OBJECTIVES: No previous studies have specifically examined the effects of ethnicity on factors pr... more OBJECTIVES: No previous studies have specifically examined the effects of ethnicity on factors precipitating hospital admissions for heart Failure (HF). The aim of the current study was to identify...
The purpose of this study is to report the prevalence, clinical characteristics, precipitating fa... more The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF). Retrospective analysis of prospectively collected data. Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared. A total of 5005 patients with HF. In-hospital and 1-year outcome. The prevalence of prior stroke in patients with HF was 8.1%. Patients with stroke with HF were more likely to be admitted under the care of internists rather than cardiologists. When compared with patients without stroke, patients with stroke were more likely to be older and to have diabetes mellitus, hypertension, atrial fibrillation, hyperlipidaemia, chro...
Background: The impact of mineralocorticoid receptor antagonist (MRA) use in acute heart failure ... more Background: The impact of mineralocorticoid receptor antagonist (MRA) use in acute heart failure (AHF) patients in the Middle East is not well studied. The objective of this study was to examine the impact of MRA therapy on all-cause mortality in AHF patients in the Middle East stratified by left ventricular ejection fraction. Methods: Data were analyzed from 3792 consecutive patients admitted to 47 hospitals in 7 Middle Eastern countries. Results: The overall mean age was 59 ± 15 years and 62% (n = 2353) were male. At discharge, MRA therapy was prescribed in 34% (n = 1301) of the patients. A total of 54% (n = 2048) of the patients had AHF with reduced ejection fraction (EF) (HFrEF) (<40%), 23% (n = 880) had HF with mid-range EF (HFmrEF) (40%–49%), and 23% (n = 864) had HF with preserved EF (HFpEF) (≥50%). MRA therapy was associated with lower cumulative all-cause 3-month mortality in those with HFrEF (adjusted odds ratio [aOR], 0.55; 95% [confidence interval (CI): 0.37–0.80: P =...
Background: Atrial Fibrillation (AF) and heart failure (HF) are two common prevalent conditions t... more Background: Atrial Fibrillation (AF) and heart failure (HF) are two common prevalent conditions that may present independent of each other or coexist. The impact of AF on mortality in patients with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF) is unclear with conflicting results. Methods: We analyzed data from the Gulf acute HF registry, a prospective, multinational registry of patients admitted with acute HF in 47 hospitals in 7 Middle Eastern Arab Gulf countries (recruited between February 13, 2012 and November 13, 2012). We compared the 12-month mortality in patients with AF versus sinus rhythm (SR) in both types of HF (HFrEF and HFpEF). Results: Among 5005 patients admitted with HF, 835 patients (16.7%) had AF and 3964 (79.2 %) had no history of AF and were in SR. Remaining percentage included patients with rhythms other than AF or SR (e.g. junctional rhythm). After excluding patients with no available echocardiography and those with other rhythms, the number of ...
This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on al... more This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all-cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East. Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% (n = 3081) were men, and 27% (n = 1319) had CRAS. Co-morbid conditions were common including hypertension (n = 3014; 61%), coronary artery disease (n = 2971; 60%), and diabetes mellitus (n = 2449; 50%). A total of 79% (n = 3576) of the patien...
The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD)... more The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD) systems is warfarin and aspirin with a targeted international normalized ratio (INR) of 2.0-3.0. Our patient is a 58-year-old male who underwent surgical HeartMate III continuous-flow LVAD implantation 3 months ago outside the country. The patient mistakenly stopped taking warfarin for 1 month prior to presenting to our center for a routine visit. Luckily, the patient was doing very well without any complication despite the fact that his INR was 1.0.
To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptors ... more To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptors blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in acute heart failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East. Data was analysed from 2,683 consecutive patients admitted with AHF and low ventricular ejection fraction (LVEF) (<40%) from 47 hospitals from February to November, 2012. Analyses were evaluated using univariate and multivariate statistical techniques. The overall mean age of the cohort was 58±15, 72% (n=1937) were males, 62% (n=1651) had coronary artery disease, 57% (n=1539) were hypertensives and 47% (n=1268) had diabetes. Overall cumulative mortality at in-hospital, 3- and 12-month follow-up was 5.8% (n=155), 12.6% (n=338) and 20.4% (n=548), respectively. Adjusting for demographic and clinical characteristics as well as medications use in the logistic regression model, ACEIs were associated with lower...
