Vascular disease as a predictor of long-term mortality in patients hospitalized for new-onset heart failure

SummaryBackgroundComorbidities have an adverse influence on the outcome of patients with heart failure (HF).AimWe investigated the impact of peripheral vascular disease (PVD) on long-term mortality in hospitalized patients with HF.MethodsWe included prospectively consecutive patients (N=799) hospitalized for a first episode of HF in all healthcare establishments within a single French department during 2000. Patients with peripheral arterial disease and/or history of stroke were considered to have PVD. Baseline characteristics and 5-year mortality were compared according to PVD status.ResultsPVD was diagnosed in 172 patients (22%) and clinical coronary artery disease in 302 patients (38%). Patients with PVD were older, predominantly men, smokers, and more often had diabetes and coronary artery disease. PVD was associated with an increased risk of crude 5-year overall mortality (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.35–2.03; P<0.001). After adjustment for covariates, the relationship remained significant (HR 1.33, 95% CI 1.08–1.65; P=0.008). Compared with the expected survival, the 5-year survival of the PVD group was dramatically lower (24% versus 67%). The risk of cardiovascular death was higher for PVD patients (HR 1.39, 95% CI 1.07–1.80; P=0.014). PVD probably modulates the impact of other covariates on outcome.ConclusionPVD is a potent predictor of adverse outcome in patients with new-onset HF

Salt substitute recommendations for heart failure patients may influence guideline‐directed medical therapies titration

Abstract Aims Reducing sodium intake is necessary for patients with chronic heart failure (CHF). Salt substitutes (saltSubs) have become increasingly popular as recommendations by healthcare professionals (HCPs) as well as options for patients and their caregivers. However, their consumption is generally potassium based and remains poorly evaluated in CHF management. Their impact on guideline‐directed medical therapies (GDMTs) also remains unknown. The primary objective of this study was to provide a description and estimate of HCP recommendations and reported use of saltSubs in France. Secondary objectives were to identify if there was an association between these recommendations by HCPs and the use of GDMTs. Methods and results A nationwide, questionnaire‐based, cross‐sectional, epidemiological study was conducted from September 2020 to July 2021. Data collection included baseline characteristics, the use and recommendations of saltSubs, and the use of GDMTs, which included (i) angiotensin‐converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) or angiotensin receptor–neprilysin inhibitors (ARNis), (ii) mineralocorticoid receptor antagonists (MRAs), and/or (iii) beta‐blockers (BBs). In total, 13% of HCPs advised saltSubs and 17% of patients and 22% of caregivers reported their consumption. CHF patients advised to take saltSubs did not differ in terms of left ventricular ejection fraction (EF) <40%, ischaemic origin, and New York Heart Association III–IV class, but were more recently hospitalized for acute HF (P = 0.004). HCPs who recommended saltSubs to patients were more likely to advise an anti‐diabetic diet (P < 0.001), cholesterol‐lowering diet (P < 0.001), and exercise (P = 0.018). In the overall population, ACEi/ARB/ARNi use was less frequent in case of saltSub recommendations (74% vs. 82%, P = 0.012). The concomitant prescription of none, one, two, or three GDMTs was less favourable in case of saltSub recommendations (P = 0.046). There was no significant difference for the presence of MRA (56% vs. 58%) and/or BB (78% vs. 82%). The under‐prescription of ACEi/ARB/ARNi was found when patients had EF < 40% (P = 0.029) and/or EF ≥ 40% (P = 0.043). In the subgroup with left ventricular EF ≥ 40%, we found a higher thiazide use (P = 0.014) and a less frequent use of low EF GDMTs (P = 0.044) in case of being recommended saltSubs. Conclusions Beyond the well‐established risk for hyperkalaemia, our preliminary results suggest a potentially negative impact of saltSubs on GDMT use, especially for ACEis/ARBs/ARNis in CHF management. saltSub recommendations and their availability from open sale outlets should be considered to avoid possible misuse or deference from GDMTs in the future. Informed advice to consumers should also be considered from HCPs or pharmacists

Diagnosis and Treatment of Iron Deficiency in Heart Failure: OFICSel study by the French Heart Failure Working Group

International audienc