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Cvijic M, Rib Y, Danojevic S, Radulescu CI, Nazghaidze N, Vardas P. Heart failure with mildly reduced ejection fraction: from diagnosis to treatment. Gaps and dilemmas in current clinical practice. Heart Fail Rev 2022:10.1007/s10741-022-10267-1. [DOI: 10.1007/s10741-022-10267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
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52
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Ouyang F, Cheng X, Zhou W, He J, Xiao S. Increased Mortality Trends in Patients With Chronic Non-communicable Diseases and Comorbid Hypertension in the United States, 2000–2019. Front Public Health 2022; 10:753861. [PMID: 35899158 PMCID: PMC9309719 DOI: 10.3389/fpubh.2022.753861] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background According to the Sustainable Development Goals (SDGs), countries are required to reduce the mortality rates of four main non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs), and cancer (CA), by one-third in 2030 from the 2015 level. However, progress fell short of expectations, partly attributed to the high rates of hypertension-related NCD mortality. This study aimed to investigate the mortality trends of SDG-targeted NCDs with comorbid hypertension. In addition, the disparities in mortality rates among different demographic subgroups were further explored. Methods Mortality data from 2000 to 2019 were acquired from the Centers for Disease Control and Prevention in the United States. SDG-targeted NCDs were considered the underlying causes of death, and hypertension was considered a multiple cause of death. Permutation tests were performed to determine the time points of Joinpoints for mortality trends. The annual percent changes and average annual percent changes (AAPCs), as well as 95% confidence intervals (CIs), were calculated to demonstrate the temporary trend of mortality rates overall and by age, sex, ethnicity, and region. Results The hypertension-related DM, CRD, and CA mortality rates increased over the 20 years, of which the AAPCs were 2.0% (95% CI: 1.4%, 2.6%), 3.2% (95% CI: 2.8%, 3.6%), and 2.1% (95% CI: 1.6%, 2.6%), respectively. Moreover, despite decreasing between 2005 and 2015, the hypertension-related CVD mortality rate increased from 2015 to 2019 [APC: 1.3% (95% CI: 0.7%, 1.9%)]. The increased trends were consistent across most age groups. Mortality rates among men were higher and increased faster than those among women. The hypertension-related CVD, DM, and CA mortality rates among African American people were higher than those among White people. The increased mortality rates in rural areas, especially in rural south, were higher than those in urban areas. Conclusion In the United States, the hypertension-related DM, CRD, and CA mortality rates increased between 2000 and 2019, as well as hypertension-related CVD mortality between 2015 and 2019. Disparities existed among different sexes, ethnicities, and areas. Actions to prevent and manage hypertension among patients with NCDs are required to reduce the high mortality rates and minimize disparities.
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Affiliation(s)
- Feiyun Ouyang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Jun He
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
- *Correspondence: Shuiyuan Xiao
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Agarwal A, Thirunarayan K, Romine WL, Alambo A, Cajita M, Banerjee T. Leveraging Natural Learning Processing to Uncover Themes in Clinical Notes of Patients Admitted for Heart Failure. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2643-2646. [PMID: 36085789 DOI: 10.1109/embc48229.2022.9871400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Heart failure occurs when the heart is not able to pump blood and oxygen to support other organs in the body as it should. Treatments include medications and sometimes hospitalization. Patients with heart failure can have both cardiovascular as well as non-cardiovascular comorbidities. Clinical notes of patients with heart failure can be analyzed to gain insight into the topics discussed in these notes and the major comorbidities in these patients. In this regard, we apply machine learning techniques, such as topic modeling, to identify the major themes found in the clinical notes specific to the procedures performed on 1,200 patients admitted for heart failure at the University of Illinois Hospital and Health Sciences System (UI Health). Topic modeling revealed five hidden themes in these clinical notes, including one related to heart disease comorbidities.
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Geng C, Feng Y, Yang Y, Yang H, Li Z, Tang Y, Wang J, Zhao H. Allergic asthma aggravates angiotensin Ⅱ-induced cardiac remodeling in mice. Transl Res 2022; 244:88-100. [PMID: 35108660 DOI: 10.1016/j.trsl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease remains the leading cause of death globally, and heart failure (HF) represents its terminal stage. Asthma, one of the most common chronic diseases, has been reported to be associated with an increased risk of cardiovascular disease. However, the link between asthma and HF has rarely been studied, and the possible mechanisms by which asthma affects HF are unclear. This study aimed to explore the influence of asthma on HF and the possible mechanisms. We analyzed data from the National Health and Nutrition Examination Survey and found a higher prevalence of HF among asthmatic individuals, and identified an independent association between HF and asthma. Subsequently, we produced mice with concurrent ovalbumin (OVA) sensitization-induced allergic asthma and angiotensin Ⅱ infusion-induced cardiac remodeling to explore the effect of asthma on cardiac remodeling in vivo. The results showed that OVA-induced asthma impaired heart function and aggravated cardiac remodeling in mice. We also found that OVA sensitization increased the expression levels of immunoglobulin E (IgE) in serum and IgE receptor (FcεR1) in the heart, and enhanced the activation of downstream signaling molecules of IgE-FcεR1 in the heart. Importantly, blockage of IgE-FcεR1 using FcεR1-deficient mice or an anti-IgE antibody prevented asthma-induced decline of cardiac function, and alleviated cardiac remodeling. These findings demonstrate the adverse effects of allergic asthma on the heart, and suggest the potential application of anti-IgE therapy in the treatment of asthma complicated with heart conditions.
