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Yılmaz Öztekin G, Genç A, Arslan Ş. Vitamin D Deficiency Is a Predictor of Mortality in Elderly with Chronic Heart Failure. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2021; 17:358-364. [PMID: 35342481 PMCID: PMC8919494 DOI: 10.4183/aeb.2021.358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Context The prevalence of both heart failure and vitamin D deficiency increases with age and is associated with poor outcome in the elderly. Objectives We aimed to investigate the relationship between all-cause mortality and vitamin D deficiency in elderly patients with chronic heart failure. Design It is a retrospective, observational cross-sectional study. Median follow-up time was 497 days. Subjects and Methods 302 patients aged ≥65 years heart failure patients was categorized into tertiles based on the 25-hydroxy-vitamin D levels. Clinical and laboratory parameters were evaluated according to tertiles. Hospitalization rates and overall survival were compared between tertiles. Independent predictors of all cause mortality were defined. Results Patients with low vitamin D tertile were mostly women (p=0.001), and had a worse NYHA functional class (p=0.005). During follow-up, deaths were more frequent in the first tertile (p = 0.001). All-cause mortality increased significantly with decreasing vitamin D tertiles (from third tertile 7.9%, to 11.9%, to 26%; log rank test p=0.003). No significant difference was observed at the composite endpoint of mortality or HF hospitalizations (P=0.451). Multivariate analysis supported that low vitamin D concentration was an independent predictor of all causes of mortality (HR 0.93; 95% CI 0.89-0.97; p=0.004). Conclusions Low vitamin D levels were independent predictors of all-cause mortality in the elderly population with chronic heart failure.
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Affiliation(s)
- G.M. Yılmaz Öztekin
- University of Health Sciences, Antalya Education and Research Hospital, Dept. of Cardiology, Antalya, Turkey
| | - A. Genç
- University of Health Sciences, Antalya Education and Research Hospital, Dept. of Cardiology, Antalya, Turkey
| | - Ş. Arslan
- University of Health Sciences, Antalya Education and Research Hospital, Dept. of Cardiology, Antalya, Turkey
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Wand AL, Russell SD, Gilotra NA. Ambulatory Management of Worsening Heart Failure: Current Strategies and Future Directions. Heart Int 2021; 15:49-53. [PMID: 36277316 PMCID: PMC9524605 DOI: 10.17925/hi.2021.15.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 10/29/2023] Open
Abstract
Heart failure (HF) is a highly prevalent and morbid disease in the USA. The chronic, progressive course of HF is defined by periodic exacerbations of symptoms, described as 'worsening heart failure' (WHF). Previously, episodes of WHF have required hospitalization for intravenous diuretics; however, recent innovations in care delivery models for patients with HF have allowed a transition from the acute care setting to the ambulatory setting. The development of remote monitoring strategies, including device-based algorithms and implantable haemodynamic monitoring systems, has facilitated more advanced surveillance of patients, aiming to prevent the clinical deterioration that leads to hospitalization. Additionally, the establishment of multidisciplinary HF clinics has provided the setting and resources for the outpatient treatment of WHF, specifically the administration of intravenous diuretics. Here we review the current state of ambulatory HF management, including mechanisms for patient monitoring and treatment, and outline future opportunities for outpatient management of this patient population.
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Affiliation(s)
- Alison L Wand
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stuart D Russell
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mefford MT, Zhuang Z, Liang Z, Chen W, Koyama SY, Taitano MT, Watson HL, Lee MS, Sidney S, Reynolds K. Temporal trends in heart failure mortality in an integrated healthcare delivery system, California, and the US, 2001-2017. BMC Cardiovasc Disord 2021; 21:261. [PMID: 34039262 PMCID: PMC8157708 DOI: 10.1186/s12872-021-02075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, decreases in mortality rates attributable to cardiovascular diseases have slowed but mortality attributable to heart failure (HF) has increased. METHODS Between 2001-2017, trends in age-adjusted mortality with HF as an underlying cause for Kaiser Permanente Southern California (KPSC) members were derived through linkage with state death files and compared with trends among California residents and the US. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated using Joinpoint regression. Analyses were repeated examining HF as a contributing cause of death. RESULTS In KPSC, the age-adjusted HF mortality rates were comparable to California but lower than the US, increasing from 23.9 per 100,000 person-years (PY) in 2001 to 44.7 per 100,000 PY in 2017, representing an AAPC of 1.3% (95% CI 0.0%, 2.6%). HF mortality also increased in California from 33.9 to 46.5 per 100,000 PY (AAPC 1.5%, 95% CI 0.3%, 2.7%), while remaining unchanged in the US at 57.9 per 100,000 PY in 2001 and 2017 (AAPC 0.0%, 95% CI - 0.5%, 0.5%). Trends among KPSC members ≥ 65 years old were similar to the overall population, while trends among members 45-64 years old were flat between 2001-2017. Small changes in mortality with HF as a contributing cause were observed in KPSC members between 2001 and 2017, which differed from California and the US. CONCLUSION Lower rates of HF mortality were observed in KPSC compared to the US. Given the aging of the US population and increasing prevalence of HF, it will be important to examine individual and care-related factors driving susceptibility to HF mortality.
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Affiliation(s)
- Matthew T Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA.
| | - Zimin Zhuang
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Zhi Liang
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Sandra Y Koyama
- Internal Medicine, Kaiser Permanente Southern California, Baldwin Park, CA, USA
| | | | - Heather L Watson
- Complete Care Support Programs, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
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Chen J, Zhang Y, Simonsick E, Starkweather A, Chen MH, McCauley P, Chyun D, Cong X. Back pain and heart failure in community-dwelling older adults: Findings from the Health ABC study. Geriatr Nurs 2021; 42:643-649. [PMID: 33823422 DOI: 10.1016/j.gerinurse.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/07/2023]
Abstract
This study explored the association of back pain and heart failure (HF) with health outcomes among community-dwelling older adults. Older adults who completed a follow-up in the 11th year (2007-2008) of the Health, Aging, and Body Composition (Health ABC) study were included. The mean age was 83.4 ± 2.78 years. Back pain and heart failure were reported by 55.40% (n = 657) and 8.09 % (n = 96) of the total subjects (N = 1186), respectively. Regression analysis indicated that older adults with back pain reported worse depressive symptoms, fatigue, and physical performance and function compared with those without back pain (p < 0.05), and HF presence increased fatigue levels and decreased physical function (p < 0.05) among older adults with back pain. The high incidence and negative impact of back pain highlight the need to develop strategies for pain management among older adults with and without HF.
