with HoS died earlier [30.3% vs. 41.6%, HR = 1.40, 99% confidence interval (1.12, 1.74), P < 0.001] and lived fewer days out of hospital than those without HoS. We could not find these changes in mortality and hospital‐free survival in the heart failure with mid‐range ejection fraction and HFpEF cohorts. HoS represented a clinically high‐risk profile within the HFrEF group—combining different risk factors. Further analyses showed that among patients with HFrEF with HoS, known cardiovascular risk factors (e.g. age, male sex, diabetes mellitus, and anaemia) were more prevalent. These constellations of the risk factors explained the effect of HoS in a multivariable Cox regression models. CONCLUSIONS: In a large cohort of patients with HF, HoS was found to be a clinically and easily accessible predictor of both overall and hospitalization‐free survival in patients with HFrEF and should thus routinely be assessed. John Wiley and Sons Inc. 2020-01-30 /pmc/articles/PMC7261586/ /pubmed/32003157 http://dx.doi.org/10.1002/ehf2.12605 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Articles
Hashemi, Djawid
Blum, Moritz
Mende, Meinhard
Störk, Stefan
Angermann, Christiane E.
Pankuweit, Sabine
Tahirovic, Elvis
Wachter, Rolf
Pieske, Burkert
Edelmann, Frank
Düngen, Hans‐Dirk
Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany
title Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany
title_full Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany
title_fullStr Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany
title_full_unstemmed Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany
title_short Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany
title_sort syncopes and clinical outcome in heart failure: results from prospective clinical study data in germany
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261586/
https://www.ncbi.nlm.nih.gov/pubmed/32003157
http://dx.doi.org/10.1002/ehf2.12605
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