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Samsky MD, Hellkamp A, Hiatt WR, Fowkes FGR, Baumgartner I, Berger JS, Katona BG, Mahaffey KW, Norgren L, Blomster JI, Rockhold FW, DeVore AD, Patel MR, Jones WS. Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID. J Am Heart Assoc 2021; 10:e018684. [PMID: 34056910 PMCID: PMC8477881 DOI: 10.1161/jaha.120.018684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Peripheral artery disease (PAD) and heart failure (HF) are each independently associated with poor outcomes. Risk factors associated with new-onset HF in patients with primary PAD are unknown. Furthermore, how the presence of HF is associated with outcomes in patients with PAD is unknown. Methods and Results This analysis examined risk relationships of HF on outcomes in patients with symptomatic PAD randomized to ticagrelor or clopidogrel as part of the EUCLID (Examining Use of Ticagrelor in Peripheral Arterial Disease) trial. Patients were stratified based on presence of HF at enrollment. Cox models were used to determine the association of HF with outcomes. A separate Cox model was used to identify risk factors associated with development of HF during follow-up. Patients with PAD and HF had over twice the rate of concomitant coronary artery disease as those without HF. Patients with PAD and HF had significantly increased risk of major adverse cardiovascular events (hazard ratio [HR], 1.31; 95% CI, 1.13-1.51) and all-cause mortality (HR, 1.39; 95% CI, 1.19-1.63). In patients with PAD, the presence of HF was associated with significantly less bleeding (HR, 0.65; 95% CI, 0.45-0.96). Characteristics associated with HF development included age ≥66 (HR, 1.29; 95% CI, 1.18-1.40 per 5 years), diabetes mellitus (HR, 1.85; 95% CI, 1.41-2.43), and weight (bidirectionally associated, ≥76 kg, HR, 0.77; 95% CI, 0.64-0.93; <76 kg, HR, 1.12; 95% CI, 1.07-1.16). Conclusions Patients with PAD and HF have a high rate of coronary artery disease with a high risk for major adverse cardiovascular events and death. These data support the possible need for aggressive treatment of (recurrent) atherosclerotic disease in PAD, especially patients with HF.
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Affiliation(s)
- Marc D Samsky
- Duke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NC
| | - Anne Hellkamp
- Duke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NC
| | - William R Hiatt
- University of Colorado School of Medicine and CPC Clinical Research Aurora CO
| | - F Gerry R Fowkes
- Usher Institute of Population Health Sciences and Informatics University of Edinburgh United Kingdom
| | - Iris Baumgartner
- Swiss Cardiovascular Centre, Inselspital Bern University HospitalUniversity of Bern Switzerland
| | - Jeffrey S Berger
- Departments of Medicine and Surgery New York University School of Medicine New York NY
| | | | - Kenneth W Mahaffey
- Stanford Center for Clinical Research Stanford University School of Medicine Stanford CA
| | - Lars Norgren
- Faculty of Medicine and Health Örebro University Örebro Sweden
| | | | - Frank W Rockhold
- Duke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NC
| | - Adam D DeVore
- Duke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NC
| | - Manesh R Patel
- Duke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NC
| | - W Schuyler Jones
- Duke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NC
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52
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Marcondes-Braga FG, Vieira JL, Souza Neto JDD, Calado G, Ayub-Ferreira SM, Bacal F, Clausell N. Emerging Topics in Heart Failure: Contemporaneous Management of Advanced Heart Failure. Arq Bras Cardiol 2021; 115:1193-1196. [PMID: 33470324 PMCID: PMC8133710 DOI: 10.36660/abc.20201194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Fabiana G Marcondes-Braga
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HCFMUSP),São Paulo, SP - Brasil
| | | | | | - Gustavo Calado
- Pontifícia Universidade Católica de Campinas (PUCC), Campinas, SP - Brasil
| | - Silvia Moreira Ayub-Ferreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HCFMUSP),São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HCFMUSP),São Paulo, SP - Brasil
| | - Nadine Clausell
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
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53