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Key Words
- AKT, protein kinase B
- ANP, natriuretic peptide type A
- Ang Ⅱ, angiotensin Ⅱ
- BALF, bronchioalveolar lavage fluid
- BMI, body mass index
- BNP, natriuretic peptide type B
- BW, body weight
- CAD, coronary heart disease
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- EF, ejection fraction
- FS, fraction shortening
- HF, heart failure
- HW, heart weight
- IgE, immunoglobulin E
- LVAW, left ventricular anterior wall
- LVID, left ventricular internal dimension
- LVPW, left ventricular posterior wall
- NHANES, National Health and Nutrition Examination Survey
- OVA, ovalbumin
- TC, total cholesterol
- TG, triglyceride
- WGA, wheat germ agglutinin
- WT, wild type
- pSmad2/3, phosphorylated small mothers against decapentaplegic 2 and 3
- α-SMA, α-smooth muscle actin
- β-MHC, β-myosin heavy chain
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Affiliation(s)
- Chi Geng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yufan Feng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yang Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Hongqin Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhiwei Li
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yaqin Tang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Hongmei Zhao
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
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55
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Tomasoni D, Adamo M, Metra M. May 2022 at a glance. Focus on treatment: from epidemiologic data to randomized trials and new devices. Eur J Heart Fail 2022; 24:735-737. [PMID: 35592905 DOI: 10.1002/ejhf.2230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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56
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Huang R, Lin Y, Liu M, Xiong Z, Zhang S, Zhong X, Ye X, Huang Y, Zhuang X, Liao X. Time in Target Range for Systolic Blood Pressure and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2022; 11:e022765. [PMID: 35289182 PMCID: PMC9075464 DOI: 10.1161/jaha.121.022765] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background The association between blood pressure control and clinical outcomes is unclear among patients with heart failure with preserved ejection fraction. Both too high and too low of systolic blood pressure (SBP) have been reported to be related to poor clinical prognosis. This study aimed to assess the association between time in SBP target range and adverse clinical events among patients with heart failure with preserved ejection fraction. Methods and Results This study was a secondary analysis of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial, a randomized clinical trial that compared the efficacy and safety of spironolactone in patients with heart failure with preserved ejection fraction. Time in target range (TTR) was calculated using linear interpolation, with the target range of SBP defined as 110 to 130 mm Hg. The association between TTR with adverse outcomes was estimated using multivariable Cox regression to adjust for multiple confounders. Participants with greater TTR were younger, more likely to be White, had less comorbidities, and lower body mass index. After adjusting for multiple covariates including mean SBP, 1‐SD increment (38.3%) of TTR was significantly associated with a decreased risk of primary composite end point (hazard ratio [HR], 0.81 [0.73–0.90]), as well as a lower risk of all‐cause mortality (HR, 0.81 [0.73–0.90]), cardiovascular death (HR, 0.78 [0.68–0.90]), and heart failure hospitalization (HR, 0.85 [0.74–0.97]). Results were similar when participants were categorized by TTR groups. Subgroup analyses showed that the associations were more significant in young people than in the old (Pinteraction=0.028). Conclusions In patients with heart failure with preserved ejection fraction, greater time in SBP target range was statistically associated with a decreased risk of cardiovascular outcomes and mortality events beyond blood pressure level, especially among younger patients.
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Affiliation(s)
- Rihua Huang
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Yifen Lin
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Menghui Liu
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Zhenyu Xiong
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Shaozhao Zhang
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Xiangbin Zhong
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Xiaomin Ye
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Yiquan Huang
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Xiaodong Zhuang
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Xinxue Liao
- Cardiology Department The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
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Vasan RS, Enserro DM, Beiser AS, Xanthakis V. Lifetime Risk of Heart Failure Among Participants in the Framingham Study. J Am Coll Cardiol 2022; 79:250-263. [PMID: 35057911 PMCID: PMC8820638 DOI: 10.1016/j.jacc.2021.10.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The residual lifetime risk (RLR) of developing heart failure (HF) may have changed over time because of the increasing population burden of hypertension, obesity, and diabetes; greater survival after myocardial infarction; and a greater lifespan. OBJECTIVES The authors assessed changes in the RLR for HF in two 25-year epochs (1965-1989 and 1990-2014). METHODS We compared the RLR of HF at age 50 years (adjusting for competing risk of death) in the 2 epochs in Framingham Study participants overall and in the following strata: sex, body mass index, blood pressure, and diabetes. RESULTS Mean life expectancy increased from 75.9 to 82.1 years in women and 72.5 to 78.1 years in men. We observed 624 HF events over 111,351 person-observations in epoch 1, and 875 HF events over 128,903 person-observations in epoch 2. The mean age at onset of HF increased across the epochs by 6.6 years (women) to 7.2 years (men). The RLR of HF at age 50 years increased across epochs from 18.86% to 22.55% (absolute increase 3.69; 95% CI: 0.90-6.49; P = 0.01) in women, and from 19.19% to 25.25% (absolute increase 6.06; 95% CI: 3.08-9.04; P < 0.001) in men. The increase in RLR of HF in the second epoch was consistent across strata with excess body mass index or higher blood pressure (relative increase of 28%-47%) and in participants without prior myocardial infarction (relative increase of 23%). CONCLUSIONS The RLR of HF has increased in our community-based sample of White individuals over the last 5 decades, possibly caused by an increase in life expectancy.
