Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study.
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BACKGROUND: QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. METHODS AND RESULTS: We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. CONCLUSIONS: QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.
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Mentz, Robert J, Melissa A Greiner, Adam D DeVore, Shannon M Dunlay, Gaurav Choudhary, Tariq Ahmad, Prateeti Khazanie, Tiffany C Randolph, et al. (2015). Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study. Circ Heart Fail, 8(2). pp. 243–251. 10.1161/CIRCHEARTFAILURE.114.001729 Retrieved from https://hdl.handle.net/10161/11076.
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I am a cardiologist with a clinical and research interest in heart failure (going from Failure to Function), including advanced therapies such as cardiac transplantation and mechanical assist devices or “heart pumps."
I serve our group as Chief of the Heart Failure Section.
I became a heart failure cardiologist in order to help patients manage their chronic disease over many months and years. I consider myself strongly committed to compassionate patient care with a focus on quality of life and patient preference.
I am the Editor in Chief of the Journal of Cardiac Failure - The official journal of the Heart Failure Society of America.
My research interests are focused on treating co-morbid diseases in heart failure patients and improving outcomes across the cardiovascular spectrum through clinical trials and outcomes research. Below, you will find my specific research interests:
- Cardiometabolic disease
- Co-morbidity characterization (diabetes, sleep apnea, renal failure) in heart failure
- Phenotypic characterization and risk prognostication of patients with heart failure
- Role of surrogate and nonfatal endpoints in clinical heart failure trials
- Biomarkers in heart failure
- Novel pharmacological and non-pharmacological approaches to heart failure
- Improving site-based heart failure research
Adam D. DeVore, MD, MHS
Dr. DeVore is a cardiologist and Associate Professor of Medicine in the Department of Medicine, Division of Cardiology, at Duke University School of Medicine. His clinical interests include caring for patients and families with heart failure, including those with left ventricular assist devices and heart transplants. He is involved in and leads multiple large studies of patients with heart failure at both Duke University Medical Center and the Duke Clinical Research Institute. He currently serves as the medical director of the Duke Heart Transplant program.
He attended medical school at the University of Chicago Pritzker School of Medicine and completed internal medicine residency at Brigham and Women’s Hospital. He then pursued cardiology training at Duke University and solidified his interests in clinical research and heart failure. He completed a research fellowship at the Duke Clinical Research Institute and a Masters of Health Sciences in Clinical Research before completing an advanced heart failure fellowship at Duke University.
The overarching goals of his research are to advance the current understanding of heart failure through clinical trials as well as develop an evidence base for implementation strategies that addresses the gap between heart failure trial results and clinical practice. For example, he has served on the Steering Committees for large clinical trials, including PIONEER-HF and SPIRRIT-HFpEF. Dr. DeVore also published the first clinical trial conducted within the American Heart Association’s Get With The Guidelines-Heart Failure program, a registry-based cluster randomized trial of quality improvement interventions. He was also the principal investigator for CONNECT-HF, a large-scale, pragmatic, cluster-randomized trial at 161 sites in the US evaluating heart failure quality improvement initiatives. Outside of his work on heart failure, Dr. DeVore is married with 4 children and spends his time corralling them all and coaching youth baseball.
As director of the Duke Heart Failure Same-Day Access Clinic, I am dedicated to improving outcomes for patients with heart failure. This clinic allows patients to see a health care provider quickly, and receive treatments for relief of symptoms. I strive to help patients with heart failure avoid the emergency department and hospital when possible, and live better at home.
As director of education IT innovations in the Department of Medicine, I lead efforts in continuing medical education.
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