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Affiliation(s)
- Jie Chen
- School of Nursing, University of Connecticut, Storrs, CT, USA.
| | - Yiming Zhang
- Department of Statistics, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, USA
| | - Eleanor Simonsick
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | - Ming-Hui Chen
- Department of Statistics, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, USA
| | - Paula McCauley
- Intermediate Unit, UConn John Dempsey Hospital, University of Connecticut Health Center, Farmington, CT, USA
| | - Deborah Chyun
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
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Jenghua K. Prevalence and associated factors of potentially inappropriate medications among Thai patients with heart failure. Int J Clin Pract 2021; 75:e13878. [PMID: 33259674 DOI: 10.1111/ijcp.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Several medications may worsen heart failure (HF), and they are considered as potentially inappropriate medications for patients with heart failure (PIMHF). No studies reported the prevalence of PIMHF use and its associated factors in Thai HF patients. OBJECTIVE To determine the prevalence of PIMHF use and identify factors associated with PIMHF use. MATERIAL AND METHOD A cross-sectional study was conducted using data on HF patients obtained from the electronic medical databases (EMDs) of two hospitals, including a secondary and a tertiary care hospital. Data collected included demographics, diagnoses and medications prescribed during 2016-2019. The prevalence of PIMHF use identified by the Thailand list of PIMHF was determined. Patient and clinical factors were examined whether they were associated with PIMHF use by calculating the adjusted odds ratio (aOR) and 95% confidence interval (95% CI) using a binary logistic regression analysis. RESULTS From the EMD, 972 and 2888 eligible HF patients from a secondary and a tertiary care hospital, respectively, were included in this study. The prevalence of PIMHF use was 45.16% and 33.07% at a secondary and a tertiary care hospital, respectively. Factors associated with PIMHF use were HFpEF (aOR = 1.68, 95% CI = 1.39-2.03), diabetes mellitus (DM) (aOR = 1.66, 95% CI = 1.35-2.05), renal failure (RF) (aOR = 1.49, 95% CI = 1.21-1.84), chronic pulmonary diseases (CPD) (aOR = 2.41, 95% CI = 1.74-3.34), connective tissue diseases (CTD) (aOR = 5.21, 95% CI = 2.17-12.49), and cancer (aOR = 2.57, 95% CI = 1.36-4.86). CONCLUSION PIMHF use according to the Thailand list of PIMHF was prevalent in Thai HF patients and associated with HFpEF, DM, RF, CPD, CTD and cancer.
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Affiliation(s)
- Kittipak Jenghua
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand
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Cardiovascular toxicity of PI3Kα inhibitors. Clin Sci (Lond) 2021; 134:2595-2622. [PMID: 33063821 DOI: 10.1042/cs20200302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Abstract
The phosphoinositide 3-kinases (PI3Ks) are a family of intracellular lipid kinases that phosphorylate the 3'-hydroxyl group of inositol membrane lipids, resulting in the production of phosphatidylinositol 3,4,5-trisphosphate from phosphatidylinositol 4,5-bisphosphate. This results in downstream effects, including cell growth, proliferation, and migration. The heart expresses three PI3K class I enzyme isoforms (α, β, and γ), and these enzymes play a role in cardiac cellular survival, myocardial hypertrophy, myocardial contractility, excitation, and mechanotransduction. The PI3K pathway is associated with various disease processes but is particularly important to human cancers since many gain-of-function mutations in this pathway occur in various cancers. Despite the development, testing, and regulatory approval of PI3K inhibitors in recent years, there are still significant challenges when creating and utilizing these drugs, including concerns of adverse effects on the heart. There is a growing body of evidence from preclinical studies revealing that PI3Ks play a crucial cardioprotective role, and thus inhibition of this pathway could lead to cardiac dysfunction, electrical remodeling, vascular damage, and ultimately, cardiovascular disease. This review will focus on PI3Kα, including the mechanisms underlying the adverse cardiovascular effects resulting from PI3Kα inhibition and the potential clinical implications of treating patients with these drugs, such as increased arrhythmia burden, biventricular cardiac dysfunction, and impaired recovery from cardiotoxicity. Recommendations for future directions for preclinical and clinical work are made, highlighting the possible role of PI3Kα inhibition in the progression of cancer-related cachexia and female sex and pre-existing comorbidities as independent risk factors for cardiac abnormalities after cancer treatment.
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Lindmark K, Boman K, Stålhammar J, Olofsson M, Lahoz R, Studer R, Proudfoot C, Corda S, Fonseca AF, Costa-Scharplatz M, Levine A, Törnblom M, Castelo-Branco A, Kopsida E, Wikström G. Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study. ESC Heart Fail 2021; 8:2144-2153. [PMID: 33751806 PMCID: PMC8120394 DOI: 10.1002/ehf2.13296] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden. Methods and results Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all‐cause mortality were evaluated. A time‐dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction‐based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient‐years of follow‐up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all‐cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all‐cause mortality increased approximately six‐fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24–7.48] and 5.59 [4.70–6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities. Conclusions There is a strong association between recurrent HFHs and CV and all‐cause mortality, with the risk increasing progressively with each recurrent HFH.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, S-901 87, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | | | | | | | | | | | | | | | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
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Yamaguchi N, Xiao J, Narke D, Shaheen D, Lin X, Offerman E, Khodadadi-Jamayran A, Shekhar A, Choy A, Wass SY, Van Wagoner DR, Chung MK, Park DS. Cardiac Pressure Overload Decreases ETV1 Expression in the Left Atrium, Contributing to Atrial Electrical and Structural Remodeling. Circulation 2021; 143:805-820. [PMID: 33225722 PMCID: PMC8449308 DOI: 10.1161/circulationaha.120.048121] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated intracardiac pressure attributable to heart failure induces electrical and structural remodeling in the left atrium (LA) that begets atrial myopathy and arrhythmias. The underlying molecular pathways that drive atrial remodeling during cardiac pressure overload are poorly defined. The purpose of this study is to characterize the response of the ETV1 (ETS translocation variant 1) signaling axis in the LA during cardiac pressure overload in humans and mouse models and explore the role of ETV1 in atrial electrical and structural remodeling. METHODS We performed gene expression profiling in 265 left atrial samples from patients who underwent cardiac surgery. Comparative gene expression profiling was performed between 2 murine models of cardiac pressure overload, transverse aortic constriction banding and angiotensin II infusion, and a genetic model of Etv1 cardiomyocyte-selective knockout (Etv1f/fMlc2aCre/+). RESULTS Using the Cleveland Clinic biobank of human LA specimens, we found that ETV1 expression is decreased in patients with reduced ejection fraction. Consistent with its role as an important mediator of the NRG1 (Neuregulin 1) signaling pathway and activator of rapid conduction gene programming, we identified a direct correlation between ETV1 expression level and NRG1, ERBB4, SCN5A, and GJA5 levels in human LA samples. In a similar fashion to patients with heart failure, we showed that left atrial ETV1 expression is downregulated at the RNA and protein levels in murine pressure overload models. Comparative analysis of LA RNA sequencing datasets from transverse aortic constriction and angiotensin II-treated mice showed a high Pearson correlation, reflecting a highly ordered process by which the LA undergoes electrical and structural remodeling. Cardiac pressure overload produced a consistent downregulation of ErbB4, Etv1, Scn5a, and Gja5 and upregulation of profibrotic gene programming, which includes Tgfbr1/2, Igf1, and numerous collagen genes. Etv1f/fMlc2aCre/+ mice displayed atrial conduction disease and arrhythmias. Correspondingly, the LA from Etv1f/fMlc2aCre/+ mice showed downregulation of rapid conduction genes and upregulation of profibrotic gene programming, whereas analysis of a gain-of-function ETV1 RNA sequencing dataset from neonatal rat ventricular myocytes transduced with Etv1 showed reciprocal changes. CONCLUSIONS ETV1 is downregulated in the LA during cardiac pressure overload, contributing to both electrical and structural remodeling.