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Affiliation(s)
- Ramachandran S. Vasan
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA,Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Danielle M. Enserro
- NRG Oncology; Clinical Trials Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Alexa S. Beiser
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Vanessa Xanthakis
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA,Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
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58
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Editorial for the Paper Titled "Hospitalization for Heart Failure in the USA, UK, Taiwan and Japan: An International Comparison of Administrative Health Records on 417,385 Individual Patients. J Card Fail 2021; 28:367-369. [PMID: 34973871 DOI: 10.1016/j.cardfail.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/20/2022]
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59
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Stretti L, Zippo D, Coats AJ, Anker MS, von Haehling S, Metra M, Tomasoni D. A year in heart failure: an update of recent findings. ESC Heart Fail 2021; 8:4370-4393. [PMID: 34918477 PMCID: PMC9073717 DOI: 10.1002/ehf2.13760] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin-converting enzyme inhibitors or an angiotensin receptor-neprilysin inhibitor, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM-AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo-controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer-related HF, also occurred. Coronavirus disease 2019 (COVID-19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.
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Affiliation(s)
- Lorenzo Stretti
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Dauphine Zippo
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | | | - Markus S. Anker
- Department of Cardiology (CBF)Charité ‐ Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Marco Metra
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Daniela Tomasoni
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
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60
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Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis. BJGP Open 2021; 5:BJGPO.2021.0094. [PMID: 34465577 PMCID: PMC9447293 DOI: 10.3399/bjgpo.2021.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background Many patients with heart failure with preserved ejection fraction (HFpEF) are undiagnosed, and UK general practice registers do not typically record heart failure (HF) subtype. Improvements in management of HFpEF is dependent on improved identification and characterisation of patients in primary care. Aim To describe a cohort of patients recruited from primary care with suspected HFpEF and compare patients in whom HFpEF was confirmed and refuted. Design & setting Baseline data from a longitudinal cohort study of patients with suspected HFpEF recruited from primary care in two areas of England. Method A screening algorithm and review were used to find patients on HF registers without a record of reduced ejection fraction (EF). Baseline evaluation included cardiac, mental and physical function, clinical characteristics, and patient reported outcomes. Confirmation of HFpEF was clinically adjudicated by a cardiologist. Results In total, 93 (61%) of 152 patients were confirmed HFpEF. The mean age of patients with HFpEF was 79 years, 46% were female, 80% had hypertension, and 37% took ≥10 medications. Patients with HFpEF were more likely to be obese, pre-frail or frail, report more dyspnoea and fatigue, were more functionally impaired, and less active than patients in whom HFpEF was refuted. Few had attended cardiac rehabilitation. Conclusion Patients with confirmed HFpEF had frequent multimorbidity, functional impairment, frailty, and polypharmacy. Although comorbid conditions were similar between people with and without HFpEF, the former had more obesity, symptoms, and worse physical function. These findings highlight the potential to optimise wellbeing through comorbidity management, medication rationalisation, rehabilitation, and supported self-management.
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Karwath A, Bunting KV, Gill SK, Tica O, Pendleton S, Aziz F, Barsky AD, Chernbumroong S, Duan J, Mobley AR, Cardoso VR, Slater K, Williams JA, Bruce EJ, Wang X, Flather MD, Coats AJS, Gkoutos GV, Kotecha D. Redefining β-blocker response in heart failure patients with sinus rhythm and atrial fibrillation: a machine learning cluster analysis. Lancet 2021; 398:1427-1435. [PMID: 34474011 PMCID: PMC8542730 DOI: 10.1016/s0140-6736(21)01638-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mortality remains unacceptably high in patients with heart failure and reduced left ventricular ejection fraction (LVEF) despite advances in therapeutics. We hypothesised that a novel artificial intelligence approach could better assess multiple and higher-dimension interactions of comorbidities, and define clusters of β-blocker efficacy in patients with sinus rhythm and atrial fibrillation. METHODS Neural network-based variational autoencoders and hierarchical clustering were applied to pooled individual patient data from nine double-blind, randomised, placebo-controlled trials of β blockers. All-cause mortality during median 1·3 years of follow-up was assessed by intention to treat, stratified by electrocardiographic heart rhythm. The number of clusters and dimensions was determined objectively, with results validated using a leave-one-trial-out approach. This study was prospectively registered with ClinicalTrials.gov (NCT00832442) and the PROSPERO database of systematic reviews (CRD42014010012). FINDINGS 15 659 patients with heart failure and LVEF of less than 50% were included, with median age 65 years (IQR 56-72) and LVEF 27% (IQR 21-33). 3708 (24%) patients were women. In sinus rhythm (n=12 822), most clusters demonstrated a consistent overall mortality benefit from β blockers, with odds ratios (ORs) ranging from 0·54 to 0·74. One cluster in sinus rhythm of older patients with less severe symptoms showed no significant efficacy (OR 0·86, 95% CI 0·67-1·10; p=0·22). In atrial fibrillation (n=2837), four of five clusters were consistent with the overall neutral effect of β blockers versus placebo (OR 0·92, 0·77-1·10; p=0·37). One cluster of younger atrial fibrillation patients at lower mortality risk but similar LVEF to average had a statistically significant reduction in mortality with β blockers (OR 0·57, 0·35-0·93; p=0·023). The robustness and consistency of clustering was confirmed for all models (p<0·0001 vs random), and cluster membership was externally validated across the nine independent trials. INTERPRETATION An artificial intelligence-based clustering approach was able to distinguish prognostic response from β blockers in patients with heart failure and reduced LVEF. This included patients in sinus rhythm with suboptimal efficacy, as well as a cluster of patients with atrial fibrillation where β blockers did reduce mortality. FUNDING Medical Research Council, UK, and EU/EFPIA Innovative Medicines Initiative BigData@Heart.
