Rolf Handschin

Kantonsspital Baselland Bruderholz, Bâle, Basel-City, Switzerland

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Publications (7)33.58 Total impact

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    ABSTRACT: Aims: The aim of this study was to evaluate whether biomarkers reflecting pathophysiological pathways are different between heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) and whether the prognostic value of biomarkers is different in HFpEF vs. HFrEF. Methods and results: A total of 458 HFrEF (LVEF ≤40%) and 112 HFpEF (LVEF ≥50%) patients aged ≥60 years with NYHA class ≥II from TIME-CHF were included. Endpoints are 18-month overall and HF hospitalization-free survival. After correction for baseline characteristics that differed between the HF types, i.e. age, gender, body mass index, systolic blood pressure, cause of HF, and AF, HFpEF patients exhibited higher soluble interleukin 1 receptor-like 1 [ST2; 37.6 (28.5-54.7) vs. 35.7 (25.6-52.2), P = 0.02], high sensitivity C-reactive protein (hsCRP; 8.54 (3.39-25.86) vs. 6.66 (2.42-15.39), P = 0.01), and cystatin-C [1.94 (1.57-2.37) vs. 1.75 (1.39-2.12), P = 0.01]. In contrast, HFrEF patients exhibited higher NT-proBNP [2142 (1473-4294) vs. 4202 (2239-7411), P < 0.001], high sensitivity troponin T [hsTnT; 27.7 (16.8-48.0) vs. 32.4 (19.2-59.0), P = 0.03], and haemoglobin [124 (110-135) vs. 134 (122-145), P < 0.001]. In addition to these clinical characteristics, NT-proBNP, haemoglobin, cystatin-C, hsTnT, and ST2 improved the area under the curve from 0.86 (0.82-0.89) to 0.91 (0.87-0.94; P < 0.001) for discriminating HFpEF from HFrEF. There were no significant interactions between HFpEF and HFrEF when considering the prognostic value of the investigated biomarkers (P > 0.10 for both endpoints), except for cystatin-C which had less prognostic impact in HFpEF (P < 0.01). Conclusion: Biomarker levels suggest a different amount of activation of several pathophysiological pathways between HFpEF and HFrEF. No important differences in the prognostic value of biomarkers in HFpEF vs. HFrEF were found except for cystatin-C, and for NT-proBNP in the NT-proBNP-guided study arm only, both of which had less prognostic value in HFpEF. Trial registration: ISRCTN43596477.
    No preview · Article · Oct 2015 · European Journal of Heart Failure
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    ABSTRACT: There is little information regarding the prognostic role of resting heart rate (HR) in older compared to younger patients with chronic heart failure (HF). In patients enrolled in the Trial of Intensified Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) with sinus rhythm, effects of baseline HR (≥70 vs. <70 bpm) on 18 months outcomes were compared between older (≥75 years; n=186) and younger ( <75 years; n=141) patients. Older patients with lower (61±6 bpm) and higher (83±9 bpm) HR had similar left ventricular ejection fraction (LVEF), NYHA class, N-terminal-pro-B-type natriuretic peptide (NT-proBNP), and survival and HF hospitalization-free survival. In contrast, younger patients with higher HR (81±7 bpm) had higher NT-proBNP and NYHA class and lower LVEF, and a higher risk of death [hazard ratio = 4.01 (95%-confidence interval, 1.17 -13.69); p= 0.02] and death or HF hospitalization [hazard ratio=2.35 (95%-confidence interval, 1.01-5.50); p= 0.04] than those with lower HR (62±5 bpm) with the association between higher HR and survival remaining significant after adjustment for NYHA class, LVEF, and NT-proBNP. In contrast to HF patients aged <75 years we found no association between HR and worse outcomes in HF patients aged ≥75 years. http://www.isrctn.org. Unique identifier: ISRCTN43596477. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jan 2015 · Journal of Cardiac Failure
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    ABSTRACT: Heart failure (HF) management is complicated by difficulties in clinical assessment. Biomarkers may help guide HF management, but the correspondence between clinical evaluation and biomarker serum levels has hardly been studied. We investigated the correlation between biomarkers and clinical signs and symptoms, the influence of patient characteristics and comorbidities on New York Heart Association (NYHA) classification and the effect of using biomarkers on clinical evaluation. This post-hoc analysis comprised 622 patients (77 ± 8 years, 76 % NYHA class ≥3, 80 % LVEF ≤45 %) participating in TIME-CHF, randomising patients to either NT-proBNP-guided or symptom-guided therapy. Biomarker measurements and clinical evaluation were performed at baseline and after 1, 3, 6, 12 and 18 months. NT-proBNP, GDF-15, hs-TnT and to a lesser extent hs-CRP and cystatin-C were weakly correlated to NYHA, oedema, jugular vein distension and orthopnoea (ρ-range: 0.12-0.33; p < 0.01). NT-proBNP correlated more strongly to NYHA class in the NT-proBNP-guided group compared with the symptom-guided group. NYHA class was significantly influenced by age, body mass index, anaemia, and the presence of two or more comorbidities. In HF, biomarkers correlate only weakly with clinical signs and symptoms. NYHA classification is influenced by several comorbidities and patient characteristics. Clinical judgement seems to be influenced by a clinician's awareness of NT-proBNP concentrations.
