TY - JOUR
T1 - Impact of tricuspid regurgitation on survival in patients with heart failure
T2 - a large electronic health record patient-level database analysis
AU - Messika-Zeitoun, David
AU - Verta, Patrick
AU - Gregson, John
AU - Pocock, Stuart J.
AU - Boero, Isabel
AU - Feldman, Ted E.
AU - Abraham, William T.
AU - Lindenfeld, Jo Ann
AU - Bax, Jeroen
AU - Leon, Martin
AU - Enriquez-Sarano, Maurice
N1 - Funding Information:
D.M.Z. is a consultant for Edwards Lifesciences, Mardil and Cardiawave and receives research grants from Edwards Lifesciences and Abbott Vascular. P.V. is an Edwards Lifesciences employee. J.G. is a consultant to Edwards and MVrX and has received research funding from Boston Scientific. S.J.P. is a consultant to Edwards, Medtronic and Boston Scientific. I.B. is a consultant for Edwards Lifesciences. T.E.F. is an Edwards Lifesciences employee. W.T.A. has received consulting fees from Edwards Lifesciences and Abbott Vascular. J.L. is a consultant for Edwards Lifesciences, Abbott Vascular, Boehringer Ingleheim, Novartis, VWave, Impulse Dynamics, CVRx, Relypsa, and receives research grants from AstraZeneca. J.B. reports speaker fees from Abbott. The department of Leiden University Medical Center has received unrestricted research grants from Boston Scientific, Medtronic, Biotronik, Edwards Lifesciences and GE Healthcare. M.L. is an unpaid member of the Edwards Lifesciences medical advisory board. The Cardiovascular Research Foundation has received research grants from Edwards Lifesciences, Abbott, Boston Scientific and Medtronic. M.E.S. has received research grants from Edwards Lifesciences. Conflict of interest:
Funding Information:
This study was funded through a research contract between Boston Consulting Group and Edwards. The statistical methodology and analyses were independently performed by John Gregson and Stuart Pocock. Conflict of interest: D.M.Z. is a consultant for Edwards Lifesciences, Mardil and Cardiawave and receives research grants from Edwards Lifesciences and Abbott Vascular. P.V. is an Edwards Lifesciences employee. J.G. is a consultant to Edwards and MVrX and has received research funding from Boston Scientific. S.J.P. is a consultant to Edwards, Medtronic and Boston Scientific. I.B. is a consultant for Edwards Lifesciences. T.E.F. is an Edwards Lifesciences employee. W.T.A. has received consulting fees from Edwards Lifesciences and Abbott Vascular. J.L. is a consultant for Edwards Lifesciences, Abbott Vascular, Boehringer Ingleheim, Novartis, VWave, Impulse Dynamics, CVRx, Relypsa, and receives research grants from AstraZeneca. J.B. reports speaker fees from Abbott. The department of Leiden University Medical Center has received unrestricted research grants from Boston Scientific, Medtronic, Biotronik, Edwards Lifesciences and GE Healthcare. M.L. is an unpaid member of the Edwards Lifesciences medical advisory board. The Cardiovascular Research Foundation has received research grants from Edwards Lifesciences, Abbott, Boston Scientific and Medtronic. M.E.S. has received research grants from Edwards Lifesciences. The authors would like to specially thank Rodolfo Estay for his support to this work. This study was funded through a research contract between Boston Consulting Group and Edwards. The statistical methodology and analyses were independently performed by John Gregson and Stuart Pocock. Conflict of interest: D.M.Z. is a consultant for Edwards Lifesciences, Mardil and Cardiawave and receives research grants from Edwards Lifesciences and Abbott Vascular. P.V. is an Edwards Lifesciences employee. J.G. is a consultant to Edwards and MVrX and has received research funding from Boston Scientific. S.J.P. is a consultant to Edwards, Medtronic and Boston Scientific. I.B. is a consultant for Edwards Lifesciences. T.E.F. is an Edwards Lifesciences employee. W.T.A. has received consulting fees from Edwards Lifesciences and Abbott Vascular. J.L. is a consultant for Edwards Lifesciences, Abbott Vascular, Boehringer Ingleheim, Novartis, VWave, Impulse Dynamics, CVRx, Relypsa, and receives research grants from AstraZeneca. J.B. reports speaker fees from Abbott. The department of Leiden University Medical Center has received unrestricted research grants from Boston Scientific, Medtronic, Biotronik, Edwards Lifesciences and GE Healthcare. M.L. is an unpaid member of the Edwards Lifesciences medical advisory board. The Cardiovascular Research Foundation has received research grants from Edwards Lifesciences, Abbott, Boston Scientific and Medtronic. M.E.S. has received research grants from Edwards Lifesciences.