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Affiliation(s)
- Naoko Yamaguchi
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, 435 E 30 Street, Science Building 723, New York, New York 10016, USA
| | - Junhua Xiao
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, 435 E 30 Street, Science Building 723, New York, New York 10016, USA
| | - Deven Narke
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, 435 E 30 Street, Science Building 723, New York, New York 10016, USA
| | - Devin Shaheen
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, 435 E 30 Street, Science Building 723, New York, New York 10016, USA
| | - Xianming Lin
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, 435 E 30 Street, Science Building 723, New York, New York 10016, USA
| | - Erik Offerman
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, 435 E 30 Street, Science Building 723, New York, New York 10016, USA
| | - Alireza Khodadadi-Jamayran
- NYU Applied Bioinformatics Labs, New York University Grossman School of Medicine, 227 E 30 Street, TRB-745, New York, New York 10016, USA
| | - Akshay Shekhar
- Regeneron Pharmaceuticals, Inc. Biotechnology, 777 Old Saw Mill River Road, Tarrytown, NY, 10591 USA
| | - Alex Choy
- Icahn Medical Institute at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Sojin Y. Wass
- Department of Cardiovascular & Metabolic Sciences; Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - David R. Van Wagoner
- Department of Cardiovascular & Metabolic Sciences; Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mina K. Chung
- Department of Cardiovascular & Metabolic Sciences; Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - David S. Park
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, 435 E 30 Street, Science Building 723, New York, New York 10016, USA
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Siriopol D, Popa R, Mihaila M, Rusu F, Sascau R, Statescu C, Cătălina Z, Vasiliu V, Bucur A, Neamtu A, Siriopol I, Cianga P, Kanbay M, Covic A. Application of survival classification and regression tree analysis for identification of subgroups of risk in patients with heart failure and reduced left ventricular ejection fraction. Int J Cardiovasc Imaging 2021; 37:1853-1861. [DOI: 10.1007/s10554-021-02159-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023]
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Faulkner KM, Uchmanowicz I, Lisiak M, Cichoń E, Cyrkot T, Szczepanowski R. Cognition and Frailty in Patients With Heart Failure: A Systematic Review of the Association Between Frailty and Cognitive Impairment. Front Psychiatry 2021; 12:713386. [PMID: 34276454 PMCID: PMC8282927 DOI: 10.3389/fpsyt.2021.713386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background/Aim: Pathological processes associated with aging increase the risk of cognitive deficits. Frailty syndrome may significantly accelerate these pathological processes in elderly patients with heart failure. The objective of this review was to better understand the association between frailty syndrome and co-occurring cognitive decline in patients with heart failure. Methods: We conducted a systematic review based on PubMed/MEDLINE, Scopus, EMBASE, and CINAHL as databases. The search followed the method described by Webb and Roe. For inclusions, the studies were selected employing cross-sectional and longitudinal designs. The included studies had to evaluate frailty syndrome and cognitive impairments among participants with heart failure. As we were interested in older adults, the search was limited to individuals >65 years of age. The search was limited to primary research articles written in English published since the year 2000. Results: Of the 1,245 studies retrieved by the systematic review, 8 relevant studies were enclosed for the full-text review. Our review revealed that most studies of patients with HF demonstrated evidence of an association between greater frailty and cognitive impairment. In particular, six studies reported evidence for the significant association between higher levels of frailty and cognitive impairment in patients with heart failure. The remaining two studies failed to find an association between frailty and cognitive impairment. Conclusions: The development of frailty and cognitive impairment in heart failure is particularly important because this cardiovascular disease is a common cause of both morbidity and mortality in the world. The results of this review fill the existing gap in the literature related to the identification of clinical factors linked with frailty syndrome that contribute to cognitive impairment in patients with a diagnosis of heart failure. The prevalence of overlapping frailty and cognitive impairment in patients with heart failure, therefore, necessitates a routine assessment of these components in the care of patients with cardiovascular disease.
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Affiliation(s)
- Kenneth M Faulkner
- Stony Brook University School of Nursing, Stony Brook, New York, NY, United States
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Lisiak
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Ewelina Cichoń
- Department of Psychology, WSB University in Torun, Torun, Poland.,Department of Psychology, Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland
| | - Tomasz Cyrkot
- Department of Psychology, Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland
| | - Remigiusz Szczepanowski
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Zhang Z, Bai J, Huang Y. The efficacy of a nursing care and follow-up program for patients with heart failure: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e23380. [PMID: 33285722 PMCID: PMC7717929 DOI: 10.1097/md.0000000000023380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Heart failure (HF) is one of the primary causes of the increasing public health costs, incidence rate and mortality of heart disease. As treatment options for the HF have evolved, people have a better understanding of overall burden of HF, resulting a more centralized method for the treatment of these patients with chronic diseases. At present, with the rapid progress of medical technology, the nursing mode must be updated accordingly. The objective of this trial is to investigate the effects of the program of nursing care and follow-up on life quality, self-care, and the rehospitalization of patients with HF. METHOD This is a randomized controlled study to be carried out from November 2020 to March 2021 and was granted through the Ethics Committee of Changshan County People's Hospital (CCPH002376). The patients meet the following criteria will be included: the age of the patients is 18 years and above, and the functional classification is NYHA II or NYHA III. The patients with the following criteria will be excluded: patients who have received the by-pass surgery in the last 6 months; cancer patients are given radiotherapy or chemotherapy; patients with severe renal failure requiring dialysis; patients with chronic obstructive pulmonary disease who need ventilation; and patients with hearing or visual impairment. In our experiment, patient information scale, the life quality scale (The Left Ventricular Dysfunction Scale) and Self-Care of HF Index are utilized for the assessment. All the analyses are implemented with SPSS for Windows Version 20.0. RESULTS Impact of experimental programs on outcomes will be illustrated in the Table. CONCLUSION We hypothesize that the nursing care conducted for the HF patients may improve the life quality and self-care. TRIAL REGISTRATION NUMBER researchregistry 6129.
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Affiliation(s)
| | | | - Yongmei Huang
- Department of Nursing, Changshan County People's Hospital, Zhejiang, China
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Chebl RB, Berbari I, Safa R, Shami A, Sabra M, Jamali S, Makki M, Tamim H, Dagher GA. Clinical Outcome of Septic Patients With Heart Failure With Preserved Ejection Fraction Presenting to the Emergency Department of a Tertiary Hospital: A Retrospective Cohort Study. Front Med (Lausanne) 2020; 7:517999. [PMID: 33195290 PMCID: PMC7662680 DOI: 10.3389/fmed.2020.517999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 10/06/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Patients with heart failure with preserved ejection fraction (HFpEF) may be at a higher risk of mortality from sepsis than patients without heart failure. Objective: The aim of this study is to compare sepsis-related morbidity and mortality between patients with HFpEF and patients without heart failure presenting to the emergency department (ED) of a tertiary medical center. Design: Single-center retrospective cohort study conducted at an academic ED between January 1, 2015 and December 31, 2018. Patients: Patients with a diagnosis of sepsis were included. Main Measures: Bivariate and multivariate analyses were performed to look at differences in demographics, infection, and treatment parameters as well as outcomes of patients with sepsis. The primary outcome of the study was in-hospital mortality. Secondary outcomes included ED mortality, lengths of stay, and treatment differences between both groups. Key Results: A total of 1,092 patients presented with sepsis to the ED, of which 305 (27.93%) had HFpEF. There was no significant difference in in-hospital mortality between the two groups (40.7% vs. 37.4%; p = 0.314). However, there was a significant increase in ED mortality for septic HFpEF patients compared to non-heart failure patients (2.4 vs. 0.4%; p = 0.003). Septic HFpEF patients presenting to the ED were older than non-heart failure patients (76.84 vs. 68.44 years old; p < 0.0001). On the other hand, there was no significant increase in the use of vasopressors in the first 24 h between both groups. There was a significantly higher rate of intubation in the first 48 h for septic HFpEF patients (17.5 vs. 8.9%; p < 0.0001). Finally, there was significantly less intravenous fluid requirement at 6 h (1.94 L vs. 2.41L; p < 0.0001) and 24 h (3.11 L vs. 3.54L; p = 0.004) for septic patients with HFpEF compared to non-heart failure patients. Conclusion: Septic HFpEF patients experienced an increase in ED mortality, intubation, and steroid use compared to septic non-heart failure patients.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Iskandar Berbari
