Factors associated with and prognostic implications of cardiac troponin elevation in decompensated heart failure with preserved ejection fraction: Findings from the American Heart Association Get With the Guidelines-Heart Failure program

Ambarish Pandey, Harsh Golwala, Shubin Sheng, Adam D. DeVore, Adrian F. Hernandez, Deepak L. Bhatt, Paul A. Heidenreich, Clyde W. Yancy, James A de Lemos, Gregg C. Fonarow

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Abstract

IMPORTANCE: Elevated levels of cardiac troponins are associated with adverse clinical outcomes among patients with heart failure (HF) and reduced ejection fraction. However, the clinical significance of troponin elevation in the setting of decompensated HF with preserved ejection fraction (HFpEF) is not well established. OBJECTIVE: To determine the clinical predictors of troponin elevation and its association with in-hospital and long-term outcomes among patients with decompensated HFpEF. DESIGN, SETTING, AND PARTICIPANTS: Observational analysis of Get With The Guidelines-HF registry participants who were admitted for decompensated HFpEF (ejection fraction 50%) from January 2009 through December 2014 and who had quantitative or categorical (elevated vs normal based on institution’s reference laboratory) measures of troponin level (troponin T or troponin I, as available). MAIN OUTCOMES AND MEASURES: In-hospital outcomes (mortality, length of stay, and discharge destination) and postdischarge outcomes (30-day mortality, 30-day readmission rate, 1-year mortality). RESULTS: We included 34 233 patients with HFpEF from 224 sites with measured troponin levels (33.4% men; median age, 79 years): 78.6% (n = 26 896) with troponin I and 21.4% (n = 7319) with troponin T measurements. Among these, 22.6% (n = 7732) had elevation in troponin levels. In adjusted analysis, higher serum creatinine level, black race, older age, and ischemic heart disease were associated with troponin elevation. Elevated troponin was associated with higher odds of in-hospital mortality (odds ratio [OR], 2.19; 95% CI, 1.88-2.56), greater length of stay (length of stay >4 days OR, 1.38; 95% CI, 1.29-1.47), and lower likelihood of discharge to home (OR, 0.65; 95% CI, 0.61-0.71) independent of other clinical predictors and measured confounders. Presence of elevated troponin I levels was also significantly associated with increased risk of 30-day mortality (hazard ratio [HR], 1.59; 95% CI, 1.42-1.80), 30-day all-cause readmission (HR, 1.12; 95% CI, 1.01-1.25), and 1-year mortality HR, 1.35; 95% CI, 1.26-1.45). CONCLUSIONS AND RELEVANCE: Troponin elevation among patients with acutely decompensated HFpEF is associated with worse in-hospital and postdischarge outcomes, independent of other predictive variables. Future studies are needed to determine if measurement of troponin levels among patients with decompensated HFpEF may be useful for risk stratification.

Original languageEnglish (US)
Pages (from-to)136-145
Number of pages10
JournalJAMA Cardiology
Volume2
Issue number2
DOIs
StatePublished - Feb 1 2017

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Troponin
Heart Failure
Guidelines
Troponin I
Length of Stay
Troponin T
Odds Ratio
Hospital Mortality
Mortality
Myocardial Ischemia
Registries
Creatinine
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Factors associated with and prognostic implications of cardiac troponin elevation in decompensated heart failure with preserved ejection fraction : Findings from the American Heart Association Get With the Guidelines-Heart Failure program. / Pandey, Ambarish; Golwala, Harsh; Sheng, Shubin; DeVore, Adam D.; Hernandez, Adrian F.; Bhatt, Deepak L.; Heidenreich, Paul A.; Yancy, Clyde W.; de Lemos, James A; Fonarow, Gregg C.

In: JAMA Cardiology, Vol. 2, No. 2, 01.02.2017, p. 136-145.

