How important is the cause of heart failure in determining prognosis?
Dec 5, 2023
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Prof Gerhard Poelzl discusses the importance of determining the cause of heart failure for prognosis prediction and the limitations of using ejection fraction alone. The study explores the connection between etiology, ejection fraction, and mortality in chronic heart failure. The findings reveal significant effects of etiology on mortality through ejection fraction and highlight the importance of clarifying the cause of heart failure for risk stratification and decision-making.
Proper etiologic determination is crucial for risk stratification and treatment decisions in heart failure patients.
The direct effect of etiology on overall mortality is generally larger than the indirect effect mediated through ejection fraction, highlighting the need to clarify etiology rather than solely focusing on ejection fraction.
Deep dives
The Importance of Etiology in Heart Failure
This podcast episode discusses the significance of etiology in heart failure prognosis. The prevalence of heart failure is high, affecting millions of patients worldwide. Traditionally, management decisions have been based on ejection fraction, but this approach has been criticized. The study featured in the episode aimed to demonstrate the importance of etiology in heart failure outcomes independently of ejection fraction. The research analyzed data from 2000 patients with chronic heart failure, found that etiology significantly affects ejection fraction, and determined that etiology is strongly associated with overall mortality, regardless of ejection fraction. The study emphasizes the need for thorough etiologic assessment in risk stratification and treatment decision-making.
Mediation Analysis and Findings
The podcast episode explains how mediation analysis was used to study the relations between etiology, ejection fraction, and mortality. The analysis decomposed the total effect of etiology on mortality into two components: the indirect effect mediated through ejection fraction and the direct effect independent of ejection fraction. The findings demonstrated that ejection fraction contributes to mortality in a small but statistically significant way, with varying impacts depending on the etiology. However, the direct effect of etiology on mortality remained significant, highlighting the importance of etiology in prognosis. The study concludes that proper etiologic determination is crucial for risk stratification and treatment decisions in heart failure patients.
Implications and Future Research
The podcast episode highlights the implications of the study's findings and suggests areas for further research. The main conclusion is that the direct effect of etiology on overall mortality is generally larger than the indirect effect mediated through ejection fraction. This emphasizes the need to clarify the etiology of heart failure rather than solely focusing on ejection fraction. The episode mentions the importance of considering clinical limitations and individual biomarkers like N-terminal pro-B-type natriuretic peptide (NT-proBNP). Future research plans involve exploring the additional effects of clinical parameters and deciphering the independent effect of NT-proBNP, with the aim of better understanding their significance in conjunction with etiology. Ultimately, the study emphasizes the importance of a comprehensive etiologic approach for a more informed and effective management of heart failure.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Prof Gerhard Poelzl from Innsbruck in Austria. They discuss the importance of determining the aetiology of heart failure for prognosis prediction via his work on mediation analysis of ejection fraction. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful.