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Kleiner-Shochat M, Kapustin D, Fudim M, Ambrosy AP, Glantz J, Kazatsker M, Kleiner I, Weinstein JM, Panjrath G, Roguin A, Meisel SR. The Degree of the Predischarge Pulmonary Congestion in Patients Hospitalized for Worsening Heart Failure Predicts Readmission and Mortality. Cardiology 2020; 146:49-59. [PMID: 33113535 DOI: 10.1159/000510073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prediction of readmission and death after hospitalization for heart failure (HF) is an unmet need. AIM We evaluated the ability of clinical parameters, NT-proBNP level and noninvasive lung impedance (LI), to predict time to readmission (TTR) and time to death (TTD). METHODS AND RESULTS The present study is a post hoc analysis of the IMPEDANCE-HF extended trial comprising 290 patients with LVEF ≤45% and New York Heart Association functional class II-IV, randomized 1:1 to LI-guided or conventional therapy. Of all patients, 206 were admitted 766 times for HF during a follow-up of 57 ± 39 months. The normal LI (NLI), representing the "dry" lung status, was calculated for each patient at study entry. The current degree of pulmonary congestion (PC) compared with its dry status was represented by ΔLIR = ([measured LI/NLI] - 1) × 100%. Twenty-six parameters recorded during HF admission were used to predict TTR and TTD. To determine the parameter which mainly impacted TTR and TTD, variables were standardized, and effect size (ES) was calculated. Multivariate analysis by the Andersen-Gill model demonstrated that ΔLIRadmission (ES = 0.72), ΔLIRdischarge (ES = -3.14), group assignment (ES = 0.2), maximal troponin during HF admission (ES = 0.19), LVEF related to admission (ES = -0.22) and arterial hypertension (ES = 0.12) are independent predictors of TTR (p < 0.01, χ2 = 1,206). Analysis of ES showed that residual PC assessed by ∆LIRdischarge was the most prominent predictor of TTR. One percent improvement in predischarge PC, assessed by ∆LIRdischarge, was associated with a likelihood of TTR increase by 14% (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.13-1.15, p < 0.01) and TTD increase by 8% (HR 1.08, 95% CI 1.07-1.09, p < 0.01). CONCLUSION The degree of predischarge PC assessed by ∆LIR is the most dominant predictor of TTR and TTD.
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Affiliation(s)
- Michael Kleiner-Shochat
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel,
| | - Daniel Kapustin
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Marat Fudim
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew P Ambrosy
- The Permanente Medical Group, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Juliya Glantz
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mark Kazatsker
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilia Kleiner
- Department of Cardiology, University Medical Center, Beer Sheva, Israel
| | | | - Gurusher Panjrath
- Department of Medicine (Cardiology), George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Ariel Roguin
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Simcha R Meisel
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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54
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Abstract
Identifying patients with heart failure at high risk for poor outcomes is important for patient care, resource allocation, and process improvement. Although numerous risk models exist to predict mortality, hospitalization, and patient-reported health status, they are infrequently used for several reasons, including modest performance, lack of evidence to support routine clinical use, and barriers to implementation. Artificial intelligence has the potential to enhance the performance of risk prediction models, but has its own limitations and remains unproved.
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Affiliation(s)
- Ramsey M Wehbe
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA. https://twitter.com/ramseywehbemd
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA. https://twitter.com/HeartDocSadiya
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA. https://twitter.com/HFpEF
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA; Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, 15th Floor, Chicago, IL 60611, USA.
