Covid-19 Associated Lymphocytic Myocarditis With Genetic Predisposition
HFSA ePoster Library. Aguilar-Gallardo J. 09/10/21; 343483; 249
Jose Aguilar-Gallardo
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Abstract
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Background: In the CardioMEMS Post Approval Study (PAS), pulmonary artery (PA) pressure monitoring in patients with NYHA Class III heart failure (HF) reduced HF hospitalizations (HFH) by 57%. Older patients with HF have both higher risks of HFH and the competing risk of all-cause hospitalization (ACH) compared to a younger cohort. We hypothesized that older patients have a decreased benefit from a CardioMEMS device due to the greater prevalence of non-cardiovascular comorbidities and death. Methods: The PAS compared the rate of HF hospitalization in the 1 year prior to CardioMEMS implant to the rate in 1 year after implant with an overall 57% reduction in the rate of HFH. Patients were placed in three age categories: <70, 70-80 and >80 years. Baseline characteristics and PA pressures were compared at baseline and the paired change in pressures over 1 year. Hospitalization rates before and after implant were compared using the Andersen-Gill model.
Results: Older patients were more likely to have EF >40%, ischemic etiology, hypertension and CKD, but diabetes mellitus was less prevalent. The baseline PA diastolic (PAD) pressures were slightly lower in the older group. At 12 months, PA systolic and PAD was lower in all age groups (Table). All age groups had significant reductions in both HFH and all-cause hospitalizations (ACH) at 1 year (p<0.0001 for HFH and ACH, all age groups). Comparison across age groups demonstrated no significant difference in the reduction of HFH, ACH, or in time to first HFH.
Conclusions: Although older patients with HF have a higher mortality and more comorbidities, the benefit of CardioMEMS in reducing HFH and all-cause hospitalizations was similar across the age categories. The proportion of HFH was decreased after CardioMEMS in all age categories due to a reduction in HFH.
Results: Older patients were more likely to have EF >40%, ischemic etiology, hypertension and CKD, but diabetes mellitus was less prevalent. The baseline PA diastolic (PAD) pressures were slightly lower in the older group. At 12 months, PA systolic and PAD was lower in all age groups (Table). All age groups had significant reductions in both HFH and all-cause hospitalizations (ACH) at 1 year (p<0.0001 for HFH and ACH, all age groups). Comparison across age groups demonstrated no significant difference in the reduction of HFH, ACH, or in time to first HFH.
Conclusions: Although older patients with HF have a higher mortality and more comorbidities, the benefit of CardioMEMS in reducing HFH and all-cause hospitalizations was similar across the age categories. The proportion of HFH was decreased after CardioMEMS in all age categories due to a reduction in HFH.
| CardioMEMS PAS - Age Subgroups | Age < 70(N=545) | 70 ≤ Age < 80 (N=421) | Age ≥ 80(N=234) |
| Age * | 59.3±8.9 | 74.4±2.8 | 84.1±3.2 |
| Female | 36.5% | 38.2% | 39.3% |
| Creatinine (mg/dL)* | 1.42±0.52 | 1.52±0.54 | 1.56±0.50 |
| EF≤40% * | 61.1% | 49.2% | 41.9% |
| Baseline 7 day PA Pressure (Sys/Dia*) | 48.3/25.5 | 49.9/24.4 | 49.1/23.5 |
| Average 12 month Paired PA Change (Sys/Dia) | -4.2/-3.6 | -3.3/-3.0 | -1.9/-2.5 |
| HFH Rate 1 Year Prior To Implant | 1.299 | 1.214 | 1.223 |
| HFH Rate 1 Year After Implant | 0.542 | 0.542 | 0.514 |
| Hazard Ratio for HFH Rate (95% CI) | 0.42 (0.36-0.48) | 0.45 (0.37-0.53) | 0.42 (0.33-0.54) |
| Hazard Ratio for ACH Rate (95% CI) | 0.70 (0.63-0.78) | 0.75 (0.67-0.85) | 0.77 (0.68-0.88) |
| Kaplan-Meier 1 year Mortality * | 9.0±1.2% | 20.1±2.0% | 25.4±2.9% |
Background: In the CardioMEMS Post Approval Study (PAS), pulmonary artery (PA) pressure monitoring in patients with NYHA Class III heart failure (HF) reduced HF hospitalizations (HFH) by 57%. Older patients with HF have both higher risks of HFH and the competing risk of all-cause hospitalization (ACH) compared to a younger cohort. We hypothesized that older patients have a decreased benefit from a CardioMEMS device due to the greater prevalence of non-cardiovascular comorbidities and death. Methods: The PAS compared the rate of HF hospitalization in the 1 year prior to CardioMEMS implant to the rate in 1 year after implant with an overall 57% reduction in the rate of HFH. Patients were placed in three age categories: <70, 70-80 and >80 years. Baseline characteristics and PA pressures were compared at baseline and the paired change in pressures over 1 year. Hospitalization rates before and after implant were compared using the Andersen-Gill model.