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Affiliation(s)
- Andreas Karwath
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Karina V Bunting
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Simrat K Gill
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Otilia Tica
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Samantha Pendleton
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Furqan Aziz
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Andrey D Barsky
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | | | - Jinming Duan
- Computer Sciences, University of Birmingham, Birmingham, UK
| | - Alastair R Mobley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Victor Roth Cardoso
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Karin Slater
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - John A Williams
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Emma-Jane Bruce
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | - Xiaoxia Wang
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK
| | | | | | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK.
| | - Dipak Kotecha
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands Site, Birmingham, UK.
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62
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Dell'Era G, Prenna E, Ziacchi M, Diemberger I, Varalda M, Guerra F, Biffi M, Occhetta E, Patti G. Management of patients explanted for implantable cardioverter defibrillator infections: Bridge therapy with external temporary ICD. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1884-1889. [PMID: 34498758 DOI: 10.1111/pace.14355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/27/2021] [Accepted: 09/05/2021] [Indexed: 02/01/2023]
Abstract
AIMS AND METHODS In case of cardiacimplantable electronicdevice (CIED)-related infections, it is mandatory to completely remove the device and administer prolonged antibiotic therapy. The management of patients explanted for an implantable defibrillator (ICD) infection is complex especially in patients needing anti-bradycardia pacing or tachyarrhythmia protection. We tested the efficacy and safety of a conventional ICD externally connected to a transvenous dual-coil lead as bridging therapy before the reimplant, comparing outcomes with a historical cohort of patients (N = 113) treated with temporary transvenous pacing. We enrolled 18 patients explanted for ICD infection and needing prolonged antibiotic therapy in three high-volume Italian centers. They received an external ICD stand-by for a mean of 16.5 (4-30) days before the reimplant. RESULTS No patient experienced malfunction of the system, with a significant reduction of this complication versus temporary transfemoral pacing (37%, p = .004). Post-procedural occurrence of other complications (infection, relevant local bleeding, ventricular tachycardia during insertion of the lead, cardiac perforation, and venous thromboembolism) was low and not different in the two groups. One patient experienced an electrical storm, effectively recognized by the external ICD and treated with anti-tachycardia pacings (ATPs) and shocks. CONCLUSIONS An approach with an external ICD seems to be a safe and viable option as bridging therapy in patients requiring ICD explant for CIED infection.
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Affiliation(s)
- Gabriele Dell'Era
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Eleonora Prenna
- Division of Cardiology, Ss. Trinità Hospital, Borgomanero, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Igor Diemberger
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marco Varalda
- Division of Cardiology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eraldo Occhetta
- Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
| | - Giuseppe Patti
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
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63
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Tomasoni D, Adamo M, Metra M. August 2021 at a glance: focus on cardiomyopathies, medical treatment and devices. Eur J Heart Fail 2021; 23:1247-1249. [PMID: 34405942 DOI: 10.1002/ejhf.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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64
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Jaconiano E, Moreira-Gonçalves D. Unveiling the role of exercise training in targeting the inflammatory paradigm of heart failure with preserved ejection fraction: a narrative review. Heart Fail Rev 2021; 27:163-190. [PMID: 34244870 DOI: 10.1007/s10741-021-10138-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/30/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is currently lacking an effective pharmacological treatment with impact on major outcomes such as hospitalization and mortality. Exercise training (EXT) is recognized as an important nonpharmacological tool, capable of improving exercise capacity and quality of life, and has even been associated with a reduction in hospitalization and cardiovascular mortality risk. However, this positive impact largely lacks a physiological explanation. The aim of this narrative review was to provide an overview of the available data supporting the hypothesis that the beneficial role of EXT in HFpEF might be due to its effects on targeting the inflammatory paradigm described for this disease. A comprehensive literature search was conducted using the PubMed-NCBI database. We reviewed the effects of EXT throughout each step of the pathophysiological pathway leading to HFpEF and found clinical and/or preclinical evidence supporting the reduction of systemic inflammation, endothelial dysfunction, microvascular rarefaction, and myocardial stiffness. We also highlighted some gaps in the knowledge or topics that deserve further clarification in future studies. In conclusion, despite the scarcity of clinical studies in this population, there is compelling evidence suggesting that EXT modulates crucial aspects of the inflammatory pathway described for HFpEF and future investigation on cellular and molecular mechanisms are encouraged.