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Rawan Safa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Ali Shami
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Mohammad Sabra
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Sarah Jamali
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Maha Makki
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Hani Tamim
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
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63
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Factors associated with health-related quality of life in Chinese patients with heart failure: a cross-sectional study. Collegian 2020. [DOI: 10.1016/j.colegn.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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64
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Wang G, Liu X, Yang Q. Symptom clusters and quality of life in Chinese patients with heart failure. Collegian 2020. [DOI: 10.1016/j.colegn.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nguyen C, Zhang X, Evers T, Willey VJ, Tan H, Power TP. Real-World Treatment Patterns, Healthcare Resource Utilization, and Costs for Patients with Newly Diagnosed Systolic versus Diastolic Heart Failure. AMERICAN HEALTH & DRUG BENEFITS 2020; 13:166-174. [PMID: 33343816 PMCID: PMC7737726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/21/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although the significant burden of heart failure (HF) is well recognized, the relative contributions of systolic HF versus diastolic HF are less defined. OBJECTIVE To explore the differential burden between patients with systolic and diastolic HF in terms of treatment patterns, healthcare resource utilization (HCRU), costs, and mortality risk. METHODS This retrospective cohort study used administrative claims data from a large US commercial health insurer integrated with mortality data. Patients newly diagnosed with HF between January 1, 2010, and June 30, 2016, were identified and grouped according to systolic HF or diastolic HF diagnosis and were followed up to 4 years after diagnosis. Treatment patterns, HCRU, costs, and mortality were compared between the 2 groups of patients. RESULTS Overall, 46,885 patients with systolic HF and 21,854 with diastolic HF were identified and included in the study. Patients with systolic HF had less HCRU than those with diastolic HF during the first year after HF diagnosis, including hospital admissions (70.2% vs 82.4%, respectively; P <.001) and emergency department visits (30.5% vs 39.1%, respectively; P <.001). The average per-patient costs for patients with systolic HF during the 1-year follow-up were higher than for those with diastolic HF ($64,154 vs $59,652, respectively; P <.001), but lower during years 2 through 4 (approximately $23,000-$25,000 annually vs approximately $28,000-$29,000 annually; P <.001). Patients with diastolic HF had a higher adjusted hospitalization risk (odds ratio, 1.62; 95% confidence interval [CI], 1.55-1.69), but comparable adjusted costs (exponentiated estimate, 1.01; 95% CI, 0.99-1.02) and slightly lower mortality risk (hazard ratio, 0.96; 95% CI, 0.93-0.99) versus patients with systolic HF. The number of HF-related medication classes received for other diagnoses during the year preceding an HF diagnosis was associated with lower risks for hospitalization, mortality, and lower costs, with a trend in benefits toward patients with systolic HF. Of note, 21.9% of patients with systolic HF and 25% of patients with diastolic HF filled no HF-related prescriptions in the year after diagnosis. CONCLUSION This real-world analysis confirms a high disease burden associated with HF and provides insight across the systolic HF and diastolic HF phenotypes. HF-related medication use after diagnosis was suboptimal and underscores a gap in patient care.
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Affiliation(s)
- Chi Nguyen
- Senior Researcher, HealthCore, an independent subsidiary of Anthem, Wilmington, DE
| | - Xian Zhang
- Senior Researcher, HealthCore, an independent subsidiary of Anthem, Wilmington, DE
| | - Thomas Evers
- Head of Real World Insights, Bayer AG, Wuppertal, Germany
| | - Vincent J Willey
- Principal Scientist, HealthCore, an independent subsidiary of Anthem, Wilmington, DE
| | - Hiangkiat Tan
- Scientific Director, HealthCore, an independent subsidiary of Anthem, Wilmington, DE
| | - Thomas P Power
- Senior Medical Director of Cardiology and Sleep Medicine, AIM Specialty Health, Chicago, IL
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Litwin SE, Adams TD, Davidson LE, McKinlay R, Simper SC, Ranson L, Hunt SC. Longitudinal Changes in Cardiac Structure and Function in Severe Obesity: 11-Year Follow-Up in the Utah Obesity Study. J Am Heart Assoc 2020; 9:e014542. [PMID: 32476544 PMCID: PMC7429060 DOI: 10.1161/jaha.119.014542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Progressive cardiac remodeling and worsening myocardial function over time have been proposed as potential mediators of heart failure in obesity. Methods and Results We serially assessed cardiac structure and function in 254 subjects participating in a longitudinal study of obesity. Demographic, clinical, laboratory, and echocardiographic features were determined at baseline and 2‐, 6‐, and 11‐year follow‐up. We measured body mass index (BMI) exposure as the area under the curve of the BMI at each of the 4 visits. At enrollment, mean age of the subjects was 47 years, 79% were women, mean BMI was 44 kg/m2, 26% had diabetes mellitus, 48% had hypertension, and 53% had hyperlipidemia. Between baseline and 11 years, BMI increased by 1.1 and 0.3 kg/m2 in men and women, respectively. There were modest increases in left ventricular (LV) end‐diastolic volume, LV mass, and left atrial volume, and significant decreases in early/late mitral diastolic flow velocity ratio and E wave deceleration time. However, there were no significant changes in LV ejection fraction or ratio of early mitral diastolic flow velocity/early mitral annular velocity, whereas right ventricular fractional area change increased. Significant predictors of the change in LV mass were male sex, baseline BMI, BMI area under the curve, and change in LV stroke volume, but not smoking, hypertension, or diabetes mellitus. Conclusions In long‐standing, persistent severe obesity, there was evidence of cardiac remodeling over a period of 11 years, but no clear worsening of systolic or diastolic function. Measures of remodeling were most strongly related to BMI. The observed changes might predispose to heart failure with preserved ejection fraction, but are not classic for an evolving dilated cardiomyopathy.
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Affiliation(s)
- Sheldon E. Litwin
- Department of Internal MedicineMedical University of South CarolinaCharlestonSC
- Ralph H. Johnson Veterans Affairs Medical CenterCharlestonSC
| | - Ted D. Adams
- Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUT
- Intermountain Health CorporationSalt Lake CityUT
| | - Lance E. Davidson
- Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUT
- Department of Exercise SciencesBrigham Young UniversityProvoUT
| | | | | | | | - Steven C. Hunt
- Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUT
- Department of Genetic MedicineWeill Cornell MedicineDohaQatar
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Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020; 22:1342-1356. [PMID: 32483830 PMCID: PMC7540043 DOI: 10.1002/ejhf.1858] [Citation(s) in RCA: 909] [Impact Index Per Article: 227.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
The heart failure syndrome has first been described as an emerging epidemic about 25 years ago. Today, because of a growing and ageing population, the total number of heart failure patients still continues to rise. However, the case mix of heart failure seems to be evolving. Incidence has stabilized and may even be decreasing in some populations, but alarming opposite trends have been observed in the relatively young, possibly related to an increase in obesity. In addition, a clear transition towards heart failure with a preserved ejection fraction has occurred. Although this transition is partially artificial, due to improved recognition of heart failure as a disorder affecting the entire left ventricular ejection fraction spectrum, links can be made with the growing burden of obesity‐related diseases and with the ageing of the population. Similarly, evidence suggests that the number of patients with heart failure may be on the rise in low‐income countries struggling under the double burden of communicable diseases and conditions associated with a Western‐type lifestyle. These findings, together with the observation that the mortality rate of heart failure is declining less rapidly than previously, indicate we have not reached the end of the epidemic yet. In this review, the evolving epidemiology of heart failure is put into perspective, to discern major trends and project future directions.
