© 2019 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Aim: To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results: We searched in relevant databases from inception to August 2018 for non-interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta-analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5-year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co-morbidities, and treatment rates. Conclusion: These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence-based treatments. Further research exploring the barriers and facilitators to treatment is recommended.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ejhf.1594

Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis.

Resumen La insuficiencia cardiaca en un problema sanitario de primer orden en nuestro pais, aunque no disponemos de cifras que permitan dimensionar su impacto con exactitud por falta de estudios con diseno apropiado. Frente a una prevalencia de insuficiencia cardiaca del 2% en otros paises europeos y en Estados Unidos, los estudios en Espana arrojan cifras del 5%, probablemente a causa de sus limitaciones metodologicas. La insuficiencia cardiaca consume enormes recursos sanitarios: es la primera causa de hospitalizacion de mayores de 65 anos y representa el 3% de todos los ingresos hospitalarios y el 2,5% del coste de la asistencia sanitaria. Hay dos patrones de insuficiencia cardiaca, uno con funcion sistolica preservada, mas asociado a la hipertension, y otro con funcion deprimida, mas relacionado con la cardiopatia isquemica. En 2010, la insuficiencia cardiaca constituyo el 3% del total de defunciones de varones y el 10% de las de mujeres. La tasa de mortalidad por insuficiencia cardiaca ha ido reduciendose en los ultimos anos. Los cambios temporales en la codificacion diagnostica podrian explicar parte del aumento en los ingresos hospitalarios y del descenso en la mortalidad por insuficiencia cardiaca, aunque hay indicios de que la adherencia a las guias de practica clinica puede haber reducido su mortalidad.

Epidemiología de la insuficiencia cardiaca en España en los últimos 20 años

Background Although frailty has been associated with increased risks for hospitalization and mortality in chronic heart failure, the precise average effect remains uncertain. We performed a systematic review and meta-analysis to summarize the hazards for mortality and incident hospitalization in patients with heart failure and frailty compared with those without frailty and explored the heterogeneity underlying the effect size estimates. Methods and Results MEDLINE , EMBASE, and Cochrane databases were queried for articles published between January 1966 and March 2018. Predefined selection criteria were used. Hazard ratios ( HRs ) were pooled for meta-analyses, and where odds ratios were used previously, original data were recalculated for HR . Overlapping data were consolidated, and only unique data points were used. Study quality and bias were assessed. Eight studies were included for mortality (2645 patients), and 6 studies were included for incident hospitalization (2541 patients) during a median follow-up of 1.82 and 1.12 years, respectively. Frailty was significantly associated with an increased hazard for mortality ( HR , 1.54; 95% confidence interval, 1.34-1.75; P<0.001) and incident hospitalization ( HR , 1.56; 95% confidence interval, 1.36-1.78; P<0.001) in chronic heart failure. The Fried phenotype estimated a 16.9% larger effect size than the combined Fried/non-Fried frailty assessment for the end point of mortality ( HR , 1.80; 95% confidence interval, 1.41-2.28; P<0.001), but not for hospitalization ( HR , 1.57; 95% confidence interval, 1.30-1.89; P<0.001). Study heterogeneity was found to be low (I2=0%), and high quality of studies was verified by the Newcastle-Ottawa scale. Conclusions Overall, the presence of frailty in chronic heart failure is associated with an increased hazard for death and hospitalization by ≈1.5-fold.

/pdf/impact-of-frailty-on-mortality-and-hospitalization-in-5948j22kwz.pdf

Impact of Frailty on Mortality and Hospitalization in Chronic Heart Failure: A Systematic Review and Meta‐Analysis

Background A thorough analysis of noncardiac determinants of mortality in heart failure (HF) is missing. Furthermore, evidence conflicts on the outcome of patients with HF and no or mild systolic d...

Noncardiac Versus Cardiac Mortality in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction

A B S T R A C T Mitochondria are dynamic organelles able to vary their morphology between elongated interconnected mitochondrial networks and fragmented disconnected arrays, through events of mitochondrial fusion and fission, respectively. These events allow the transmission of signaling messengers and exchange of metabolites within the cell. They have also been implicated in a variety of biological processes including embryonic development, metabolism, apoptosis, and autophagy. Although the majority of these studies have been confined to noncardiac cells, emerging evidence suggests that changes in mitochondrial morphology could participate in cardiac development, the response to ischemia-reperfusion injury, heart failure, and diabetes mellitus. In this article, we review how the mitochondrial dynamics are altered in different cardiac pathologies, with special emphasis on heart failure, and how this knowledge may provide new therapeutic targets for treating cardiovascular diseases.

