Emil Loldrup Fosbøl

• MD, PhD
• Rigshospitalet

Introduction Contrary to the current guidelines patients with symptomatic severe aortic stenosis and ≤65 years of age are often referred for transcatheter aortic valve replacement (TAVR). However, the outcome after TAVR in this patient cohort remains unclear. Objectives This study aimed to assess the rationale for denial of surgical aortic valve r...

Background Obesity is common in heart failure with reduced ejection fraction (HFrEF). As anti-obesity treatments advance, understanding how body mass index (BMI) affects outcomes in HFrEF is increasingly important. Objective To examine whether a BMI >27 kg/m² is linked to higher risks of all-cause mortality, cardiovascular death, and heart failure...

Background Liver injury is a frequent complication in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). The Model for End-Stage Liver Disease incorporating albumin (MELD-albumin) quantifies liver injury. This study assesses the association between MELD-albumin score and all-cause mortality among patients with AMICS...

Background The recent DanGer shock trial found reduced mortality, but increased risk of acute kidney injury (AKI) in patients treated with a microaxial flow pump after an acute myocardial infarct with cardiogenic shock. AKI has previously been associated with increased short-term mortality, whereas data on long-term outcomes are sparse. We aimed to...

European Society of Cardiology (ESC) Guidelines provide best practice, evidence-based recommendations for diagnosing and treating patients with cardiovascular diseases. It is not always possible for best practices to be followed, however, particularly in low-resource settings. To address this issue, a set of guideline-related documents were created...

Background Heart failure (HF) and frailty often coexist. However, it is unknown how the interplay between HF and frailty at HF onset impacts prognosis of frail patients with HF and how this has evolved over time. Methods and Results We identified 131 235 patients with new‐onset HF (median age 74 years, 39.7% women) from Danish nationwide registers...

Background Antithrombotic therapy post-transcatheter aortic valve implantation (TAVI) has been widely debated in the past two decades. Data describing practice patterns of antithrombotic therapy are warranted. This study examined the trends in use of antithrombotic therapy post-TAVI in Denmark. Methods Danish patients with aortic stenosis who unde...

Introduction: Cardiac Amyloidosis (CA) is characterised by amyloid fibril deposits causing heart failure (HF). Lumbar spinal stenosis (LSS) is recognised as a potential red flag for CA, but the association remains underexplored in large-scale studies. Methods: This nationwide registry-based cohort study in Denmark included subjects ≥60 years wit...

BACKGROUND Sparse information regarding the long-term risk of acute myocardial infarction (MI) following a transient ischemic attack (TIA) emphasizes further research to guide preventive strategies and risk stratification in patients with a TIA. METHODS We conducted a nationwide cohort study to investigate the 5-year risk of MI and all-cause morta...

Background Little is known about long-term outcomes beyond survival following acute aortic dissection. The aim of this research was to evaluate rates of home care initiation and nursing home admission during the first year after discharge and to assess factors associated with these needs. Methods All patients in Denmark with a first-time diagnosis...

Aims Although certain autoimmune diseases (AIDs) have been associated with an increased rate of heart failure (HF), data on the long‐term rate of HF across the spectrum of AIDs are lacking. We investigated the long‐term rate of HF in individuals with a history of 28 different AIDs. Methods and results Individuals diagnosed with an AID (2000–2021)...

Background and objectives: Transient ischemic attack (TIA) is associated with a higher short-term incidence of stroke. However, long-term data on this association are lacking. Therefore, this study aimed to determine the long-term incidence of ischemic stroke after TIA according to ABCD2 score and to identify factors associated with stroke after T...

Aims Atrial fibrillation (AF) is associated with heart failure (HF). However, it is unclear if postoperative AF (POAF) following non‐cardiac surgery differs from non‐surgical AF in terms of the risk of HF. We compared the long‐term rate of incident HF in patients developing new‐onset POAF following non‐cardiac surgery with patients who did not deve...