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Affiliation(s)
- Amy Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Arno W Hoes
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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68
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Seferović PM, Jankowska E, Coats AJS, Maggioni AP, Lopatin Y, Milinković I, Polovina M, Lainščak M, Timmis A, Huculeci R, Vardas P. The Heart Failure Association Atlas: rationale, objectives, and methods. Eur J Heart Fail 2020; 22:638-645. [PMID: 32125085 DOI: 10.1002/ejhf.1768] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 12/28/2022] Open
Abstract
Heart failure (HF) constitutes the growing cardiovascular burden and the major public health issue, but comprehensive statistics on HF epidemiology and related management in Europe are missing. The Heart Failure Association (HFA) Atlas has been initiated in 2016 in order to close this gap, representing the continuity directly rooted in the European Society of Cardiology (ESC) Atlas of Cardiology. The major aim of the HFA Atlas is to establish a contemporary dataset on HF epidemiology, resources and reimbursement policies for HF management, organization of the National Heart Failure Societies (NHFS) and their major activities, including education and HF awareness. These data are gathered in collaboration with the network of NHFS of the ESC member and ESC affiliated countries. The dataset will be continuously improved and advanced based on the experience and enhanced understanding of data collection in the forthcoming years. This will enable revealing trends, disparities and gaps in knowledge on epidemiology and management of HF. Such data are highly needed by the clinicians of different specialties (aside from cardiologists and cardiac surgeons), researchers, healthcare policy makers, as well as HF patients and their caregivers. It will also allow to map the snapshot of realities in HF care, as well as to provide insights for evidence-based health care policy in contemporary management of HF. Such data will support the ESC/HFA efforts to improve HF management ant outcomes through stronger recommendations and calls for action. This will likely influence the allocation of funds for the prevention, treatment, education and research in HF.
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Affiliation(s)
- Petar M Seferović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Ewa Jankowska
- Cardiology Department, Centre for Heart Diseases, 4th Military Clinical Hospital in Wrocław, Wrocław, Poland
| | | | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Yuri Lopatin
- Volgograd State Medical University, Cardiology Center, Volgograd, Russia
| | - Ivan Milinković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Polovina
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Mitja Lainščak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Adam Timmis
- Barts Heart Centre and Queen Mary University London, London, UK
| | - Radu Huculeci
- Jean Jeener NMR Center, Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium.,Structural Biology Research Center, Brussels, Belgium
| | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece.,European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
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69
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Revuelta JM, Alconero-Camarero AR. Corazón de mujer. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stehlik J, Schmalfuss C, Bozkurt B, Nativi-Nicolau J, Wohlfahrt P, Wegerich S, Rose K, Ray R, Schofield R, Deswal A, Sekaric J, Anand S, Richards D, Hanson H, Pipke M, Pham M. Continuous Wearable Monitoring Analytics Predict Heart Failure Hospitalization. Circ Heart Fail 2020; 13:e006513. [DOI: 10.1161/circheartfailure.119.006513] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Implantable cardiac sensors have shown promise in reducing rehospitalization for heart failure (HF), but the efficacy of noninvasive approaches has not been determined. The objective of this study was to determine the accuracy of noninvasive remote monitoring in predicting HF rehospitalization.
Methods:
The LINK-HF study (Multisensor Non-invasive Remote Monitoring for Prediction of Heart Failure Exacerbation) examined the performance of a personalized analytical platform using continuous data streams to predict rehospitalization after HF admission. Study subjects were monitored for up to 3 months using a disposable multisensor patch placed on the chest that recorded physiological data. Data were uploaded continuously via smartphone to a cloud analytics platform. Machine learning was used to design a prognostic algorithm to detect HF exacerbation. Clinical events were formally adjudicated.
Results:
One hundred subjects aged 68.4±10.2 years (98% male) were enrolled. After discharge, the analytical platform derived a personalized baseline model of expected physiological values. Differences between baseline model estimated vital signs and actual monitored values were used to trigger a clinical alert. There were 35 unplanned nontrauma hospitalization events, including 24 worsening HF events. The platform was able to detect precursors of hospitalization for HF exacerbation with 76% to 88% sensitivity and 85% specificity. Median time between initial alert and readmission was 6.5 (4.2–13.7) days.
Conclusions:
Multivariate physiological telemetry from a wearable sensor can provide accurate early detection of impending rehospitalization with a predictive accuracy comparable to implanted devices. The clinical efficacy and generalizability of this low-cost noninvasive approach to rehospitalization mitigation should be further tested.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique Identifier: NCT03037710.
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Affiliation(s)
- Josef Stehlik
- George E. Wahlen VA Medical Center, Salt Lake City, UT (J.S., J.N.-N., H.H.)
- University of Utah School of Medicine, Salt Lake City, UT (J.S., J.N.-N., P.W.)
| | | | - Biykem Bozkurt
- Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (B.B., A.D.)
| | - Jose Nativi-Nicolau
- George E. Wahlen VA Medical Center, Salt Lake City, UT (J.S., J.N.-N., H.H.)
- University of Utah School of Medicine, Salt Lake City, UT (J.S., J.N.-N., P.W.)
| | - Peter Wohlfahrt
- University of Utah School of Medicine, Salt Lake City, UT (J.S., J.N.-N., P.W.)
| | | | - Kevin Rose
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
| | - Ranjan Ray
- VA Palo Alto Health Care System, Palo Alto, CA (R.R., M.P.)
| | | | - Anita Deswal
- Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (B.B., A.D.)
| | | | - Sebastian Anand
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
| | - Dylan Richards
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
| | - Heather Hanson
- George E. Wahlen VA Medical Center, Salt Lake City, UT (J.S., J.N.-N., H.H.)
| | - Matthew Pipke
- VA Palo Alto Health Care System, Palo Alto, CA (R.R., M.P.)
| | - Michael Pham
- PhysIQ Inc, Chicago, IL (S.W., K.R., J.S., S.A., D.R., M.P.)
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Li X, Liao J, Jiang Z, Liu X, Chen S, He X, Zhu L, Duan X, Xu Z, Qi B, Guo X, Tong R, Shi J. A concise review of recent advances in anti-heart failure targets and its small molecules inhibitors in recent years. Eur J Med Chem 2020; 186:111852. [PMID: 31759729 DOI: 10.1016/j.ejmech.2019.111852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
Heart failure is a disease with high mortality and the risk of heart failure increases in magnitude with age. The patients of heart failure is increasing year by year. Hence, Pharmaceutical researchers have to develop new drugs with better pharmacological effects to coping with this phenomenon. In this article, we reviewed the small molecule compounds for heart failure that have been marketed in recent years or are promising to enter clinical research. We also reviewed the SAR (structure activity relationship) of these molecules, such as renin inhibitors, ROMK inhibitors, a kind of new diuretics, and some dual-targets inhibitors. These small molecules proven to be beneficial effect on heart failure patients. Which may provide ideas for the design of novel anti-heart failure therapeutic drugs.
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Affiliation(s)
- Xingxing Li
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China
| | - Jing Liao
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China; Pediatric Department Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, People's Republic of China, Chengdu, 610072, China
| | - Zhongliang Jiang
- Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Xinyu Liu
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China
| | - Shan Chen
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China
| | - Xia He
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China; Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Individual Key Laboratory, Chengdu, People's Republic of China, Chengdu, 610072, China
| | - Ling Zhu
- Eastern Hospital, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Xingmei Duan
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China; Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Individual Key Laboratory, Chengdu, People's Republic of China, Chengdu, 610072, China
| | - Zhuyu Xu
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China
| | - Baowen Qi
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu, 610106, China
| | - Xiaoqiang Guo
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu, 610106, China
| | - Rongsheng Tong
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China; Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Individual Key Laboratory, Chengdu, People's Republic of China, Chengdu, 610072, China.
| | - Jianyou Shi
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, 610054, China; Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Individual Key Laboratory, Chengdu, People's Republic of China, Chengdu, 610072, China.
