Background— No therapy has been shown to improve survival in heart failure (HF) with a normal ejection fraction (EF). There are plausible reasons to hypothesize that statins may be of benefit in HF with a normal EF. Methods and Results— We evaluated 137 patients with HF and an EF ≥0.50. The effect of treatment received at study entry on survival was determined. During a follow-up of 21±12 months, 20 deaths were observed. Treatment with an ACE inhibitor or receptor blocker, β-blocker, or calcium blocker had no significant effect on survival. In contrast, treatment with a statin was associated with a substantial improvement in survival (relative risk of death [95% CI] 0.22 [0.07 to 0.64]; P =0.006). Patients receiving statins had higher baseline LDL cholesterol than those not receiving statins (153±45 versus 98±33 mg/dL, P <0.01). After statin therapy, LDL cholesterol levels fell to a similar level (101±32 mg/dL) as in patients not receiving statins (98±33 mg/dL). After adjustment for differences in baseline clinical variables between groups (hypertension, diabetes, coronary artery disease, and serum creatinine), statin therapy was associated with lower mortality (adjusted relative risk of death [95% CI] 0.20 [0.06 to 0.62]; P =0.005). Similarly, after propensity matching, statin therapy was associated with improved survival (log-rank 6.12; P =0.013) and a trend toward improved survival without cardiovascular hospitalization (log-rank 3.02; P =0.082). Conclusions— Statin therapy may be associated with improved survival in patients with HF and a normal EF.

Background. Although decreased heart rate variability (HRV) is an independent predictor of death in various populations, its prognostic value in patients with end‐stage renal disease on chronic haemodialysis is unknown. Methods. We prospectively studied 120 chronic haemodialysis patients (age 61±11 years; males 51%; diabetics 38%; duration of haemodialysis therapy 50±114 months) who underwent 24 h electrocardiography at baseline for analysis of time‐ and frequency‐domain HRV. Results. All HRV measures in the patients were significantly reduced compared with those obtained from 62 age‐matched healthy subjects. During a follow‐up period of 26±10 months, 21 patients died (17.5%); 10 from cardiac causes and 11 from non‐cardiac causes (seven fatal strokes and four other causes). A Cox proportional hazards model revealed that, of the HRV measures, decreases in the triangular index (TI), very‐low‐frequency (0.0033–0.04 Hz) power, ultra‐low‐frequency (<0.0033 Hz) power (ULF) and the ratio of low‐frequency (0.04–0.15 Hz) power to high‐frequency (0.15–0.4 Hz) power had significant predictive value for cardiac death. None of the HRV measures, however, had predictive value for non‐cardiac death, including stroke death. Even after adjustment for other univariate predictors including age, diabetes, serum albumin and coronary artery disease, the predictive value of decreased TI and ULF remained significant—adjusted relative risk (95% confidence interval) per 1 SD decrement of TI and ULF, 3.28 (1.08–9.95) and 1.92 (1.01–3.67), respectively. Conclusions. Decreases in some HRV measures, particularly those reflecting long‐term variability, are independent predictors of cardiac death in chronic haemodialysis patients.

Patients with heart failure with preserved ejection fraction (HFpEF) are often elderly and their primary chronic symptom is severe exercise intolerance that results in a reduced quality of life (QOL).Thus, improvement of exercise capacity and QOL presents an important clinical outcome in HFpEF patients. Although the effects of interventions such as cardiovascular drugs and exercise training on exercise capacity and QOL in HFpEF patients have been examined in a number of clinical trials, the results are inconsistent due in part to limited power with small sample sizes. We aimed to conduct a meta-analysis of the randomized controlled trial (RCT)s on the effect of drug or exercise intervention on exercise capacity and QOL in HFpEF patients. The search of electronic databases identified five RCTs on exercise (245 patients) and eight RCTs on cardiovascular drugs (1080 patients). The pooled analysis showed that exercise training improved peak exercise oxygen uptake (VO2) (weighted mean difference (WMD) 2.283, 95% confidence interval (CI)) (1.318-3.248) ml/min/kg), six-minute walk distance (6MWD) (30.275 m (4.315-56.234)), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score (8.974 points (3.321-14.627)) compared with usual care. In contrast, drug intervention did not improve peak VO2 (WMD (95% CI), -0.393 (-1.005-0.220) ml/min/kg), 6MWD (-9.463 (-21.455-2.530) m), or MLHFQ total score (1.042 (-0.982-3.066) point) compared with placebo or no treatment. Our meta-analysis indicates that exercise training may be a therapeutic option to improve functional capacity and QOL in HFpEF patients.