Background Kidney and liver injury are frequent complications in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) because of hypoperfusion and venous congestion. Model of End-Stage Liver Disease replacing INR with albumin (MELD-Albumin) score quantifies liver and kidney function and has been associated with mortali...

To examine temporal changes in patient characteristics, the incidence rate of surgical intervention, and the three-year mortality rate for patients undergoing surgical intervention for mitral valve stenosis (MS) from 2001 to 2021 in Denmark. Utilizing Danish nationwide registries, we identified all adult patients undergoing first-time surgical inte...

Background: Chronic kidney disease (CKD) is a frequent comorbidity in heart failure (HF) patients, affecting prognosis and mortality. This study investigates the relationship between kidney function and adverse kidney events preceding death in HF patients. Methods: We analyzed registry data of HF patients who died between 2014 and 2021, with at lea...

Background Patients undergoing transcatheter aortic valve implantation (TAVI) for bicuspid aortic stenosis (AS) frequently present with ascending aortic (AAo) dilatation which is left untreated. The objective of this study was to study the natural progression and underlying mechanisms of AAo dilatation after TAVI for bicuspid AS. Methods Patients...

Background Staphylococcus aureus bacteremia (SAB) is a high-risk condition associated with high morbidity and mortality. In the presence of cardiac implantable electronic devices (CIEDs), SAB may cause or clinically indicate device infection. We aimed to estimate the 10-year absolute risk of SAB in adult Danish first-time CIED carriers. Secondary a...

Background and aims Endometriosis, a systemic gynecological disease affecting 10% of women in reproductive age, shares pathophysiological characteristics with cardiovascular disease. However, data on the relationship between endometriosis and cardiovascular outcomes are scarce, prompting this study to address the knowledge-gap. Methods Using Danis...

Background and Aims Patients with congenital heart disease (CHD) form a high-risk subgroup for infective endocarditis (IE), necessitating tailored prevention and treatment strategies. However, comprehensive nationwide data comparing IE characteristics and outcomes in patients with and without CHD, including children, are sparse. This study aims to...

Aims We aimed to investigate temporal trends in all-cause mortality, heart failure (HF) hospitalisation, and stroke from 1997 to 2018 in patients diagnosed with both HF and atrial fibrillation (AF). Methods and results From Danish nationwide registers, we identified 152 059 patients with new-onset HF between 1997 and 2018. Patients were grouped ac...

Aims Chronic kidney disease (CKD) is a well‐established risk factor for heart failure (HF); however, patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² have been systematically excluded from clinical trials. This study investigated the incidence of HF and kidney outcomes in HF patients with and without advanced CKD, th...

Objectives To investigate return to work and workforce detachment in ischemic stroke, including the association with age and level of education. Methods Patients in the workforce aged 18 to 60 with first-time ischemic stroke between 1997 and 2017 were identified in Danish registers and followed for 5 years. The cumulative incidence of return to wo...

Aims Pre-eclampsia (PE), a pregnancy-induced hypertensive disorder, affects 4–5% of pregnancies worldwide. It is well known that hypertension is associated with an increased risk of arrhythmias; however, data on the association between PE and arrhythmias are sparse. Methods and results In this observational cohort study, we identified all primipar...

Background Blood levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been suggested as a future guidance tool for the selection of patients for aortic valve replacement. This study aimed to examine how levels of NT-proBNP pre-transcatheter aortic valve implantation (TAVI) is associated with one-year rates of heart failure (HF) admis...

Infective native aneurysms (INA) of the infrapopliteal arteries are rare and have previously been poorly described. This systematic review aims to provide an overview of the literature of this entity. Furthermore, two case reports of our own clinical experience are presented. PubMed, ScienceDirect, Cochrane, Ovid Embase, Ovid MEDLINE, and Web of Sc...

