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Clinical Trajectories and Long-Term Outcomes of Alcoholic Versus Other Forms of Dilated Cardiomyopathy
Amanda Fernandes1, Alan Manivannan2, Morten Schou3
1Department of Medicine, Section of Cardiovascular Medicine, Boston University Medical Center, Boston, MA, USA.
Insights
Alcoholic cardiomyopathy (ACM) patients face higher mortality than other dilated cardiomyopathy (DCM) forms, despite similar cardiovascular risks. Guideline-directed therapies are underused in ACM, contributing to poorer outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Toxicology
Background:
- Alcoholic cardiomyopathy (ACM) is a severe form of dilated cardiomyopathy (DCM) linked to heavy alcohol consumption.
- ACM is associated with poor patient outcomes, yet specific risk factors remain unclear.
Purpose of the Study:
- To compare the risks and outcomes of alcoholic cardiomyopathy (ACM) with other forms of dilated cardiomyopathy (DCM).
- To investigate differences in hospitalizations, mortality, and treatment patterns between ACM and DCM patients.
Main Methods:
- A cohort study identified patients with a first diagnosis of ACM or DCM between 1997 and 2018.
- Cumulative incidence of hospitalizations and mortality was calculated using Fine-Gray and Kaplan-Meier methods.
Main Results:
- 1,237 ACM patients and 17,211 DCM patients were analyzed. ACM patients had higher 5-year mortality (49% vs. 33%) and lower use of beta-blockers and defibrillators.
- While cardiovascular risks and hospitalization patterns were similar, ACM showed higher prevalence of obstructive lung and liver disease.
- Adjusted hazard ratio for mortality in ACM vs. DCM was 2.11.
Conclusions:
- Alcoholic cardiomyopathy patients experience significantly greater mortality compared to other DCM types.
- Despite similar cardiovascular risks, ACM patients receive guideline-directed therapies less frequently.
- These findings highlight the need for improved management strategies for alcoholic cardiomyopathy.
Background:
Alcoholic cardiomyopathy (ACM) is a form of dilated cardiomyopathy (DCM) occurring secondary to long-standing heavy alcohol use and is associated with poor outcomes, but the cause-specific risks are insufficiently understood.
Method:
Between 1997 and 2018, we identified all patients with a first diagnosis of ACM or DCM. The cumulative incidence of different causes of hospitalisation and mortality in the two groups was calculated using the Fine-Gray and Kaplan-Meier methods.
Results:
A Total of 1,237 patients with ACM (mean age 56.3±10.1 years, 89% men) and 17,211 individuals with DCM (mean age 63.6±13.8 years, 71% men) were identified. Diabetes (10% vs 15%), hypertension (22% vs 31%), and stroke (8% vs 10%) were less common in ACM than DCM, whereas obstructive lung disease (15% vs 12%) and liver disease (17% vs 2%) were more prevalent (p<0.05). Cumulative 5-year mortality was 49% in ACM vs 33% in DCM, p<0.0001, multivariable adjusted hazards ratio 2.11 (95% confidence interval 1.97-2.26). The distribution of causes of death was similar in ACM and DCM, with the predominance of cardiovascular causes in both groups (42% in ACM vs 44% in DCM). 5-year cumulative incidence of heart failure hospitalisations (48% vs 54%) and any somatic cause (59% vs 65%) were also similar in ACM vs DCM. At 1 year, the use of beta blockers (55% vs 80%) and implantable cardioverter defibrillators (3% vs 14%) were significantly less often used in ACM vs DCM.
Conclusions:
Patients with ACM had similar cardiovascular risks and hospitalisation patterns as other forms of DCM, but lower use of guideline-directed cardiovascular therapies and greater mortality.
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