Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie? Eur Heart J. Wehner GJ, Jing L, Haggerty CM, Suever JD, Leader JB, Hartzel DN, et al.
The 3A3B score: The simple risk score for heart failure with preserved ejection fraction - A report from the CHART-2 Study. Kasahara S, Sakata Y, Nochioka K, Tay WT, Claggett BL, Abe R, et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Køber L, Squire IB, et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predictors of mortality in patients with heart failure and preserved systolic function in the Digitalis Investigation Group trial. Predicting Risk in Patients Hospitalized for Acute Decompensated Heart Failure and Preserved Ejection Fraction: The Atherosclerosis Risk in Communities Study Heart Failure Community Surveillance. Thorvaldsen T, Claggett BL, Shah A, Cheng S, Agarwal SK, Wruck LM, et al. Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: a randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction. 2020 8:172–84.ĭesai AS, Lewis EF, Li R, Solomon SD, Assmann SF, Boineau R, et al. Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone. 2014 370:1383–92.Ĭohen JB, Schrauben SJ, Zhao L, Basso MD, Cvijic ME, Li Z, et al. Spironolactone for heart failure with preserved ejection fraction. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al.
#TOPCAT TRIAL UPDATE#
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al.
#TOPCAT TRIAL TRIAL#
Trial RegistrationĬ Identifier: NCT00094302. This easy-to-use risk score provides a practical tool that can facilitate risk stratification and tailoring therapy for those who benefit most from spironolactone.
Patients at very high risk derive great benefits from spironolactone therapy. This simple risk score stratifies patients with HFpEF by their baseline risk of cardiovascular death. Spironolactone therapy significantly reduced the risk of cardiovascular death in the very high-risk group (HR: 0.57 95%CI, 0.39–0.84 P =0.005 and P for interaction 0.03) but showed similar risk of drug discontinuation across risk categories ( P for interaction=0.928). ARR with spironolactone therapy was observed only in patients at very high risk (7.9%). The risk score scheme showed good discrimination in placebo cohort ( C index=0.70). ResultsĪ simple risk score scheme was constructed based on five risk indicators weighted by estimates from the model, including age, diastolic blood pressure, renal dysfunction, white blood cell, and left ventricular ejection fraction. COX regressions were performed to assess the hazard ratios (HRs) of spironolactone therapy for cardiovascular death and drug discontinuation in each risk category. The absolute risk reduction (ARR) in cardiovascular death with spironolactone was evaluated across baseline risk groups. We screened candidate risk indicators and determined strong risk predictors using COX regression. We developed risk stratification scheme for cardiovascular death in placebo arm of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT). We aimed to develop a simple risk score for patients with HFpEF and assessed the efficacy of spironolactone across baseline risk.
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