Funding Information:
This study was funded through a research contract between Boston Consulting Group and Edwards. The statistical methodology and analyses were independently performed by John Gregson and Stuart Pocock.
Publisher Copyright:
© 2020 European Society of Cardiology
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Aims: More evidence is needed to quantify the association between tricuspid regurgitation (TR) and mortality in patients with heart failure (HF). Methods and results: Between 2008–2017, using the Optum longitudinal database, a patient-level database that integrates multiple US-based electronic health and claim records from several health care providers, we identified 435 679 patients with new HF diagnosis and both an assessment of the left ventricular ejection fraction and at least 1 year of history. TR was graded as mild, moderate or severe and classified as prevalent (at the time of the initial HF diagnosis) or incident (subsequent new cases thereafter). For prevalent TR, the analysis was performed using a Cox proportional hazards model with adjustment for patient covariates. Incident TR was modelled as a time-updated covariate, as were other non-fatal events during follow-up. Prevalence of mild, moderate and severe TR at baseline was 10.1%, 5.1% and 1.4%, respectively. Over a median follow-up of 1.5 years, 121 273 patients (27.8%) died and prevalent TR was independently associated with survival. Compared to patients with no TR at baseline, the adjusted hazard ratios for mortality were 0.99 [95% confidence interval (CI) 0.97–1.01], 1.17 (95% CI 1.14–1.20) and 1.34 (95% CI 1.28–1.39) for mild, moderate and severe TR, respectively. In the 363 270 patients free from TR at baseline, incident TR (at least mild, at least moderate, or severe) developed during follow-up in 12.1%, 5.1% and 1.1%, respectively. Adjusted mortality hazard ratios for such new cases were 1.48 (95% CI 1.44–1.52), 1.92 (95% CI 1.86–1.99) and 2.44 (95% CI 2.32–2.57), respectively. Findings were consistent across all patient subgroups based on age, gender, rhythm, associated comorbidities, prior cardiac surgery, B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide, and left ventricular ejection fraction. Conclusions: In this large contemporary patient-level database of almost half-million US patients with HF, TR was associated with a marked increases in mortality risk overall and in all subgroups. Future randomized controlled trials will evaluate the impact of TR correction on clinical outcomes and the causal relationship between TR and mortality.
AB - Aims: More evidence is needed to quantify the association between tricuspid regurgitation (TR) and mortality in patients with heart failure (HF). Methods and results: Between 2008–2017, using the Optum longitudinal database, a patient-level database that integrates multiple US-based electronic health and claim records from several health care providers, we identified 435 679 patients with new HF diagnosis and both an assessment of the left ventricular ejection fraction and at least 1 year of history. TR was graded as mild, moderate or severe and classified as prevalent (at the time of the initial HF diagnosis) or incident (subsequent new cases thereafter). For prevalent TR, the analysis was performed using a Cox proportional hazards model with adjustment for patient covariates. Incident TR was modelled as a time-updated covariate, as were other non-fatal events during follow-up. Prevalence of mild, moderate and severe TR at baseline was 10.1%, 5.1% and 1.4%, respectively. Over a median follow-up of 1.5 years, 121 273 patients (27.8%) died and prevalent TR was independently associated with survival. Compared to patients with no TR at baseline, the adjusted hazard ratios for mortality were 0.99 [95% confidence interval (CI) 0.97–1.01], 1.17 (95% CI 1.14–1.20) and 1.34 (95% CI 1.28–1.39) for mild, moderate and severe TR, respectively. In the 363 270 patients free from TR at baseline, incident TR (at least mild, at least moderate, or severe) developed during follow-up in 12.1%, 5.1% and 1.1%, respectively. Adjusted mortality hazard ratios for such new cases were 1.48 (95% CI 1.44–1.52), 1.92 (95% CI 1.86–1.99) and 2.44 (95% CI 2.32–2.57), respectively. Findings were consistent across all patient subgroups based on age, gender, rhythm, associated comorbidities, prior cardiac surgery, B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide, and left ventricular ejection fraction. Conclusions: In this large contemporary patient-level database of almost half-million US patients with HF, TR was associated with a marked increases in mortality risk overall and in all subgroups. Future randomized controlled trials will evaluate the impact of TR correction on clinical outcomes and the causal relationship between TR and mortality.
KW - Heart failure
KW - Mortality
KW - Tricuspid regurgitation
UR - http://www.scopus.com/inward/record.url?scp=85085144776&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085144776&partnerID=8YFLogxK
U2 - 10.1002/ejhf.1830
DO - 10.1002/ejhf.1830
M3 - Article
C2 - 32367642
AN - SCOPUS:85085144776
VL - 22
SP - 1803
EP - 1813
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 10
ER -