ORIGINAL ARTICLE   

Minerva Cardiology and Angiology 2025 April;73(2):174-83

DOI: 10.23736/S2724-5683.24.06665-1

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Circadian variation in patients with acute heart failure with preserved ejection fraction

Kenichi MATSUSHITA ^{1, 2} ✉, Kazumasa HARADA ¹, Takahiro JIMBA ¹, Takashi KOHNO ¹, Hiroki NAKANO ¹, Akito SHINDO ¹, Makoto TAKEI ¹, Shun KOHSAKA ¹, Hideaki YOSHINO ¹, Takeshi YAMAMOTO ¹, Ken NAGAO ¹, Morimasa TAKAYAMA ¹

¹ Tokyo CCU Network Scientific Committee, Tokyo, Japan; ² Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan

BACKGROUND: The circadian system influences the pathophysiology of many cardiovascular diseases; however, circadian variations in patients with heart failure with preserved ejection fraction (HFpEF) are unknown. Thus, this study aimed to compare the clinical characteristics and risk factors for in-hospital mortality between patients with daytime- versus nighttime-onset HFpEF.
METHODS: This multicenter retrospective study included 3875 consecutive patients with acute HFpEF. Daytime and nighttime periods were defined as 6:00-17:59 and 18:00-5:59, respectively. Potential prognostic factors for in-hospital mortality were selected using univariable analyses. Those with P values of <0.10 were used in multivariable logistic regression analyses with forward selection (likelihood ratios) to identify significant prognostic factors.
RESULTS: The incidence of daytime-onset HFpEF was significantly lower but the in-hospital mortality was significantly higher than that of nighttime-onset HFpEF. Independent prognostic factors for in-hospital mortality in patients with daytime-onset HFpEF were age (odds ratio [OR], 1.057) and systolic blood pressure (OR: 0.979). In contrast, age (OR: 1.067), coexisting atrial fibrillation/flutter (OR: 2.023), systolic blood pressure (OR: 0.989), estimated glomerular filtration rate (OR: 0.971), treatment with diuretics (OR: 0.282), and treatment with beta-blockers (OR: 0.514) were independent prognostic factors in patients with nighttime-onset HFpEF.
CONCLUSIONS: The incidence of acute HFpEF exhibits circadian variations, and onset-related differences in clinical characteristics and prognostic factors for in-hospital mortality were identified. These findings may provide new insights for future research and guide individualized patient management strategies.

KEY WORDS: Circadian clocks; Heart failure, diastolic; Mortality; Phenotype