Aims Although recent randomized clinical trials have demonstrated the advantages of heart failure (HF) therapy in both frail and not frail patients, there is insufficient information on the use of HF therapy based on frailty status in a real‐world setting. The aim was to examine how frailty status in HF patients associates with use of HF therapy an...

Purpose Surgery is required in 20–50% of patients with infective endocarditis (IE). Frailty increases surgical risk; however, the prognostic implications of frailty in patients undergoing IE-related surgery remain poorly understood. We aimed to assess the association between frailty and all-cause mortality or rehospitalization after discharge (≥ 14...

Background and aims: Patients with atrial fibrillation (AF) are at increased risks of cardiovascular diseases and mortality, but risks according to age at diagnosis have not been reported. This study investigated age-specific risks of outcomes among patients with AF and the background population. Methods: This nationwide population-based cohort...

Aims Vegetation size assessed by transoesophageal echocardiography (TOE) is a decisive metric in guiding surgical intervention and prognosis in patients with definite infective endocarditis (IE). The aim of this study was to assess the impact of echocardiographic experience on the reliability and reproducibility of TOE measurements of vegetations i...

In this case, an unusual presentation of Enterococcus faecalis (E.faecalis) endocarditis and clinical signs of wrist and forearm infection are reported. Before the patient was diagnosed with E.faecalis endocarditis, the patient managed to be treated with both prednisolone, various antibiotics, and colchicine on suspicion of gout, erysipelas, and de...

Aims Although selected autoimmune diseases (AIDs) have been linked to an increased risk of ventricular arrhythmias (VAs), data on the long-term rate of VAs across the spectrum of AIDs are lacking. The aim of this study was to investigate the long-term rate of VAs (a composite of ventricular tachycardia, ventricular fibrillation, ventricular flutter...

Background:It remains unknown how the prognosis has changed for patients with heart failure (HF) and concomitant atrial fibrillation (AF), which is why we aimed to investigate temporal trends in clinical outcomes from 1997 to 2018. Methods:From Danish nationwide registries, we identified 152,059 patients with a first-time HF-diagnosis from 1997 to...

Background Prevention and management of childhood overweight involves the entire family. We aimed to investigate purchase patterns in households with at least one member with overweight in childhood by describing expenditure on different food groups. Methods This Danish register-based cohort study included households where at least one member dona...

Background The incidence and distribution of acute and chronic dialysis among patients with heart failure (HF), stratified by diabetes, remain uncertain. We hypothesized that with improved survival and rising comorbidities, the demand for dialysis would increase over time. Methods and Results Patients with incident HF, aged 18 to 100 years, betwee...

BACKGROUND Oral anticoagulation is suggested in patients with atrial fibrillation and a CHA 2 DS 2 -VASc score ≥1 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65–74 years, and sex score). To assess granular differences within CHA 2 DS 2 -VASc 1, the incidence of arterial thromboembolism according t...

Aims It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS). Methods and results Subjects who underwent two hsTnI measurements (Siemens TnI Flex® Reagent) separated by 1–7 h, during a first-time hospitalization for myocardial infarction, uns...

Aims To examine temporal changes in patient characteristics, incidence rate of surgery, and three-year mortality rate for patients undergoing surgery for mitral valve stenosis in Denmark (2001-2021).. Methods and results: Utilizing Danish nationwide registries, we identified all adult patients undergoing first-time MS-intervention (2001-2021). Temp...

Importance As venous thromboembolism (VTE) remains one of the leading causes of maternal mortality, identifying women at increased risk of VTE is of great importance. Preeclampsia is a pregnancy-induced hypertensive disorder with generalized endothelial dysfunction. Some studies suggest that preeclampsia is associated with an increased risk of VTE,...

Background and Aims In the Partial Oral Treatment of Endocarditis (POET) trial, stabilized patients with left-sided infective endocarditis (IE) were randomized to oral step-down antibiotic therapy (PO) or conventional continued intravenous antibiotic treatment (IV), showing non-inferiority after 6 months. In this study, the first guideline-driven c...