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55
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Dziewięcka E, Gliniak M, Winiarczyk M, Karapetyan A, Wiśniowska-Śmiałek S, Karabinowska A, Dziewięcki M, Podolec P, Rubiś P. Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy-tailored prognostic model. ESC Heart Fail 2020; 7:2455-2467. [PMID: 32853471 PMCID: PMC7524139 DOI: 10.1002/ehf2.12809] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/04/2020] [Accepted: 05/14/2020] [Indexed: 12/28/2022] Open
Abstract
Aims The aims of this paper were to investigate the analytical performance of the nine prognostic scales commonly used in heart failure (HF), in patients with dilated cardiomyopathy (DCM), and to develop a unique prognostic model tailored to DCM patients. Methods and results The hospital and outpatient records of 406 DCM patients were retrospectively analysed. The information on patient status was gathered after 48.2 ± 32.0 months. Tests were carried out to ascertain the prognostic accuracy in DCM using some of the most frequently applied HF prognostic scales (Barcelona Bio‐Heart Failure, Candesartan in Heart Failure‐Assessment of Reduction in Mortality and Morbidity, Studio della Streptochinasi nell'Infarto Miocardico‐Heart Failure, Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, Meta‐Analysis Global Group in Chronic Heart Failure, MUerte Subita en Insuficiencia Cardiaca, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure, Seattle Heart Failure Model) and one dedicated to DCM, that of Miura et al. At follow‐up, 70 DCM patients (17.2%) died. Most analysed scores substantially overestimated the mortality risk, especially in survivors. The prognostic accuracy of the scales were suboptimal, varying between 60% and 80%, with the best performance from Barcelona Bio‐Heart Failure and Seattle Heart Failure Model for 1–5 year mortality [areas under the receiver operating curve 0.792–0.890 (95% confidence interval 0.725–0.918) and 0.764–0.808 (95% confidence interval 0.682–0.934), respectively].Based on our accumulated data, a self‐developed DCM prognostic model was constructed. The model consists of age, gender, body mass index, symptoms duration, New York Heart Association class, diabetes mellitus, prior stroke, abnormal liver function, dyslipidaemia, left bundle branch block, left ventricle end‐diastolic diameter, ejection fraction, N terminal pro brain natriuretic peptide, haemoglobin, estimated glomerular filtration rate, and pharmacological and resynchronisation therapy. This newly created prognostic model outperformed the analysed HF scales. Conclusions An analysis of various HF prognostic models found them to be suboptimal for DCM patients. A self‐developed DCM prognostic model showed improved performance over the nine other models studied. However, further validation of the prognostic model in different DCM populations is required.
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Affiliation(s)
- Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | - Matylda Gliniak
- Jagiellonian University Collegium Medicum, Students' Scientific Group at the Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Mateusz Winiarczyk
- Jagiellonian University Collegium Medicum, Students' Scientific Group at the Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Arman Karapetyan
- Jagiellonian University Collegium Medicum, Students' Scientific Group at the Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Sylwia Wiśniowska-Śmiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | - Aleksandra Karabinowska
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | | | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
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56
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Abstract
IMPORTANCE Worldwide, the burden of heart failure has increased to an estimated 23 million people, and approximately 50% of cases are HF with reduced ejection fraction (HFrEF). OBSERVATIONS Heart failure is a clinical syndrome characterized by dyspnea or exertional limitation due to impairment of ventricular filling or ejection of blood or both. HFrEF occurs when the left ventricular ejection fraction (LVEF) is 40% or less and is accompanied by progressive left ventricular dilatation and adverse cardiac remodeling. Assessment for heart failure begins with obtaining a medical history and physical examination. Also central to diagnosis are elevated natriuretic peptides above age- and context-specific thresholds and identification of left ventricular systolic dysfunction with LVEF of 40% or less as measured by echocardiography. Treatment strategies include the use of diuretics to relieve symptoms and application of an expanding armamentarium of disease-modifying drug and device therapies. Unless there are specific contraindications, patients with HFrEF should be treated with a β-blocker and one of an angiotensin receptor-neprilysin inhibitor, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker as foundational therapy, with addition of a mineralocorticoid receptor antagonist in patients with persistent symptoms. Ivabradine and hydralazine/isosorbide dinitrate also have a role in the care of certain patients with HFrEF. More recently, sodium-glucose cotransporter 2 (SGLT2) inhibitors have further improved disease outcomes, significantly reducing cardiovascular and all-cause mortality irrespective of diabetes status, and vericiguat, a soluble guanylate cyclase stimulator, reduces heart failure hospitalization in high-risk patients with HFrEF. Device therapies may be beneficial in specific subpopulations, such as cardiac resynchronization therapy in patients with interventricular dyssynchrony, transcatheter mitral valve repair in patients with severe secondary mitral regurgitation, and implantable cardiac defibrillators in patients with more severe left ventricular dysfunction particularly of ischemic etiology. CONCLUSIONS AND RELEVANCE HFrEF is a major public health concern with substantial morbidity and mortality. The management of HFrEF has seen significant scientific breakthrough in recent decades, and the ability to alter the natural history of the disease has never been better. Recent developments include SGLT2 inhibitors, vericiguat, and transcatheter mitral valve repair, all of which incrementally improve prognosis beyond foundational neurohormonal therapies. Disease morbidity and mortality remain high, with a 5-year survival rate of 25% after hospitalization for HFrEF.