[Mitochondrial dynamics: a potential new therapeutic target for heart failure].

Introduccion y objetivos La mortalidad de la insuficiencia cardiaca es similar o incluso superior a la de muchos canceres. Suele ocurrir por progresion de la enfermedad, aunque la muerte subita se ha descrito como una causa frecuente. El objetivo es evaluar la mortalidad y sus causas en una poblacion ambulatoria de pacientes con insuficiencia cardiaca de etiologia diversa tratados en una unidad especializada multidisciplinaria y analizar los factores asociados con ellas. Metodos Estudio de seguimiento de cohorte (mediana, 36 meses) de 960 pacientes (el 70,9% varones; mediana de edad, 69 anos; mayoritariamente de etiologia isquemica, con fraccion de eyeccion del 31% y en clase funcional fundamentalmente II y III). Resultados Se registraron 351 fallecimientos (36,5%): 230 de causa cardiovascular (65,5%), fundamentalmente por insuficiencia cardiaca (33,2%) y muerte subita (16%), 94 de causa no cardiovascular (26,8%), fundamentalmente neoplasias (10,5%) y procesos septicos (6,8%), y 27 (7,7%) de causa desconocida. Mostraron relacion independiente con la mortalidad: edad, sexo, clase funcional, fraccion de eyeccion, tiempo de evolucion, etiologia isquemica, diabetes mellitus, aclaramiento de creatinina, vasculopatia periferica, fragilidad y ausencia de tratamiento con inhibidores de la enzima de conversion de angiotensina o antagonistas de los receptores de la angiotensina II, bloqueadores beta, estatinas y antiagregantes. El factor principal asociado a muerte cardiovascular fue la etiologia isquemica. No hallamos ningun factor predictor claramente determinante de muerte subita. Conclusiones Aunque la mortalidad de los pacientes atendidos en una unidad especializada de insuficiencia cardiaca no fue baja, una cuarta parte fallecio de causa no cardiovascular. El principal factor asociado a muerte cardiovascular fue la etiologia isquemica. La muerte subita afecto solo al 5,8% de la poblacion.

Mortalidad y causas de muerte en pacientes con insuficiencia cardiaca: experiencia de una unidad especializada multidisciplinaria

Introduction and objectives Heart failure mortality is similar to or even higher than that due to various cancers It is usually associated with disease progression, though sudden death has also been reported as a frequent cause of mortality The objectives of this study were to investigate mortality and its causes in outpatients with heart failure of different etiologies who were treated in a specialist multidisciplinary unit, and to identify associated factors Methods The follow-up cohort study (median duration, 36 months) involved 960 patients (709% male; median age, 69 years; ejection fraction, 31%; and the majority had an ischemic etiology and were in functional class II or III) Results Overall, 351 deaths (365%) occurred: 230 due to cardiovascular causes (655%), mainly heart failure (332%) and sudden death (16%); 94 due to noncardiovascular causes (268%), mainly malignancies (105%) and septic processes (68%); and 27 (77%) due to unknown causes Mortality was independently associated with age, sex, functional class, ejection fraction, time since symptom onset, ischemic etiology, diabetes, creatinine clearance rate, peripheral vascular disease, fragility, and the absence of treatment with an angiotensin-converting enzyme inhibitor or angiotensin-II receptor blocker, betablockers, statins or antiplatelet agents The principal factor associated with cardiovascular death was an ischemic etiology No factor studied clearly predicted sudden death Conclusions Even though mortality in patients treated at a specialist heart failure unit was not low, a quarter died from non-cardiovascular causes The principal factor associated with cardiovascular death was an ischemic etiology Only 58% of the study population experienced sudden death

Mortality and Cause of Death in Patients With Heart Failure: Findings at a Specialist Multidisciplinary Heart Failure Unit

Is “socio-ecological culture” really being taken into account to manage conflicts in the coastal zone? Inputs from Spanish Mediterranean beaches

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Mortalidad y causas de muerte en pacientes con insuficiencia cardiaca: experiencia de una unidad especializada multidisciplinaria

Mortality and Cause of Death in Patients With Heart Failure: Findings at a Specialist Multidisciplinary Heart Failure Unit

Is “socio-ecological culture” really being taken into account to manage conflicts in the coastal zone? Inputs from Spanish Mediterranean beaches