Results: Older patients were more likely to have EF >40%, ischemic etiology, hypertension and CKD, but diabetes mellitus was less prevalent. The baseline PA diastolic (PAD) pressures were slightly lower in the older group. At 12 months, PA systolic and PAD was lower in all age groups (Table). All age groups had significant reductions in both HFH and all-cause hospitalizations (ACH) at 1 year (p<0.0001 for HFH and ACH, all age groups). Comparison across age groups demonstrated no significant difference in the reduction of HFH, ACH, or in time to first HFH.
Conclusions: Although older patients with HF have a higher mortality and more comorbidities, the benefit of CardioMEMS in reducing HFH and all-cause hospitalizations was similar across the age categories. The proportion of HFH was decreased after CardioMEMS in all age categories due to a reduction in HFH.
Results: Older patients were more likely to have EF >40%, ischemic etiology, hypertension and CKD, but diabetes mellitus was less prevalent. The baseline PA diastolic (PAD) pressures were slightly lower in the older group. At 12 months, PA systolic and PAD was lower in all age groups (Table). All age groups had significant reductions in both HFH and all-cause hospitalizations (ACH) at 1 year (p<0.0001 for HFH and ACH, all age groups). Comparison across age groups demonstrated no significant difference in the reduction of HFH, ACH, or in time to first HFH.
Conclusions: Although older patients with HF have a higher mortality and more comorbidities, the benefit of CardioMEMS in reducing HFH and all-cause hospitalizations was similar across the age categories. The proportion of HFH was decreased after CardioMEMS in all age categories due to a reduction in HFH.
| CardioMEMS PAS - Age Subgroups | Age < 70(N=545) | 70 ≤ Age < 80 (N=421) | Age ≥ 80(N=234) |
| Age * | 59.3±8.9 | 74.4±2.8 | 84.1±3.2 |
| Female | 36.5% | 38.2% | 39.3% |
| Creatinine (mg/dL)* | 1.42±0.52 | 1.52±0.54 | 1.56±0.50 |
| EF≤40% * | 61.1% | 49.2% | 41.9% |
| Baseline 7 day PA Pressure (Sys/Dia*) | 48.3/25.5 | 49.9/24.4 | 49.1/23.5 |
| Average 12 month Paired PA Change (Sys/Dia) | -4.2/-3.6 | -3.3/-3.0 | -1.9/-2.5 |
| HFH Rate 1 Year Prior To Implant | 1.299 | 1.214 | 1.223 |
| HFH Rate 1 Year After Implant | 0.542 | 0.542 | 0.514 |
| Hazard Ratio for HFH Rate (95% CI) | 0.42 (0.36-0.48) | 0.45 (0.37-0.53) | 0.42 (0.33-0.54) |
| Hazard Ratio for ACH Rate (95% CI) | 0.70 (0.63-0.78) | 0.75 (0.67-0.85) | 0.77 (0.68-0.88) |
| Kaplan-Meier 1 year Mortality * | 9.0±1.2% | 20.1±2.0% | 25.4±2.9% |
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