Research output: Contribution to journalArticle

Pandey, Ambarish ; Golwala, Harsh ; Sheng, Shubin ; DeVore, Adam D. ; Hernandez, Adrian F. ; Bhatt, Deepak L. ; Heidenreich, Paul A. ; Yancy, Clyde W. ; de Lemos, James A ; Fonarow, Gregg C. / Factors associated with and prognostic implications of cardiac troponin elevation in decompensated heart failure with preserved ejection fraction : Findings from the American Heart Association Get With the Guidelines-Heart Failure program. In: JAMA Cardiology. 2017 ; Vol. 2, No. 2. pp. 136-145.
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title = "Factors associated with and prognostic implications of cardiac troponin elevation in decompensated heart failure with preserved ejection fraction: Findings from the American Heart Association Get With the Guidelines-Heart Failure program",
abstract = "IMPORTANCE: Elevated levels of cardiac troponins are associated with adverse clinical outcomes among patients with heart failure (HF) and reduced ejection fraction. However, the clinical significance of troponin elevation in the setting of decompensated HF with preserved ejection fraction (HFpEF) is not well established. OBJECTIVE: To determine the clinical predictors of troponin elevation and its association with in-hospital and long-term outcomes among patients with decompensated HFpEF. DESIGN, SETTING, AND PARTICIPANTS: Observational analysis of Get With The Guidelines-HF registry participants who were admitted for decompensated HFpEF (ejection fraction 50{\%}) from January 2009 through December 2014 and who had quantitative or categorical (elevated vs normal based on institution’s reference laboratory) measures of troponin level (troponin T or troponin I, as available). MAIN OUTCOMES AND MEASURES: In-hospital outcomes (mortality, length of stay, and discharge destination) and postdischarge outcomes (30-day mortality, 30-day readmission rate, 1-year mortality). RESULTS: We included 34 233 patients with HFpEF from 224 sites with measured troponin levels (33.4{\%} men; median age, 79 years): 78.6{\%} (n = 26 896) with troponin I and 21.4{\%} (n = 7319) with troponin T measurements. Among these, 22.6{\%} (n = 7732) had elevation in troponin levels. In adjusted analysis, higher serum creatinine level, black race, older age, and ischemic heart disease were associated with troponin elevation. Elevated troponin was associated with higher odds of in-hospital mortality (odds ratio [OR], 2.19; 95{\%} CI, 1.88-2.56), greater length of stay (length of stay >4 days OR, 1.38; 95{\%} CI, 1.29-1.47), and lower likelihood of discharge to home (OR, 0.65; 95{\%} CI, 0.61-0.71) independent of other clinical predictors and measured confounders. Presence of elevated troponin I levels was also significantly associated with increased risk of 30-day mortality (hazard ratio [HR], 1.59; 95{\%} CI, 1.42-1.80), 30-day all-cause readmission (HR, 1.12; 95{\%} CI, 1.01-1.25), and 1-year mortality HR, 1.35; 95{\%} CI, 1.26-1.45). CONCLUSIONS AND RELEVANCE: Troponin elevation among patients with acutely decompensated HFpEF is associated with worse in-hospital and postdischarge outcomes, independent of other predictive variables. Future studies are needed to determine if measurement of troponin levels among patients with decompensated HFpEF may be useful for risk stratification.",
author = "Ambarish Pandey and Harsh Golwala and Shubin Sheng and DeVore, {Adam D.} and Hernandez, {Adrian F.} and Bhatt, {Deepak L.} and Heidenreich, {Paul A.} and Yancy, {Clyde W.} and {de Lemos}, {James A} and Fonarow, {Gregg C.}",
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TY - JOUR

T1 - Factors associated with and prognostic implications of cardiac troponin elevation in decompensated heart failure with preserved ejection fraction

T2 - Findings from the American Heart Association Get With the Guidelines-Heart Failure program

AU - Pandey, Ambarish

AU - Golwala, Harsh

AU - Sheng, Shubin

AU - DeVore, Adam D.

AU - Hernandez, Adrian F.

AU - Bhatt, Deepak L.

AU - Heidenreich, Paul A.

AU - Yancy, Clyde W.