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Evaluating risk prediction models for adults with heart failure: A systematic literature review. PLoS One 2020; 15:e0224135. [PMID: 31940350 PMCID: PMC6961879 DOI: 10.1371/journal.pone.0224135] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/24/2019] [Indexed: 12/25/2022] Open
Abstract
Background The ability to predict risk allows healthcare providers to propose which patients might benefit most from certain therapies, and is relevant to payers’ demands to justify clinical and economic value. To understand the robustness of risk prediction models for heart failure (HF), we conducted a systematic literature review to (1) identify HF risk-prediction models, (2) assess statistical approach and extent of validation, (3) identify common variables, and (4) assess risk of bias (ROB). Methods Literature databases were searched from March 2013 to May 2018 to identify risk prediction models conducted in an out-of-hospital setting in adults with HF. Distinct risk prediction variables were ranked according to outcomes assessed and incorporation into the studies. ROB was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). Results Of 4720 non-duplicated citations, 40 risk-prediction publications were deemed relevant. Within the 40 publications, 58 models assessed 55 (co)primary outcomes, including all-cause mortality (n = 17), cardiovascular death (n = 9), HF hospitalizations (n = 15), and composite endpoints (n = 14). Few publications reported detail on handling missing data (n = 11; 28%). The discriminatory ability for predicting all-cause mortality, cardiovascular death, and composite endpoints was generally better than for HF hospitalization. 105 distinct predictor variables were identified. Predictors included in >5 publications were: N-terminal prohormone brain-natriuretic peptide, creatinine, blood urea nitrogen, systolic blood pressure, sodium, NYHA class, left ventricular ejection fraction, heart rate, and characteristics including male sex, diabetes, age, and BMI. Only 11/58 (19%) models had overall low ROB, based on our application of PROBAST. In total, 26/58 (45%) models discussed internal validation, and 14/58 (24%) external validation. Conclusions The majority of the 58 identified risk-prediction models for HF present particular concerns according to ROB assessment, mainly due to lack of validation and calibration. The potential utility of novel approaches such as machine learning tools is yet to be determined. Registration number The SLR was registered in Prospero (ID: CRD42018100709).
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73
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Kim YJ, Radloff JC, Crane PA, Bolin LP. Rehabilitation Intervention for Individuals With Heart Failure and Fatigue to Reduce Fatigue Impact: A Feasibility Study. Ann Rehabil Med 2019; 43:686-699. [PMID: 31918531 PMCID: PMC6960084 DOI: 10.5535/arm.2019.43.6.686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/07/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate feasibility of recruitment, tablet use in intervention delivery, and use of self-report outcome measures and to analyze the effect of Energy Conservation plus Problem-Solving Therapy versus Health Education interventions for individuals with heart failure-associated fatigue. METHODS This feasibility study was a block-randomized controlled trial involving 23 adults, blinded to their group assignment, in a rural southern area in the United States. Individuals with heart failure and fatigue received the interventions for 6 weeks through videoconferencing or telephone. Participants were taught to solve their fatiguerelated problems using energy conservation strategies and the process of Problem-Solving Therapy or educated about health-related topics. RESULTS The recruitment rate was 23%. All participants completed the study participation according to their group assignment, except for one participant in the Energy Conservation plus Problem-Solving Therapy group. Participants primarily used the tablet (n=21) rather than the phone (n=2). Self-report errors were noted on Activity Card Sort (n=23). Reported fatigue was significantly lower for both the Energy Conservation plus Problem-Solving Therapy (p=0.03, r=0.49) and Health Education (p=0.004, r=0.64) groups. The Health Education group reported significantly lower fatigue impact (p=0.019, r=0.48). Participation was significantly different in low-physical demand leisure activities (p=0.008; r=0.55) favoring the Energy Conservation plus Problem-Solving Therapy group. CONCLUSION The recruitment and delivery of the interventions were feasible. Activity Card Sort may not be appropriate for this study population due to recall bias. The interventions warrant future research to reduce fatigue and decrease participation in sedentary activities (Clinical Trial Registration number: NCT03820674).
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Affiliation(s)
- Young Joo Kim
- Department of Occupational Therapy, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA
| | - Jennifer C Radloff
- Department of Occupational Therapy, AdventHealth University, Orlando, FL, USA
| | - Patricia A Crane
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Linda P Bolin
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, NC, USA
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Abstract
Heart failure (HF) with reduced ejection fraction (HFrEF) presents as the severest phenotype on the spectrum of HF. Although great progress has been made with respect to its treatment over the past 3 decades, morbidity and mortality remain high, posing a big burden on human health. Recent evidence suggests vitamin D has a critical role in maintaining heart health through activation of the vitamin D receptor expressed in cardiomyocytes, and vitamin D deficiency may be implicated in the pathophysiology of HFrEF through activation of the renin-angiotensin system, impaired calcium handling, exaggerated inflammation, secondary hyperparathyroidism, pro-fibrotic properties, and proatherogenic potential. Additionally, epidemiological data disclosed that vitamin D deficiency is highly prevalent in patients with HFrEF and is associated with poor clinical outcomes. However, randomized control trials of vitamin D supplementation in HF, especially in HFrEF, have shown inconsistent results. Thus, this article aims to review the epidemiology, pathophysiology, and prognostic value of vitamin D deficiency in HF, with a special focus on randomized control trials associated with vitamin D supplementation in patients with HFrEF.
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75
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Norahan MH, Pourmokhtari M, Saeb MR, Bakhshi B, Soufi Zomorrod M, Baheiraei N. Electroactive cardiac patch containing reduced graphene oxide with potential antibacterial properties. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 104:109921. [DOI: 10.1016/j.msec.2019.109921] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/16/2019] [Accepted: 06/26/2019] [Indexed: 12/30/2022]
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Lenzi J, Avaldi VM, Molinazzi D, Descovich C, Urbinati S, Cappelli V, Fantini MP. Are degree of urbanisation and travel times to healthcare services associated with the processes of care and outcomes of heart failure? A retrospective cohort study based on administrative data. PLoS One 2019; 14:e0223845. [PMID: 31658280 PMCID: PMC6816546 DOI: 10.1371/journal.pone.0223845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
A few studies have found that patients with heart failure (HF) living in less densely populated areas have reduced use of services and poorer outcomes. However, there is a lack of evidence regarding transport accessibility measured as the actual distance between the patient's home and the healthcare facility. The aim of this study was to investigate if different urbanisation levels and travel times to healthcare services are associated with the processes of care and the outcomes of HF. This retrospective cohort study included patients residing in the Local Healthcare Authority of Bologna (2915 square kilometres) who were discharged from hospital with a diagnosis of HF between 1 January and 31 December 2017. Six-month study outcomes included both process (cardiology follow-up visits) and outcome measures (all-cause readmissions, emergency room visits, all-cause mortality). Of the 2022 study patients, 963 (47.6%) lived in urban areas, 639 (31.6%) in intermediate density areas, and 420 (20.8%) in rural communities. Most patients lived ≤30 minutes away from the nearest healthcare facility, either inpatient or outpatient. After controlling for a number of individual factors, no significant association between travel times and outcomes was present. However, rural patients as opposed to urban patients were more likely to see a cardiologist during follow-up (OR 1.42, 99% CI 1.03-1.96). These follow-up visits were associated with reduced mortality within 6 months of discharge (OR 0.53, 99% CI 0.32-0.87). We also found that multidisciplinary interventions for HF were more common in rural than in urban settings (18.8% vs. 4.0%). In conclusion, travel times had no impact on the quality of care for patients with HF. Differences between urban and rural patients were possibly mediated by more proximal factors, some of which are potential targets for intervention such as the availability and utilisation of follow-up cardiology services and multidisciplinary models of care.