Background: Linezolid in combination with rifampicin has been used in treatment of infective endocarditis especially for patients infected with staphylococci. Objectives: Because rifampicin has been reported to reduce the plasma concentration of linezolid, the present study aimed to characterize the population pharmacokinetics of linezolid for t...

Background Estimating how type 2 diabetes (T2D) affects the rate of depression in cardiovascular disease (CVD) can help identify high-risk patients. The aim is to investigate how T2D affects the rate of depression according to specific subtypes of CVD. Methods Incident CVD patients, free of psychiatric disease, with and without T2D, were included...

Introduction: Data on temporal trends in guideline-based medical and device therapies in real-world chronic heart failure (HF) patients are lacking. Methods: Register-based nationwide follow-ups of temporal trends in characteristics, guideline-recommended therapies, one-year all-cause mortality, and HF rehospitalizations in incident HF patients in...

Background: The short-term incidence of ischemic stroke after a transient ischemic attack (TIA) is high. However, data on the long-term incidence are not well known but are needed to guide preventive strategies. Methods: Patients with first-time TIA (index date) in the Danish Stroke Registry (January 2014-December 2020) were included and matched 1:...

Infective endocarditis (IE) is a major public health challenge.1 In 2019, the estimated incidence of IE was 13.8 cases per 100 000 subjects per year, and IE accounted for 66 300 deaths worldwide.2 Due to the associated high morbidity and mortality (1723.59 disability-adjusted life years and 0.87 death cases per 100 000 population, respectively), id...

Background For women whose first pregnancy was complicated by pre-eclampsia (PE), particularly if severe and requiring early birth, the risk of recurrence and maternal and neonatal outcomes at subsequent birth are important considerations. Methods In this observational cohort study, all primiparous women who gave birth in Denmark between 1997 and...

Aim: Expected 1-year survival is essential to risk stratification of patients with heart failure (HF); however, little is known about the 1-year prognosis of patients with HF and cancer. Thus, the objective was to investigate the 1-year prognosis following new-onset HF stratified by cancer status in patients with breast-, gastrointestinal-, or lun...

Background: Patients with heart failure are vulnerable to the SARS-CoV-2 infection. However, limited evidence exists on the safety of the SARS-CoV-2 mRNA vaccines in this patient population. The objective of this study was to investigate the risk of all-cause mortality, worsening heart failure, venous thromboembolism, and myocarditis associated wi...

Background: Troponin concentrations above upper reference are associated with increased mortality in patients with pulmonary embolism (PE). We aimed to assess whether risk of 30-day mortality increases in a dose-response relationship with concentration of troponin. Methods: Using Danish national registries, we identified patients ≥ 18 years of a...

Background Use of medical therapies for heart failure (HF) patients with moderate kidney dysfunction is low. We hypothesized that lack of initiation of HF therapy reflects the clinicians’ reluctance in very elderly and frail patients more than kidney dysfunction itself. Methods HF patients were identified from nationwide registers between 2014 and...

Background Guidelines recommend that patients with myocardial infarction (MI) receive equal care regardless of age. However, withholding treatment may be justified in elderly and frail patients. This study aimed to investigate trends in treatments and outcomes of older patients with MI according to frailty. Methods and Results All patients aged ≥7...

Background: We aimed to describe characteristics and outcomes in a nationwide population of patients with acute Type-A and Type-B aortic dissection. Methods: All patients in Denmark with a first-time diagnosis of acute aortic dissection between 2006-2015 were identified using national registries. The main outcomes were in-hospital mortality and...

Background: Anthracycline-based chemotherapy has improved the prognosis of various malignancies, but increases the long-term risk of heart failure (HF). Identification of patients at risk prior to treatment initiation is warranted. Therefore, the aim of this study was to evaluate if a familial predisposition to HF increases the risk of anthracycli...