AU - de Lemos, James A

AU - Fonarow, Gregg C.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - IMPORTANCE: Elevated levels of cardiac troponins are associated with adverse clinical outcomes among patients with heart failure (HF) and reduced ejection fraction. However, the clinical significance of troponin elevation in the setting of decompensated HF with preserved ejection fraction (HFpEF) is not well established. OBJECTIVE: To determine the clinical predictors of troponin elevation and its association with in-hospital and long-term outcomes among patients with decompensated HFpEF. DESIGN, SETTING, AND PARTICIPANTS: Observational analysis of Get With The Guidelines-HF registry participants who were admitted for decompensated HFpEF (ejection fraction 50%) from January 2009 through December 2014 and who had quantitative or categorical (elevated vs normal based on institution’s reference laboratory) measures of troponin level (troponin T or troponin I, as available). MAIN OUTCOMES AND MEASURES: In-hospital outcomes (mortality, length of stay, and discharge destination) and postdischarge outcomes (30-day mortality, 30-day readmission rate, 1-year mortality). RESULTS: We included 34 233 patients with HFpEF from 224 sites with measured troponin levels (33.4% men; median age, 79 years): 78.6% (n = 26 896) with troponin I and 21.4% (n = 7319) with troponin T measurements. Among these, 22.6% (n = 7732) had elevation in troponin levels. In adjusted analysis, higher serum creatinine level, black race, older age, and ischemic heart disease were associated with troponin elevation. Elevated troponin was associated with higher odds of in-hospital mortality (odds ratio [OR], 2.19; 95% CI, 1.88-2.56), greater length of stay (length of stay >4 days OR, 1.38; 95% CI, 1.29-1.47), and lower likelihood of discharge to home (OR, 0.65; 95% CI, 0.61-0.71) independent of other clinical predictors and measured confounders. Presence of elevated troponin I levels was also significantly associated with increased risk of 30-day mortality (hazard ratio [HR], 1.59; 95% CI, 1.42-1.80), 30-day all-cause readmission (HR, 1.12; 95% CI, 1.01-1.25), and 1-year mortality HR, 1.35; 95% CI, 1.26-1.45). CONCLUSIONS AND RELEVANCE: Troponin elevation among patients with acutely decompensated HFpEF is associated with worse in-hospital and postdischarge outcomes, independent of other predictive variables. Future studies are needed to determine if measurement of troponin levels among patients with decompensated HFpEF may be useful for risk stratification.

AB - IMPORTANCE: Elevated levels of cardiac troponins are associated with adverse clinical outcomes among patients with heart failure (HF) and reduced ejection fraction. However, the clinical significance of troponin elevation in the setting of decompensated HF with preserved ejection fraction (HFpEF) is not well established. OBJECTIVE: To determine the clinical predictors of troponin elevation and its association with in-hospital and long-term outcomes among patients with decompensated HFpEF. DESIGN, SETTING, AND PARTICIPANTS: Observational analysis of Get With The Guidelines-HF registry participants who were admitted for decompensated HFpEF (ejection fraction 50%) from January 2009 through December 2014 and who had quantitative or categorical (elevated vs normal based on institution’s reference laboratory) measures of troponin level (troponin T or troponin I, as available). MAIN OUTCOMES AND MEASURES: In-hospital outcomes (mortality, length of stay, and discharge destination) and postdischarge outcomes (30-day mortality, 30-day readmission rate, 1-year mortality). RESULTS: We included 34 233 patients with HFpEF from 224 sites with measured troponin levels (33.4% men; median age, 79 years): 78.6% (n = 26 896) with troponin I and 21.4% (n = 7319) with troponin T measurements. Among these, 22.6% (n = 7732) had elevation in troponin levels. In adjusted analysis, higher serum creatinine level, black race, older age, and ischemic heart disease were associated with troponin elevation. Elevated troponin was associated with higher odds of in-hospital mortality (odds ratio [OR], 2.19; 95% CI, 1.88-2.56), greater length of stay (length of stay >4 days OR, 1.38; 95% CI, 1.29-1.47), and lower likelihood of discharge to home (OR, 0.65; 95% CI, 0.61-0.71) independent of other clinical predictors and measured confounders. Presence of elevated troponin I levels was also significantly associated with increased risk of 30-day mortality (hazard ratio [HR], 1.59; 95% CI, 1.42-1.80), 30-day all-cause readmission (HR, 1.12; 95% CI, 1.01-1.25), and 1-year mortality HR, 1.35; 95% CI, 1.26-1.45). CONCLUSIONS AND RELEVANCE: Troponin elevation among patients with acutely decompensated HFpEF is associated with worse in-hospital and postdischarge outcomes, independent of other predictive variables. Future studies are needed to determine if measurement of troponin levels among patients with decompensated HFpEF may be useful for risk stratification.

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