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

Telemonitoring versus standard of care in heart failure: a randomised multicentre trial

International audienceAims: The aim was to assess the effect of a telemonitoring programme vs. standard care (SC) in preventing all‐cause deaths or unplanned hospitalisations in heart failure (HF) at 18 months.Methods and results: OSICAT was a randomised, multicentre, open‐label French study in 937 patients hospitalised for acute HF ≤12 months before inclusion. Patients were randomised to telemonitoring (daily body weight measurement, daily recording of HF symptoms, and personalised education) (n = 482) or to SC (n = 455). Mean ± standard deviation number of events for the primary outcome was 1.30 ± 1.85 for telemonitoring and 1.46 ± 1.98 for SC [rate ratio 0.97, 95% confidence interval (CI) 0.77–1.23; P = 0.80]. In New York Heart Association (NYHA) class III or IV HF, median time to all‐cause death or first unplanned hospitalisation was 82 days in the telemonitoring group and 67 days in the SC group (P = 0.03). After adjustment for known predictive factors, telemonitoring was associated with a 21% relative risk reduction in first unplanned hospitalisation for HF [hazard ratio (HR) 0.79, 95% CI 0.62–0.99; P = 0.044); the relative risk reduction was 29% in patients with NYHA class III or IV HF (HR 0.71, 95% CI 0.53–0.95; P = 0.02), 38% in socially isolated patients (HR 0.62, 95% CI 0.39–0.98; P = 0.043), and 37% in patients who were ≥70% adherent to body weight measurement (HR 0.63, 95% CI 0.45–0.88; P = 0.006).Conclusion: Telemonitoring did not result in a significantly lower rate of all‐cause deaths or unplanned hospitalisations in HF patients. The pre‐specified subgroup results suggest the telemonitoring approach improves clinical outcomes in selected populations but need further confirmation