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Affiliation(s)
- Eliane Jaconiano
- Cardiovascular R&D Center (UnIC) and Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Daniel Moreira-Gonçalves
- Centre of Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
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65
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Tomii D, Horiuchi Y, Gonda Y, Yoshiura D, Nakajima M, Sekiguchi M, Watanabe Y, Nakamura K, Setoguchi N, Nakase M, Kikushima H, Ninomiya K, Tanaka T, Asami M, Yahagi K, Yuzawa H, Komiyama K, Tanaka J, Aoki J, Tanabe K. The role of the renal resistance index in patients with heart failure with reduced or preserved ejection fraction. J Cardiol 2021; 78:301-307. [PMID: 34088562 DOI: 10.1016/j.jjcc.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Renal impairment is a common phenomenon that portends a poor prognosis of heart failure (HF). The renal arterial resistance index (RRI) can be useful for defining renal function and predicting outcomes in patients with HF. This study aimed to investigate the determining factors of the RRI in HF patients with preserved ejection fraction (HFpEF) and with reduced EF (HFrEF). METHODS This retrospective study included 330 patients with HF. We investigated the determining factors for the RRI and the association between the RRI and 1-year composite outcome, comprising all-cause mortality and re-hospitalization for HF. RESULTS The independent predictors of the RRI were tricuspid regurgitation peak gradient and estimated glomerular filtration rate in HFpEF, and pulse pressure and blood urea nitrogen in HFrEF. During the follow-up, 30 (9.1%) patients presented the composite outcome. Cox proportional hazard analysis revealed the association of the RRI with the composite outcome in both HFrEF (HR 1.08; 95% CI 1.03-1.14) and HFpEF (HR 1.07; 95% CI 1.03-1.12) without an interaction (p for interaction = 0.770). CONCLUSIONS The RRI was a consistent prognosticator in patients with HFpEF and those with HFrEF, while factors defining RRI were different between these groups.
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Affiliation(s)
- Daijiro Tomii
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
| | - Yuki Gonda
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Daiki Yoshiura
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Momoka Nakajima
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Yusuke Watanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kosuke Nakamura
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Naoto Setoguchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masaaki Nakase
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hosei Kikushima
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kai Ninomiya
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tetsu Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hitomi Yuzawa
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jun Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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66
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Bueno H, Moura B, Lancellotti P, Bauersachs J. The year in cardiovascular medicine 2020: heart failure and cardiomyopathies. Eur Heart J 2021; 42:657-670. [PMID: 33388764 DOI: 10.1093/eurheartj/ehaa1061] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/26/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Héctor Bueno
- Multidisciplinary Translational Cardiovascular Research Group. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, Madrid 28029, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Brenda Moura
- Cardiology Department, Military Hospital, Av. da Boavista S/N, 4050-115 Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Avenue de L'Hôpital 1, 4000 Liège, Belgium.,Cardiology Departments, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola Bari, Italy and Via Corriera, 1, 48033 Cotignola RA, Italy and Anthea Hospital, Via Camillo Rosalba, 35/37, 70124 Bari BA, Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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67
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Li Z, Zhao H, Wang J. Metabolism and Chronic Inflammation: The Links Between Chronic Heart Failure and Comorbidities. Front Cardiovasc Med 2021; 8:650278. [PMID: 34026868 PMCID: PMC8131678 DOI: 10.3389/fcvm.2021.650278] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) patients often suffer from multiple comorbidities, such as diabetes, atrial fibrillation, depression, chronic obstructive pulmonary disease, and chronic kidney disease. The coexistance of comorbidities usually leads to multi morbidity and poor prognosis. Treatments for HF patients with multi morbidity are still an unmet clinical need, and finding an effective therapy strategy is of great value. HF can lead to comorbidity, and in return, comorbidity may promote the progression of HF, creating a vicious cycle. This reciprocal correlation indicates there may be some common causes and biological mechanisms. Metabolism remodeling and chronic inflammation play a vital role in the pathophysiological processes of HF and comorbidities, indicating metabolism and inflammation may be the links between HF and comorbidities. In this review, we comprehensively discuss the major underlying mechanisms and therapeutic implications for comorbidities of HF. We first summarize the potential role of metabolism and inflammation in HF. Then, we give an overview of the linkage between common comorbidities and HF, from the perspective of epidemiological evidence to the underlying metabolism and inflammation mechanisms. Moreover, with the help of bioinformatics, we summarize the shared risk factors, signal pathways, and therapeutic targets between HF and comorbidities. Metabolic syndrome, aging, deleterious lifestyles (sedentary behavior, poor dietary patterns, smoking, etc.), and other risk factors common to HF and comorbidities are all associated with common mechanisms. Impaired mitochondrial biogenesis, autophagy, insulin resistance, and oxidative stress, are among the major mechanisms of both HF and comorbidities. Gene enrichment analysis showed the PI3K/AKT pathway may probably play a central role in multi morbidity. Additionally, drug targets common to HF and several common comorbidities were found by network analysis. Such analysis has already been instrumental in drug repurposing to treat HF and comorbidity. And the result suggests sodium-glucose transporter-2 (SGLT-2) inhibitors, IL-1β inhibitors, and metformin may be promising drugs for repurposing to treat multi morbidity. We propose that targeting the metabolic and inflammatory pathways that are common to HF and comorbidities may provide a promising therapeutic strategy.