Effect of atrial fibrillation (AF) on short- and long-term outcomes in heart failure (HF) is cont... more Effect of atrial fibrillation (AF) on short- and long-term outcomes in heart failure (HF) is controversial. Accordingly, we examined this relationship in a national multicenter project using data from the Hearts Function Assessment Registry Trial in Saudi Arabia that studied the clinical features and outcomes of patients admitted with de novo and acute on chronic HF. Out of 2593 patients with HF, 449 (17.8%) had AF at presentation. Patients with AF were more likely to be males and older (mean age 65.2 ± 15.0 vs 60.5 ± 14.8 years) to have a history of ventricular tachycardia/ventricular fibrillation (3.1% vs 1.9%) or cerebrovascular accident (15.0% vs 8.5%). However, they were less likely to have diabetes (66.0% vs 55.9%) or coronary artery disease (55.6% vs 42.3%). The 1-, 2-, and 3-year crude mortality rates were significantly higher in patients with AF (23.2% vs 18.3%, 27.4% vs 22.3%, and 27.8% vs 23.2%, respectively). However, there was no significant difference in mortality after adjusting for covariates. Thus, in patients admitted with HF, AF upon presentation was not associated with increased mortality.
Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they shoul... more Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. Analysis of prospectively collected data. The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. 5005 patients with acute HF. We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%. 44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in...
A U-shaped relationship has been reported between BMI and cardiovascular events among patients wi... more A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF. We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m(2)), normal weight (referent group, 20-24.9kg/m(2)), overweight, (25-29.9kg/m(2)), obese (30-34.9kg/m(2)) and severely obese (≥35kg/m(2)), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE). Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After...
OBJECTIVES: No previous studies have specifically examined the effects of ethnicity on factors pr... more OBJECTIVES: No previous studies have specifically examined the effects of ethnicity on factors precipitating hospital admissions for heart Failure (HF). The aim of the current study was to identify...
The purpose of this study is to report the prevalence, clinical characteristics, precipitating fa... more The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF). Retrospective analysis of prospectively collected data. Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared. A total of 5005 patients with HF. In-hospital and 1-year outcome. The prevalence of prior stroke in patients with HF was 8.1%. Patients with stroke with HF were more likely to be admitted under the care of internists rather than cardiologists. When compared with patients without stroke, patients with stroke were more likely to be older and to have diabetes mellitus, hypertension, atrial fibrillation, hyperlipidaemia, chro...
Background: The impact of mineralocorticoid receptor antagonist (MRA) use in acute heart failure ... more Background: The impact of mineralocorticoid receptor antagonist (MRA) use in acute heart failure (AHF) patients in the Middle East is not well studied. The objective of this study was to examine the impact of MRA therapy on all-cause mortality in AHF patients in the Middle East stratified by left ventricular ejection fraction. Methods: Data were analyzed from 3792 consecutive patients admitted to 47 hospitals in 7 Middle Eastern countries. Results: The overall mean age was 59 ± 15 years and 62% (n = 2353) were male. At discharge, MRA therapy was prescribed in 34% (n = 1301) of the patients. A total of 54% (n = 2048) of the patients had AHF with reduced ejection fraction (EF) (HFrEF) (<40%), 23% (n = 880) had HF with mid-range EF (HFmrEF) (40%–49%), and 23% (n = 864) had HF with preserved EF (HFpEF) (≥50%). MRA therapy was associated with lower cumulative all-cause 3-month mortality in those with HFrEF (adjusted odds ratio [aOR], 0.55; 95% [confidence interval (CI): 0.37–0.80: P =...