    Full-text · Article · Dec 2013 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    ABSTRACT: Background and AIMS: Inflammation is part of the pathophysiology of congestive heart failure (CHF). However, little is known about the impact of the presence of systemic inflammatory disease (SID), defined as inflammatory syndrome with constitutional symptoms and involvement of at least two organs as co-morbidity on the clinical course and prognosis of patients with CHF.Methods and RESULTS: This is an analysis of all 622 patients included in TIME-CHF. After an 18 months follow-up, outcomes of patients with and without SID were compared. Primary endpoint was all-cause hospitalization free survival. Secondary endpoints were overall survival and CHF hospitalization free survival. At baseline, 38 patients had history of SID (6.1%). These patients had higher NT-proBNP and worse renal function than patients without SID. SID was a risk factor for adverse outcome (primary endpoint: hazard ratio (HR)=1.73 [95%-CI: 1.18-2.55, p=0.005]; survival: HR=2.60 [1.49-4.55, p=0.001]; CHF hospitalization free survival: HR=2.3 [1.45-3.65, p<0.001]). In multivariate models, SID remained the strongest independent risk factor for survival and for CHF hospitalization free survival. In elderly patients with CHF, SID is independently accompanied with adverse outcome. Given the increasing prevalence of SID in the elderly population, these findings are clinically important for both risk stratification and patient management.
    No preview · Article · Oct 2013 · QJM: monthly journal of the Association of Physicians
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    ABSTRACT: Background: In patients with chronic heart failure (HF), high heart rate (HR) is a marker of poor prognosis, and HR reduction is associated with improved outcomes. However, these data are based on trials including relatively young patients (typically less than 75 years), and there is little information regarding the prognostic role of HR in older HF patients. Accordingly, the aim of the present study was to compare the relationship between HR and outcomes in younger (age <75 years) and older (age ≥75 years) patients with chronic HF. Methods: Patients enrolled in the randomized, controlled multicenter Trial of Intensified Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) with sinus rhythm and without any device (pacemaker, defibrillator) throughout the trial were included in this post-hoc analysis. The effects of baseline HR (≥70 vs. <70 beats per minute (bpm) on 18 months outcomes (survival, HF hospitalization-free survival) were compared between younger (n=141, age 69±4 years) and older (n=186, age 82±4 years) patients. Results: Younger patients with higher baseline HR (n=86; HR 81±7 bpm) had worse left ventricular ejection fraction (LVEF; p=0.01), worse NYHA class (p=0.006) and higher N-terminal-pro-B-type natriuretic peptide (NT-proBNP; p=0.003) than those with lower HR (n=55; HR 62±5 bpm) but groups did not differ in terms of management strategy allocation (NT-proBNP-guided vs. symptom-guided). Survival and HF hospitalization-free survival at 18 months were worse in those with higher compared to those with lower HR [hazard ratio = 4.01 (95% CI, 1.17 -13.69), p= 0.02 and hazard ratio=2.35 (95% CI, 1.01-5, 50), p= 0.04; respectively], even after adjustment for LVEF, NYHA class, and NT-proBNP. In contrast, older patients with lower (n=77; HR 61±6 bpm) and higher (n=109; HR 83±9 bpm) baseline HR did not differ in terms of LVEF, NYHA class, NT-proBNP, and management strategy, and outcomes did not differ between those with higher and lower HR [for survival hazard ratio= 0.87 (95% CI, 0.47-1.61), p= 0.66 and HF hospitalization-free survival hazard ratio =0.84 (95% CI, 0.52-1.34), p= 0.46]. In older patients, the relationship between HR and outcomes was similar across LVEF categories (>45% and ≤45%) and was not influenced by betablocker use (p value for interaction > 0.33 for all endpoints). Conclusion: In accordance with previous data, we observed better outcomes in younger patients with chronic HF with lower HR compared to those with higher HR. In contrast, an association between HR and outcomes was not seen in older patients with chronic HF.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Contemporary heart failure (HF) patients are elderly and have a high rate of early rehospitalization or death, resulting in a high burden for both the patients and the health care system. Prior studies were focused on younger and less well-characterized patients. We aimed to identify predictors of early hospital readmission and death in elderly patients with HF. Patients with chronic HF taking part in the TIME-CHF study (n = 614, age 77 +/- 8 years, 41% female, left ventricular ejection fraction 35% +/- 13%) were evaluated with respect to predictors of hospital readmission or death 30 and 90 days after inclusion. Demographic, clinical, laboratory, echocardiographic, and social variables were obtained at baseline and included in a multivariable logistic regression analysis to identify predictors of early events. The rate of hospital readmission or death was high at 30 (11%) and 90 days (26%). The reason for hospitalization was HF in 33%, other cardiovascular in 32%, and noncardiovascular in 45% of the cases, respectively. Predictors of readmission or death at 30 days were angina, lower systolic blood pressure, anemia, more extensive edema, higher creatinine levels, and dry cough; and at 90 days were coronary artery disease, prior pacemaker implantation, high jugular venous pressure, pulmonary rales, prior abdominal surgery, older age, and depressive symptoms. Early hospital readmission or death was frequent among elderly HF patients. A very large proportion of readmissions were due to noncardiovascular causes. In addition to clinical signs of HF, comorbidities are important predictors of early events in elderly HF patients.
    Full-text · Article · Aug 2010 · American heart journal
  • R. Handschin · P.S. Rickenbacher

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