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Article Dans Une Revue European Journal of Heart Failure Année : 2023

Health status across major subgroups of patients with heart failure and preserved ejection fraction

1 UMMC - University of Mississippi Medical Center
2 Berlin-Brandenburg Center for Regenerative Therapies [Berlin, Germany]
3 DZHK - German Center for Cardiovascular Research
4 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
5 NKUA - National and Kapodistrian University of Athens
6 “Attikon” University Hospital
7 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
8 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
9 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
10 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
11 Heart Failure Clinic, Centro Hospitalar de Vila Nova de Gaia/Espinho
12 Cardiovascular R&D Centre-UnIC@RISE
13 FMUP - Faculdade de Medicina da Universidade do Porto
14 LSHTM - London School of Hygiene and Tropical Medicine
15 Saarland University [Saarbrücken]
16 UKS - Saarland University Hospital
17 Boehringer Ingelheim International GmbH
18 University of Heidelberg, Medical Faculty
19 Max Super Speciality Hospital
20 Boehringer Ingelheim Pharma GmbH & Co. KG
21 Massachusetts General Hospital [Boston]
22 Baim Institute for Clinical Research Boston MA
23 CMU - Central Michigan University
24 Wrocław Medical University
25 Azienda Ospedaliera Ospedale Papa Giovanni XXIII [Bergamo, Italy]
26 University of Toronto
27 St. Michael's Hospital
28 PUMCH - Peking Union Medical College Hospital [Beijing]
29 China Academy of Chinese Medical Sciences
30 Imperial College London
31 BSWRI - Baylor Scott & White Research Institute
Vijay K Chopra
Piotr Ponikowski

Résumé

Aims: There are limited data on health status and changes in it over time across major subgroups of patients with heart failure and preserved ejection fraction (HFpEF), including ejection fraction spectrum, age, sex, region, body mass index (BMI), and comorbidities including diabetes, chronic kidney disease (CKD), anaemia, and atrial fibrillation/flutter. Methods and results: In the EMPEROR-Preserved trial, the Kansas City Cardiomyopathy Questionnaire (KCCQ) was assessed at baseline, 12, 32 and 52 weeks. Determinants of baseline KCCQ score and change over time, and the impact of empagliflozin on KCCQ scores were studied in specified subgroups. A Cox model was used to assess the association between 5- and 10-point increase and 5-point decrease in KCCQ score from baseline to week 12 and later outcomes. Among 2979 participants in the placebo arm, mean KCCQ clinical summary score (CSS) was 70.7 (20.8). Older age, female sex, BMI, anaemia, and a history of diabetes, and CKD were associated with worse scores. KCCQ-CSS score improved during follow-up; patients with atrial fibrillation/flutter at enrollment (p trend = 0.014) and CKD (p trend < 0.001) had less improvement. A 5-point increase in KCCQ-CSS at week 12 was associated with lower risk of cardiovascular death or heart failure hospitalization (5%), cardiovascular death (8%), and first heart failure hospitalization (4%) subsequently. A similar trend was seen with KCCQ total symptom score (TSS) and overall summary score (OSS). Empagliflozin improved KCCQ-CSS, -TSS and -OSS scores similarly across subgroups studied except for greater improvement in patients with the highest BMI (p trend = 0.153, 0.08 and 0.078, respectively). Conclusion: Health status in patients with HFpEF is impaired, especially in elderly, women, and those with obesity and comorbidities. Empagliflozin improved health status among all key subgroups studied with a greater effect in obese patients.
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hal-04106809 , version 1 (25-05-2023)

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Tariq Jamal Siddiqi, Stefan D Anker, Gerasimos Filippatos, João Pedro Ferreira, Stuart J Pocock, et al.. Health status across major subgroups of patients with heart failure and preserved ejection fraction. European Journal of Heart Failure, 2023, ⟨10.1002/ejhf.2831⟩. ⟨hal-04106809⟩
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