Background: Atrial Fibrillation (AF) and heart failure (HF) are two common prevalent conditions t... more Background: Atrial Fibrillation (AF) and heart failure (HF) are two common prevalent conditions that may present independent of each other or coexist. The impact of AF on mortality in patients with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF) is unclear with conflicting results. Methods: We analyzed data from the Gulf acute HF registry, a prospective, multinational registry of patients admitted with acute HF in 47 hospitals in 7 Middle Eastern Arab Gulf countries (recruited between February 13, 2012 and November 13, 2012). We compared the 12-month mortality in patients with AF versus sinus rhythm (SR) in both types of HF (HFrEF and HFpEF). Results: Among 5005 patients admitted with HF, 835 patients (16.7%) had AF and 3964 (79.2 %) had no history of AF and were in SR. Remaining percentage included patients with rhythms other than AF or SR (e.g. junctional rhythm). After excluding patients with no available echocardiography and those with other rhythms, the number of ...
This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on al... more This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all-cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East. Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% (n = 3081) were men, and 27% (n = 1319) had CRAS. Co-morbid conditions were common including hypertension (n = 3014; 61%), coronary artery disease (n = 2971; 60%), and diabetes mellitus (n = 2449; 50%). A total of 79% (n = 3576) of the patien...
The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD)... more The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD) systems is warfarin and aspirin with a targeted international normalized ratio (INR) of 2.0-3.0. Our patient is a 58-year-old male who underwent surgical HeartMate III continuous-flow LVAD implantation 3 months ago outside the country. The patient mistakenly stopped taking warfarin for 1 month prior to presenting to our center for a routine visit. Luckily, the patient was doing very well without any complication despite the fact that his INR was 1.0.
To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptors ... more To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptors blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in acute heart failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East. Data was analysed from 2,683 consecutive patients admitted with AHF and low ventricular ejection fraction (LVEF) (<40%) from 47 hospitals from February to November, 2012. Analyses were evaluated using univariate and multivariate statistical techniques. The overall mean age of the cohort was 58±15, 72% (n=1937) were males, 62% (n=1651) had coronary artery disease, 57% (n=1539) were hypertensives and 47% (n=1268) had diabetes. Overall cumulative mortality at in-hospital, 3- and 12-month follow-up was 5.8% (n=155), 12.6% (n=338) and 20.4% (n=548), respectively. Adjusting for demographic and clinical characteristics as well as medications use in the logistic regression model, ACEIs were associated with lower...
Effect of atrial fibrillation (AF) on short- and long-term outcomes in heart failure (HF) is cont... more Effect of atrial fibrillation (AF) on short- and long-term outcomes in heart failure (HF) is controversial. Accordingly, we examined this relationship in a national multicenter project using data from the Hearts Function Assessment Registry Trial in Saudi Arabia that studied the clinical features and outcomes of patients admitted with de novo and acute on chronic HF. Out of 2593 patients with HF, 449 (17.8%) had AF at presentation. Patients with AF were more likely to be males and older (mean age 65.2 ± 15.0 vs 60.5 ± 14.8 years) to have a history of ventricular tachycardia/ventricular fibrillation (3.1% vs 1.9%) or cerebrovascular accident (15.0% vs 8.5%). However, they were less likely to have diabetes (66.0% vs 55.9%) or coronary artery disease (55.6% vs 42.3%). The 1-, 2-, and 3-year crude mortality rates were significantly higher in patients with AF (23.2% vs 18.3%, 27.4% vs 22.3%, and 27.8% vs 23.2%, respectively). However, there was no significant difference in mortality after adjusting for covariates. Thus, in patients admitted with HF, AF upon presentation was not associated with increased mortality.
Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they shoul... more Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. Analysis of prospectively collected data. The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. 5005 patients with acute HF. We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%. 44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in...
A U-shaped relationship has been reported between BMI and cardiovascular events among patients wi... more A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF. We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m(2)), normal weight (referent group, 20-24.9kg/m(2)), overweight, (25-29.9kg/m(2)), obese (30-34.9kg/m(2)) and severely obese (≥35kg/m(2)), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE). Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After...
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