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Affiliation(s)
- Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Vera Maria Avaldi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
- * E-mail:
| | - Dario Molinazzi
- Department of Management Control and Administrative Data, Bologna Local Healthcare Authority, Bologna, Italy
| | - Carlo Descovich
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | | | - Veronica Cappelli
- Directorate of Assistance, Technology and Rehabilitation, Bologna Local Healthcare Authority, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
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77
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Chen J, Walsh S, Delaney C, Cong X. Pain Management in Patients with Heart Failure: A Survey of Nurses' Perception. Pain Manag Nurs 2019; 21:365-370. [PMID: 31623989 DOI: 10.1016/j.pmn.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/11/2019] [Accepted: 09/16/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Over 50% of patients with heart failure (HF) report suffering from pain and pain-related burdens; however, pain in HF patients has not been recognized or well treated. Few studies have comprehensively examined pain management in patients with HF from nurses' perception. AIMS To investigate nurses' perception of pain management in HF patients. METHODS Members of American Association of Heart Failure Nurses (AAHFN) were invited to participate in a cross-sectional online survey. RESULTS A total of 147 nurses responded and completed the survey. The majority agreed that pain in HF patients was related to anxiety, depression, fatigue, and unplanned hospitalization, and that pain should be individually assessed and managed. More than 80% thought pain management practice in HF patients should be improved, and 78.1% were interested in getting more information and believed an online education module was the most preferable approach. Lack of pain assessment tools, drug addiction, side effect, overuse, underuse, and contraindication with other medications were the main concerns regarding opioid use in pain management in HF. The gaps in pain management in HF patients included lack of knowledge of opioid use, lack of consideration and awareness of pain, no clinical guidelines for pain assessment and treatment, and complicated pain management with multiple chronic conditions. CONCLUSIONS The impact of pain and need for individual assessment and management of pain in HF patients were perceived by nurses; improvement in pain management practice in HF patients is needed. Concerns regarding opioid use and gaps in pain management of HF patients should be addressed.
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Affiliation(s)
- Jie Chen
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Stephen Walsh
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Colleen Delaney
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Xiaomei Cong
- University of Connecticut School of Nursing, Storrs, Connecticut; Center for Advancement in Managing Pain, University of Connecticut School of Nursing, Storrs, Connecticut.
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78
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Kossman DA, Wolfrom SD, Haines S, Bagga M, Denno M, Ljubic L, O'Connor N. Just-in-Time Interdisciplinary Education for Hospice Care of Ventricular-Assist Device Patients. J Palliat Med 2019; 22:1167-1169. [DOI: 10.1089/jpm.2018.0581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Mary Denno
- Penn Medicine Hospice, Philadelphia, Pennsylvania
| | - Luann Ljubic
- Penn Medicine Hospice, Philadelphia, Pennsylvania
| | - Nina O'Connor
- Palliative and Hospice Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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79
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Li Z, Solomonidis EG, Meloni M, Taylor RS, Duffin R, Dobie R, Magalhaes MS, Henderson BEP, Louwe PA, D’Amico G, Hodivala-Dilke KM, Shah AM, Mills NL, Simons BD, Gray GA, Henderson NC, Baker AH, Brittan M. Single-cell transcriptome analyses reveal novel targets modulating cardiac neovascularization by resident endothelial cells following myocardial infarction. Eur Heart J 2019; 40:2507-2520. [PMID: 31162546 PMCID: PMC6685329 DOI: 10.1093/eurheartj/ehz305] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS A better understanding of the pathways that regulate regeneration of the coronary vasculature is of fundamental importance for the advancement of strategies to treat patients with heart disease. Here, we aimed to investigate the origin and clonal dynamics of endothelial cells (ECs) associated with neovascularization in the adult mouse heart following myocardial infarction (MI). Furthermore, we sought to define murine cardiac endothelial heterogeneity and to characterize the transcriptional profiles of pro-angiogenic resident ECs in the adult mouse heart, at single-cell resolution. METHODS AND RESULTS An EC-specific multispectral lineage-tracing mouse (Pdgfb-iCreERT2-R26R-Brainbow2.1) was used to demonstrate that structural integrity of adult cardiac endothelium following MI was maintained through clonal proliferation by resident ECs in the infarct border region, without significant contributions from bone marrow cells or endothelial-to-mesenchymal transition. Ten transcriptionally discrete heterogeneous EC states, as well as the pathways through which each endothelial state is likely to enhance neovasculogenesis and tissue regeneration following ischaemic injury were defined. Plasmalemma vesicle-associated protein (Plvap) was selected for further study, which showed an endothelial-specific and increased expression in both the ischaemic mouse and human heart, and played a direct role in regulating human endothelial proliferation in vitro. CONCLUSION We present a single-cell gene expression atlas of cardiac specific resident ECs, and the transcriptional hierarchy underpinning endogenous vascular repair following MI. These data provide a rich resource that could assist in the development of new therapeutic interventions to augment endogenous myocardial perfusion and enhance regeneration in the injured heart.
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Affiliation(s)
- Ziwen Li
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Emmanouil G Solomonidis
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marco Meloni
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard S Taylor
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rodger Duffin
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ross Dobie
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marlene S Magalhaes
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Beth E P Henderson
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Pieter A Louwe
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Gabriela D’Amico
- Centre for Tumour Biology, Barts Cancer Institute, CRUK-Barts Centre, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, UK
| | - Kairbaan M Hodivala-Dilke
- Centre for Tumour Biology, Barts Cancer Institute, CRUK-Barts Centre, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, UK
| | - Ajay M Shah
- Department for Cardiovascular Sciences, King’s College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, London, UK
| | - Nicholas L Mills
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Benjamin D Simons
- Cavendish Laboratory, Department of Physics, University of Cambridge, J.J. Thomson Avenue, Cambridge, UK
- The Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Tennis Court Road, Cambridge, UK
- Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Gillian A Gray
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neil C Henderson
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew H Baker
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Mairi Brittan
- Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure. J Cardiovasc Nurs 2019; 33:E15-E20. [PMID: 28574973 DOI: 10.1097/jcn.0000000000000428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status. OBJECTIVE The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association. METHODS In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status. RESULTS There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001). CONCLUSIONS Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.
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81
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Morillas-Climent H, Seller-Moya J, Vicedo-López Á, Galcerá-Jornet E, Alania-Torres E, Rodríguez-Pichardo Y, Larumbe-Rodríguez A, Valle-Muñoz A. Evolution of functional class, biochemical and echocardiographic parameters and clinical outcomes after sacubitril/valsartan initiation in daily practice. J Comp Eff Res 2019; 8:685-697. [DOI: 10.2217/cer-2019-0014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To analyze the impact of sacubitril/valsartan on functional class, surrogate parameters and clinical outcomes in clinical practice. Methods: Retrospective study of patients with heart failure and reduced ejection fraction that started treatment with sacubitril/valsartan. Results: 149 patients (70.7 ± 9.6 years) were included. At baseline, 83.9, 15.4 and 0.7% were taking sacubitril/valsartan 24/26, 49/51 and 97/103 mg, respectively. After 316.1 ± 155.9 days, these numbers moved to 38.9, 39.6, 12.8% (8.7% discontinued). Sacubitril/valsartan improved functional class (from 2.3 ± 0.6 to 1.8 ± 0.5; p < 0.001), increased ejection fraction (from 31.2 ± 7.0 to 37.3 ± 10.5%; p < 0.001) and reduced NT-proBNP (from 3884 ± 4871 to 1975.3 ± 3006.6 pg/ml; p = 0.0001). Rates of any event, cardiovascular death and heart failure hospitalization/decompensation were 13.2 events/100 patient-years. Conclusion: Sacubitril/valsartan is effective and safe in routine practice.