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Affiliation(s)
- Zhiwei Li
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Hongmei Zhao
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
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68
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Gevaert AB, Tibebu S, Mamas MA, Ravindra NG, Lee SF, Ahmad T, Ko DT, Januzzi JL, Van Spall HGC. Clinical phenogroups are more effective than left ventricular ejection fraction categories in stratifying heart failure outcomes. ESC Heart Fail 2021; 8:2741-2754. [PMID: 33934542 PMCID: PMC8318507 DOI: 10.1002/ehf2.13344] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/12/2021] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Heart failure (HF) guidelines place patients into 3 discrete groups according to left ventricular ejection fraction (LVEF): reduced (<40%), mid‐range (40–49%), and preserved LVEF (≥50%). We assessed whether clinical phenogroups offer better prognostication than LVEF. Methods and results This was a sub‐study of the Patient‐Centered Care Transitions in HF trial. We analysed baseline characteristics of hospitalized patients in whom LVEF was recorded. We used unsupervised machine learning to identify clinical phenogroups and, thereafter, determined associations between phenogroups and outcomes. Primary outcome was the composite of all‐cause death or rehospitalization at 6 and 12 months. Secondary outcome was the composite cardiovascular death or HF rehospitalization at 6 and 12 months. Cluster analysis of 1693 patients revealed six discrete phenogroups, each characterized by a predominant comorbidity: coronary heart disease, valvular heart disease, atrial fibrillation (AF), sleep apnoea, chronic obstructive pulmonary disease (COPD), or few comorbidities. Phenogroups were LVEF independent, with each phenogroup encompassing a wide range of LVEFs. For the primary composite outcome at 6 months, the hazard ratios (HRs) for phenogroups ranged from 1.25 [95% confidence interval (CI) 1.00–1.58 for AF] to 2.04 (95% CI 1.62–2.57 for COPD) (log‐rank P < 0.001); and at 12 months, the HRs for phenogroups ranged from 1.15 (95% CI 0.94–1.41 for AF) to 1.87 (95% 1.52–3.20 for COPD) (P < 0.002). LVEF‐based classifications did not separate patients into different risk categories for the primary outcomes at 6 months (P = 0.69) and 12 months (P = 0.30). Phenogroups also stratified risk of the secondary composite outcome at 6 and 12 months more effectively than LVEF. Conclusion Among patients hospitalized for HF, clinical phenotypes generated by unsupervised machine learning provided greater prognostic information for a composite of clinical endpoints at 6 and 12 months compared with LVEF‐based categories. Trial Registration: ClinicalTrials.gov Identifier: NCT02112227
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Affiliation(s)
- Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Semra Tibebu
- ICES, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - Neal G Ravindra
- Section of Cardiovascular Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Department of Computer Science, Yale University, New Haven, CT, USA
| | - Shun Fu Lee
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
| | - Dennis T Ko
- ICES, University of Toronto, Hamilton, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
| | - Harriette G C Van Spall
- ICES, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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69
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Zamfirescu MB, Ghilencea LN, Popescu MR, Bejan GC, Maher SM, Popescu AC, Dorobanțu M. The E/e' Ratio-Role in Risk Stratification of Acute Heart Failure with Preserved Ejection Fraction. ACTA ACUST UNITED AC 2021; 57:medicina57040375. [PMID: 33924367 PMCID: PMC8070491 DOI: 10.3390/medicina57040375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Heart failure with preserved ejection fraction (HFpEF) remains a worldwide management problem. Although there is a general effort for characterizing this population, few studies have assessed the predictive value of the echocardiographic E/e’ ratio in patients with acute HFpEF. The aim of the study was to identify groups with different prognosis in patients hospitalized with a first acute episode of HFpEF. Materials and Methods: The primary endpoint of the study was heart failure readmissions (HFR) at 6 months, while the secondary outcome was six-month mortality. We consecutively enrolled 91 patients hospitalized for the first time with acute HFpEF. We examined the E/e’ ratio as an independent predictor for HFR using univariate regression. Results: We identified and validated the E/e’ ratio as an independent predictor for HFR. An E/e’ ratio threshold value of 13.80 was calculated [(area under the receiver operating characteristic curve (AUROC) = 0.693, sensitivity = 78.60%, specificity = 55%, p < 0.004)] and validated as an inflection point for an increased number of HFR. Thus, we divided the study cohort into two groups: group 1 with an E/e’ ratio < 13.80 (n = 39) and group 2 with an E/e’ ratio > 13.80 (n = 49). Compared to group 1, group 2 had an increased number of HFR (p = 0.003) and a shorter time to first HFR (p = 0.002). However, this parameter did not influence all-cause mortality within six months (p = 0.84). Conclusions: The dimensionless E/e’ ratio is a useful discriminator between patients with acute HFpEF. An E/e’ value over 13.80 represents a simple, yet effective instrument for assessing the HFR risk. However, all-cause mortality at six months is not influenced by the E/e’ ratio.
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Affiliation(s)
- Marilena-Brîndușa Zamfirescu
- Cardiothoracic Pathology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-B.Z.); (G.C.B.); (A.-C.P.); (M.D.)
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Liviu-Nicolae Ghilencea
- Cardiothoracic Pathology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-B.Z.); (G.C.B.); (A.-C.P.); (M.D.)