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Affiliation(s)
- Sean P Murphy
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Nasrien E Ibrahim
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Baim Institute for Clinical Research, Boston, Massachusetts
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57
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Suzuki K, Claggett B, Minamisawa M, Packer M, Zile MR, Rouleau J, Swedberg K, Lefkowitz M, Shi V, McMurray JJV, Zucker SD, Solomon SD. Liver function and prognosis, and influence of sacubitril/valsartan in patients with heart failure with reduced ejection fraction. Eur J Heart Fail 2020; 22:1662-1671. [PMID: 32407608 DOI: 10.1002/ejhf.1853] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS The prevalence of liver function abnormalities is common in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We assessed the impact of liver function on prognosis and the effect of sacubitril/valsartan on measures of liver function in patients with HFrEF. METHODS AND RESULTS The PARADIGM-HF trial was a randomized, double-blind, active treatment-controlled trial. We included 8232 HFrEF patients with available measures of liver function, including transaminases, alkaline phosphatase (ALP) and bilirubin; the primary endpoint was a composite of HF hospitalization and cardiovascular (CV) death. At screening, 11.6% of study patients had total bilirubin above the upper limit of normal (20.5 μmol/L) and 9.2% had ALP above the upper limit of normal (123 IU/L). Although ALP and albumin were associated with an increased risk of outcomes, among conventional test of liver function, total bilirubin was the strongest predictor for the primary endpoint [hazard ratio (HR) 1.10; 95% confidence interval (CI) 1.04-1.15; P < 0.001], HF hospitalization (HR 1.14; 95% CI 1.07-1.22; P < 0.001); CV death (HR 1.07; 95% CI 1.00-1.14; P = 0.040), and all-cause death (HR 1.08; 95% CI 1.02-1.14; P = 0.009). All conventional measures of liver function were significantly improved in the sacubitril/valsartan group compared with the enalapril group after randomization (between-group reduction: total bilirubin 2.4%, 95% CI 0.7-4.2%, P = 0.007; aspartate aminotransferase 7.9%, 95% CI 6.7-9.0%, P < 0.001; alanine aminotransferase 7.7%; 95% CI 6.2-9.3%, P < 0.001; ALP 5.4%, 95% CI 4.4-6.4%, P < 0.001). CONCLUSION Total bilirubin was a significant and independent predictor of CV death or HF hospitalization and all-cause mortality in patients with HFrEF enrolled in PARADIGM-HF. Sacubitril/valsartan improved measures of liver function compared with enalapril.
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Affiliation(s)
- Kota Suzuki
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Masatoshi Minamisawa
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Jean Rouleau
- University of Montreal, Montreal, Quebec, Canada
| | | | | | | | | | - Stephen D Zucker
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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58
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Dewan P, Jhund PS, McMurray JJ. VICTORIA
in context. Eur J Heart Fail 2020; 22:1747-1751. [DOI: 10.1002/ejhf.1833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/04/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Pooja Dewan
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
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