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B. Schrage

Bio: B. Schrage is an academic researcher from Karolinska Institutet. The author has contributed to research in topics: Heart failure & Hazard ratio. The author has an hindex of 5, co-authored 17 publications receiving 94 citations. Previous affiliations of B. Schrage include University of Kiel & University of Hamburg.

Papers
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TL;DR: In a contemporary HFrEF population, ICD for primary prevention was underused although it was associated with reduced short- and long-term all-cause mortality, consistent across all the investigated subgroups.
Abstract: Background: Most randomized trials on implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction enrolled patien...

63 citations

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TL;DR: In this article, the authors used multivariable logistic regressions to assess patient characteristics independently associated with ID testing and use of ferric carboxymaltose (FCM) and its predictors in patients with ID.
Abstract: AIMS Iron deficiency (ID) is associated with poor prognosis regardless of anaemia. Intravenous iron improves quality of life and outcomes in patients with ID and heart failure (HF) with reduced ejection fraction (HFrEF). In the Swedish HF registry, we assessed (i) frequency and predictors of ID testing; (ii) prevalence and outcomes of ID with/without anaemia; (iii) use of ferric carboxymaltose (FCM) and its predictors in patients with ID. METHODS AND RESULTS We used multivariable logistic regressions to assess patient characteristics independently associated with ID testing/FCM use, and Cox regressions to assess risk of outcomes associated with ID. Of 21 496 patients with HF and any ejection fraction enrolled in 2017-2018, ID testing was performed in 27%. Of these, 49% had ID and more specifically 36% had ID-/anaemia-, 15% ID-/anaemia+, 29% ID+/anaemia-, and 20% ID+/anaemia+ (48%, 39%, 13%, 30% and 18% in HFrEF, respectively). Risk of recurrent all-cause hospitalizations was higher in patients with ID regardless of anaemia. Of 1959 patients with ID, 19% received FCM (24% in HFrEF). Important independent predictors of ID testing and FCM use were anaemia, higher New York Heart Association class, having HFrEF, and referral to HF specialty care. CONCLUSION In this nationwide HF registry, ID testing occurred in only about a quarter of the patients. Among tested patients, ID was present in one half, but only one in five patients received FCM indicating low adherence to current guidelines on screening and treatment.

27 citations

Journal ArticleDOI
TL;DR: This work assessed the association between beta‐blocker use and outcomes in HFrEF patients aged ≥80 years and found no significant association.
Abstract: Background Beta‐blockers reduce mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials. We assessed the association between beta‐blocker use and outcomes in HFrEF patients aged ≥80 years. Methods and results We included patients with an ejection fraction <40% and aged ≥80 years from the Swedish HF Registry. The association between beta‐blocker use, all‐cause mortality and cardiovascular (CV) mortality/HF hospitalization was assessed by Cox proportional hazard models in a 1:1 propensity score‐matched cohort. To assess consistency, the same analyses were performed in a positive control cohort with age <80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged ≥80 years, 5640 (86%) received beta‐blockers. In the matched cohort including 1732 patients, beta‐blocker use was associated with a significant reduction in the risk of all‐cause mortality [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.79–0.99]. Reduction in CV mortality/HF hospitalization was not significant (HR 0.94, 95% CI 0.85–1.05) due to the lack of association with HF hospitalization, whereas CV death was significantly reduced. After adjustment rather than matching for the propensity score in the overall cohort, beta‐blocker use was associated with reduced risk of all outcomes. In patients aged <80 years, use of beta‐blockers was associated with reduced risk of all‐cause death (HR 0.79, 95% CI 0.68–0.92) and of the composite outcome (HR 0.88, 95% CI 0.77–0.99). Conclusions In HFrEF patients ≥80 years of age, use of beta‐blockers was high and was associated with improved all‐cause and CV survival.

22 citations

Journal ArticleDOI
TL;DR: In this paper, the authors investigated the association between SGLT2i use and outcomes in real-world heart failure patients with Type 2 diabetes mellitus and found that SGL2i was associated with a 30% lower risk of cardiovascular (CV) death/first HF hospitalisation (hazard ratio 0.70, 95% confidence interval 0.52-0.95).
Abstract: Aims Use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in real-world heart failure (HF) is poorly characterised. In contemporary patients with HF and type 2 diabetes mellitus (T2DM) we assessed over time SGLT2i use, clinical characteristics and outcomes associated with SGLT2i use. Methods and results Type 2 diabetes patients enrolled in the Swedish HF Registry between 2016-2018 were considered. We performed multivariable logistic regression models to assess the independent predictors of SGLT2i use and Cox regression models in a 1:3 propensity score-matched cohort and relevant subgroups to investigate the association between SGLT2i use and outcomes. Of 6805 eligible HF patients with T2DM, 376 (5.5%) received SGLT2i, whose use increased over time with 12% of patients on treatment at the end of 2018. Independent predictors of SGLT2i use were younger age, HF specialty care, ischaemic heart disease, preserved kidney function, and absence of anaemia. Over a median follow-up of 256 days, SGLT2i use was associated with a 30% lower risk of cardiovascular (CV) death/first HF hospitalisation (hazard ratio 0.70, 95% confidence interval 0.52-0.95), which was consistent regardless of ejection fraction, background metformin treatment and kidney function. SGLT2i use was also associated with a lower risk of all-cause and CV death, HF and CV hospitalisation, and CV death/myocardial infarction/stroke. Conclusion In a contemporary HF cohort with T2DM, SGLT2i use increased over time, was more common with specialist care, younger age, ischaemic heart disease, and preserved renal function, and was associated with lower mortality and morbidity.

20 citations


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TL;DR: A contemporary overview on the global burden of HF is provided, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
Abstract: Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the aging of the population, improved treatment of and survival with ischemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.

189 citations

Journal ArticleDOI
TL;DR: In this paper , the authors provide a contemporary overview on the global burden of heart failure, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide, and provide a comprehensive overview of the available evidence-based therapies for patients with heart failure.
Abstract: Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.

171 citations