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Correspondence: (L.-N.G.); (M.-R.P.); Tel.: +44-753-504-3647 (L.-N.G.); +40-723-583-365 (M.-R.P.)
| | - Mihaela-Roxana Popescu
- Cardiothoracic Pathology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-B.Z.); (G.C.B.); (A.-C.P.); (M.D.)
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Correspondence: (L.-N.G.); (M.-R.P.); Tel.: +44-753-504-3647 (L.-N.G.); +40-723-583-365 (M.-R.P.)
| | - Gabriel Cristian Bejan
- Cardiothoracic Pathology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-B.Z.); (G.C.B.); (A.-C.P.); (M.D.)
| | - Sean Martin Maher
- Department of Accidents and Emergencies, St. Vincent University Hospital, D04 N2E0 Dublin 4, Ireland;
| | - Andreea-Catarina Popescu
- Cardiothoracic Pathology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-B.Z.); (G.C.B.); (A.-C.P.); (M.D.)
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Maria Dorobanțu
- Cardiothoracic Pathology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-B.Z.); (G.C.B.); (A.-C.P.); (M.D.)
- Department of Cardiology, Clinic Emergency Hospital, 20322 Bucharest, Romania
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70
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Chow C, Mentz RJ, Greene SJ. Update on the Impact of Comorbidities on the Efficacy and Safety of Heart Failure Medications. Curr Heart Fail Rep 2021; 18:132-143. [PMID: 33835396 DOI: 10.1007/s11897-021-00512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Multiple newer medications benefit patients with heart failure with reduced ejection fraction (HFrEF). While these therapies benefit the broad population with HFrEF, the efficacy and safety of these therapies have been less well characterized in patients with significant comorbidities. RECENT FINDINGS Common comorbidities of high interest in heart failure (HF) include diabetes mellitus, chronic kidney disease (CKD), atrial fibrillation, and obesity, and each has potential implications for clinical management. As the burden of comorbidities increases in HF populations, risk-benefit assessments of HF therapies in the context of different comorbidities are increasingly relevant for clinical practice. This review summarizes data regarding the core HFrEF therapies in the context of comorbidities, with specific attention to sodium-glucose cotransporter 2 inhibitors, sacubitril/valsartan, mineralocorticoid receptor antagonists (MRAs), and beta-blockers. In general, studies support consistent treatment effects with regard to clinical outcome benefits in the presence of comorbidities. Likewise, safety profiles are relatively consistent irrespective of comorbidities, with the exception of heightened risk of hyperkalemia with MRA therapy in patients with severe CKD. In conclusion, while HF management is complex in the context of multiple comorbidities, the totality of evidence strongly supports guideline-directed medical therapies as foundational for improving outcomes in these high-risk patients.
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Affiliation(s)
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA.
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Lin H, Hartley P, Forsyth F, Pilling M, Hobbs FDR, Taylor CJ, Schiff R, Deaton C. Clinical and demographic correlates of accelerometer-measured physical activity in participants enrolled in the OPTIMISE HFpEF study. Eur J Cardiovasc Nurs 2021; 21:67-75. [PMID: 33837414 DOI: 10.1093/eurjcn/zvab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/25/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
AIMS This study aimed to measure physical activity (PA) in participants with suspected heart failure with preserved ejection fraction (HFpEF) and assess associations between PA and participant characteristics. METHODS AND RESULTS Adults with presumed HFpEF were recruited and received diagnostic evaluation and clinical assessment. Physical activity was objectively measured using accelerometers over 7 days. To examine predictors of PA, a best subset analysis was used, with the optimal model defined as that with the lowest Bayesian information criterion. One hundred and twenty-four participants with presumed HFpEF who had valid accelerometer data were included in this study. Seventy-six were confirmed by a cardiologist as meeting the European Society of Cardiology diagnosis criteria for HFpEF. The median age of all participants was 80.1 years, and 47.4% were female. Patients spent most of each 24-h period at low-intensity PA and few or no durations at high-intensity PA, with lower activity for those with HFpEF. Gait speed was the best univariate correlate of activity levels (adjusted R2 0.29). The optimal model using best subsets regression included six variables and improved adjusted R2 to 0.47. In the model, lower levels of PA were associated with slower gait speed, lower levels of anxiety, higher levels of depression, past smoking history, a confirmed HFpEF diagnosis, and higher body mass index. CONCLUSION Participants demonstrated very low PA levels. The study has identified important patient characteristics associated with PA, which may help to identify those most in need of interventions. Notably, participants with confirmed HFpEF were more inactive than participants with other heart failure phenotypes.