Background The mineralocorticoid receptor antagonists (MRAs) eplerenone and spironolactone are beneficial in heart failure with reduced ejection fraction (HFrEF), but have not been prospectively compared. We compared clinical outcomes, daily dosages, and discontinuation rates for the two drugs in a nationwide cohort. Methods We identified all pati...

Background Whether continued follow-up in specialized heart failure (HF) clinics after optimization of guideline-directed therapy improves long-term outcomes in patients with HF with reduced ejection fraction (HFrEF) is unknown. Methods and results 921 medically optimized HFrEF patients enrolled in the NorthStar study were randomly assigned to fol...

Aims: To date, potential differences in outcomes for immigrants and non-immigrants with a cardiac resynchronization therapy (CRT), in a European setting, remain underutilized and unknown. Hence, we examined the efficacy of CRT measured by heart failure (HF)-related hospitalizations and all-cause mortality among immigrants and non-immigrants. Meth...

Objectives: Patients with chronic renal failure on hemodialysis carry a significant risk of infective endocarditis (IE), but data on whether these patients differ from other patients with IE in terms of comorbidity, microbiology, rates of surgery and mortality are sparse. Methods: Using Danish nationwide registries, all patients with IE diagnose...

Background: Valve-in-valve-transcatheter aortic valve implantation (TAVI) is a feasible and increasingly used treatment option for failed surgical aortic prosthesis, but data from clinical practice are limited. Objectives: We aimed to examine patient characteristics and outcomes of patients undergoing TAVI in a surgical valve (valve-in-valve TAV...

Aims: While clinical trials have suggested that a high ventricular rate is associated with increased risk of heart failure (HF) and mortality, all-comers studies are warranted. Objective: To assess 1-year risk of new-onset diagnosed HF and all-cause mortality among rate-control treated patients presenting with atrial fibrillation (AF) on an elec...

Background: Severe chronic obstructive pulmonary disease (COPD) has been associated with futile outcome after transcatheter aortic valve replacement (TAVR). Data on outcomes according to COPD severity are warranted to aid identification of patients who may not benefit from TAVR. We aimed to examine the association between risk of COPD exacerbation...

Purpose Streptococcal bloodstream infections (BSIs) are common, yet prognostic factors are poorly investigated. We aimed to investigate the mortality according to streptococcal species and seasonal variation. Methods Patients with streptococcal BSIs from 2008 to 2017 in the Capital Region of Denmark were investigated, and data were crosslinked wit...

Background: In the POET (Partial Oral Endocarditis Treatment) trial, oral step-down therapy was noninferior to full-length intravenous antibiotic administration. The aim of the present study was to perform pharmacokinetic/pharmacodynamic analyses for oral treatments of infective endocarditis to assess the probabilities of target attainment (PTAs)....

Background: Cardiogenic shock is known to induce an inflammatory response. The prognostic utility of this remains unclear. Purpose: To investigate the association between C-reactive protein (CRP) levels and leucocyte count and mortality in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). Methods: Consecutive...

Purpose. Transthyretin is produced in the retina and approximately one quarter of patients with variant transthyretin amyloidosis (ATTRv) develop ocular involvement. Glaucoma is the most important ocular manifestation, leading to rapid loss of vision. The usefulness of glaucoma as a red flag for cardiac amyloidosis is unknown. Materials and Methods...

Aims: Autoimmune diseases (AIDs) are associated with a higher risk of heart failure (HF). However, data on the prognosis of HF patients with a history of AID is limited. The aim was to investigate the rates of all-cause mortality and HF hospitalization in a large, nationwide cohort of patient with HF according to a history of 29 AIDs. Methods: U...

Introduction Antibiotic prophylaxis is recommended for patients considered in high risk of infective endocarditis (i.e., patients with prior infective endocarditis, heart valve prosthesis, and certain congenital heart diseases). Methods This study investigated prescription patterns and prescription filling patterns of antibiotic prophylaxis in pat...