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Affiliation(s)
- Helen Lin
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB22 5DT, UK
| | - Peter Hartley
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB22 5DT, UK
| | - Faye Forsyth
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB22 5DT, UK
| | - Mark Pilling
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB22 5DT, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Rebekah Schiff
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB22 5DT, UK
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72
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Canepa M, Ameri P, Lainscak M. Chronic obstructive pulmonary disease and comorbidities in heart failure: the next frontier of sodium-glucose co-transporter 2 inhibitors? Eur J Heart Fail 2021; 23:644-647. [PMID: 33502827 DOI: 10.1002/ejhf.2109] [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: 01/14/2021] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marco Canepa
- Department of Internal Medicine, University of Genova, Genoa, Italy.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network, Genoa, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genoa, Italy.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network, Genoa, Italy
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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73
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Spitaleri G, Lupón J, Domingo M, Santiago-Vacas E, Codina P, Zamora E, Cediel G, Santesmases J, Diez-Quevedo C, Troya MI, Boldo M, Altmir S, Alonso N, González B, Núñez J, Bayes-Genis A. Mortality trends in an ambulatory multidisciplinary heart failure unit from 2001 to 2018. Sci Rep 2021; 11:732. [PMID: 33436787 PMCID: PMC7804393 DOI: 10.1038/s41598-020-79926-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022] Open
Abstract
To assess mortality trends at 1 and 3 years from 2001 to 2018 in a real-life cohort of HF outpatients from different etiologies with depressed and preserved LVEF. A total of 2368 consecutive patients with HF (mean age 66.4 ± 12.9 years, 71% men, 15.4% with preserved LVEF) admitted to a HF clinic from August 2001 to September 2018 were included in the study. Patients were divided into five quintiles (Q) according to the period of admission. Trends for all-cause and cardiovascular mortality from Q1 to Q5 were assessed by linear regression. Patients with LVEF < 50% had a progressive decrease in the rates of all-cause and cardiovascular death at 1 year (12.1% in Q1 to 6.5% in Q5, p = 0.003; and 8.4% in Q1 to 3.8% in Q5, p = 0.007, respectively) and 3 years (30.5% in Q1 to 17.0% in Q5, p = 0.003; and 23.9% in Q1 to 9.8% in Q5, p = 0.003, respectively). These trends remained significant after adjusting for clinical characteristics and risk. No significant trend in mortality was observed in patients with LVEF ≥ 50%. In a cohort of real-life ambulatory patients with HF, mortality progressively declined in patients with LVEF < 50%, but the same trend was not observed in patients with preserved LVEF.
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Affiliation(s)
- Giosafat Spitaleri
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Josep Lupón
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Domingo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Evelyn Santiago-Vacas
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Pau Codina
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Elisabet Zamora
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Cediel
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Javier Santesmases
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Crisanto Diez-Quevedo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Maria Isabel Troya
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Maria Boldo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Salvador Altmir
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Nuria Alonso
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Beatriz González
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Julio Núñez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA, València, Spain.,Department of Medicine, Universitat de València, València, Spain
| | - Antoni Bayes-Genis
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain. .,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain. .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. .,Heart Institute, Hospital Universitari Germans Trias I Pujol, Department of Medicine, Universitat Autonoma de Barcelona, Carretera del Canyet s/n 08916, Badalona, Spain.
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74
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Expect the Unexpected in the Medical Treatment of Heart Failure with Reduced Ejection Fraction: between Scientific Evidence and Clinical Wisdom. INTERNATIONAL JOURNAL OF HEART FAILURE 2021; 3:205-218. [PMID: 36262556 PMCID: PMC9536688 DOI: 10.36628/ijhf.2021.0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/20/2022]
Abstract
Over the past three decades, pharmacological treatment of heart failure (HF) with reduced ejection fraction (HFrEF) has witnessed a significant progress with the introduction of multiple disease-modifying therapies with a proven benefit on morbidity, mortality and quality of life. Recently, several novel medications (sacubitril/valsartan, sodium-glucose contransporter-2 [SGLT2] inhibitors, vericiguat and omecamtiv mecarbil) have shown to provide further improvement in outcomes in patients already receiving standard therapy for HFrEF. Available evidence suggests that sacubitril/valsartan and SGLT2 inhibitors (dapagliflozin and empagliflozin) are beneficial and well-tolerated in the majority inpatients and could be the mainstay treatment of HFrEF. Another group of medications (vericiguat and omecamtiv mecarbil) has shown promising results in reducing the risk of the composite of HF hospitalisation or cardiovascular mortality in patients with the more severe or advanced HF requiring recent hospitalisation. Therefore, these medications may be considered for the treatment of select group of patients with HFrEF with persisting or worsening symptoms despite optimal treatment. In addition, advances in pharmacological management of comorbidities frequently seen in HFrEF patients (diabetes, iron deficiency/anaemia, hyperkalaemia) provide further opportunities to improve outcomes. Given the increasing complexity of evidence-based therapies for HFrEF, there is a growing need to provide a practical perspective to their use. The purpose of this review is to summarise scientific evidence on the efficacy and safety of new and emerging medical therapies in HFrEF, with a focus on the clinical perspective of their use.
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Adamo M, Lombardi CM, Metra M. June 2020 at a glance: focus on COVID-19, quality of life and comorbidities. Eur J Heart Fail 2020; 22:917-918. [PMID: 32731308 DOI: 10.1002/ejhf.1515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Carlo Mario Lombardi
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
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76
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Aimo A, Barison A, Castiglione V, Emdin M. The unbearable underreporting of comorbidities in heart failure clinical trials. Eur J Heart Fail 2020; 22:1043-1044. [DOI: 10.1002/ejhf.1846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 08/30/2023] Open
Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionUniversity Hospital of Pisa Pisa Italy
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionFondazione Toscana ‘Gabriele Monasterio’ Pisa Italy
| | - Vincenzo Castiglione
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionUniversity Hospital of Pisa Pisa Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa Italy
- Cardiology DivisionFondazione Toscana ‘Gabriele Monasterio’ Pisa Italy
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