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82
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Metabolic modulation predicts heart failure tests performance. PLoS One 2019; 14:e0218153. [PMID: 31220103 PMCID: PMC6586291 DOI: 10.1371/journal.pone.0218153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/27/2019] [Indexed: 12/19/2022] Open
Abstract
The metabolic changes that accompany changes in Cardiopulmonary testing (CPET) and heart failure biomarkers (HFbio) are not well known. We undertook metabolomic and lipidomic phenotyping of a cohort of heart failure (HF) patients and utilized Multiple Regression Analysis (MRA) to identify associations to CPET and HFBio test performance (peak oxygen consumption (Peak VO2), oxygen uptake efficiency slope (OUES), exercise duration, and minute ventilation-carbon dioxide production slope (VE/VCO2 slope), as well as the established HF biomarkers of inflammation C-reactive protein (CRP), beta-galactoside-binding protein (galectin-3), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP)). A cohort of 49 patients with a left ventricular ejection fraction < 50%, predominantly males African American, presenting a high frequency of diabetes, hyperlipidemia, and hypertension were used in the study. MRA revealed that metabolic models for VE/VCO2 and Peak VO2 were the most fitted models, and the highest predictors’ coefficients were from Acylcarnitine C18:2, palmitic acid, citric acid, asparagine, and 3-hydroxybutiric acid. Metabolic Pathway Analysis (MetPA) used predictors to identify the most relevant metabolic pathways associated to the study, aminoacyl-tRNA and amino acid biosynthesis, amino acid metabolism, nitrogen metabolism, pantothenate and CoA biosynthesis, sphingolipid and glycerolipid metabolism, fatty acid biosynthesis, glutathione metabolism, and pentose phosphate pathway (PPP). Metabolite Set Enrichment Analysis (MSEA) found associations of our findings with pre-existing biological knowledge from studies of human plasma metabolism as brain dysfunction and enzyme deficiencies associated with lactic acidosis. Our results indicate a profile of oxidative stress, lactic acidosis, and metabolic syndrome coupled with mitochondria dysfunction in patients with HF tests poor performance. The insights resulting from this study coincides with what has previously been discussed in existing literature thereby supporting the validity of our findings while at the same time characterizing the metabolic underpinning of CPET and HFBio.
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83
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Abdi A, Soufinia A, Borji M, Tarjoman A. The Effect of Religion Intervention on Life Satisfaction and Depression in Elderly with Heart Failure. JOURNAL OF RELIGION AND HEALTH 2019; 58:823-832. [PMID: 30421268 DOI: 10.1007/s10943-018-0727-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The elderly suffering from heart failure is facing with some problems such as lowering of life satisfaction and depression. Regarding a lack of information in this issue, the current study was conducted to determine the effect of religion intervention on life satisfaction and depression in the elderly with heart failure, in Ilam-Iran. In a clinical trial study conducted on the elderly with heart failure disease in Ilam-Iran, the patients were randomly allocated into two experimental (46) and control (47) groups. The used instruments were a demographic checklist, life satisfaction questionnaire of LSI-Z and Beck depression inventory. The intervention done for test group was a religion-spiritual program designed based on the Richards and Bergin model, and according to Islam and Shia regulations and conducted during six sessions, each 30-45 min. The tools were completed before and after intervention. Gathered data were entered into SPSS software and analyzed by descriptive (mean and standard deviation) and inferential (independent t test and ANOVA) statistics. The results showed that there was no significant difference between the mean (SD) of life satisfaction in the experimental group [5.47 (3.37)] and control [5.85 (3.92)] before the intervention (P = 0.62) but after the intervention. The mean (SD) of life satisfaction of the test group [8.08 (4.36)] was higher than that of the control group [5.55 (3.96)] (P = 0.006). Also, no significant difference between the mean (SD) of depression in the experimental group [47.80 (10.48)] and control [49.87 (11.40)] before the intervention (P = 0.62) but after the intervention. The mean (SD) of depression of the test group [28.28 (14.78)] was lower than that of the control group [50.44 (14.02)] (P = 0.006). Regarding the positive effect of religion-spiritual program in depression and life satisfaction of the elderly with heart failure, it is suggested this program will be educated to these patients by health-care workers.
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Affiliation(s)
- Alireza Abdi
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Iran
- Nursing and Midwifery School, Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Askar Soufinia
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Iran.
- Nursing and Midwifery School, Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Asma Tarjoman
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Abstract
PURPOSE OF THE REVIEW Cardiorenal syndrome (CRS), defined as concomitant heart and kidney disease, has been a focus of attention for nearly a decade. As more patients survive severe acute and chronic heart and kidney diseases, CRS has emerged as an "epidemic" of modern medicine. Significant advances have been made in unraveling the complex mechanisms that underlie CRS based on classification of the condition into five pathophysiologic subtypes. In types 1 and 2, acute or chronic heart disease results in renal dysfunction, while in types 3 and 4, acute or chronic kidney diseases are the inciting factors for heart disease. Type 5 CRS is defined as concomitant heart and kidney dysfunction as part of a systemic condition such as sepsis or autoimmune disease. RECENT FINDINGS There are ongoing efforts to better define subtypes of CRS based on historical information, clinical manifestations, laboratory data (including biomarkers), and imaging characteristics. Systematic evaluation of CRS by advanced cardiac imaging, however, has been limited in scope and mostly focused on type 4 CRS. This is in part related to lack of clinical trials applying advanced cardiac imaging in the acute setting and exclusion of patients with significant renal disease from studies of such techniques in chronic HF. Advanced cardiac nuclear imaging is well poised for assessment of the pathophysiology of CRS by offering a myriad of molecular probes without the need for nephrotoxic contrast agents. In this review, we examine the current or potential future application of advanced cardiac imaging to evaluation of myocardial perfusion, metabolism, and innervation in patients with CRS.
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Affiliation(s)
- Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Ostrum Street, Bethlehem, PA, 18015, USA.
| | - Srinidhi Meera
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Ostrum Street, Bethlehem, PA, 18015, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, The University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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85
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Sangaralingham LR, Sangaralingham SJ, Shah ND, Yao X, Dunlay SM. Adoption of Sacubitril/Valsartan for the Management of Patients With Heart Failure. Circ Heart Fail 2019; 11:e004302. [PMID: 29453287 DOI: 10.1161/circheartfailure.117.004302] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The US Food and Drug Administration approved the use of sacubitril/valsartan in patients with heart failure with reduced ejection fraction in July 2015. We aimed to assess the adoption and prescription drug costs of sacubitril/valsartan in its first 18 months after Food and Drug Administration approval. METHODS AND RESULTS Using a large US insurance database, we identified privately insured and Medicare Advantage beneficiaries who filled a first prescription for sacubitril/valsartan between July 1, 2015, and December 31, 2016. We compared them to patients treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Outcomes included adoption, prescription drug costs, and 180-day adherence, defined as a proportion of days covered ≥80%. A total of 2244 patients initiated sacubitril/valsartan. Although the number of users increased over time, the proportion of heart failure with reduced ejection fraction patients taking sacubitril/valsartan remained low (<3%). Patients prescribed sacubitril/valsartan were younger, more often male, with less comorbidity than those taking an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Although a majority of prescription costs were covered by the health plan (mean, $328.37; median, $362.44 per 30-day prescription), out-of-pocket costs were still high (mean, $71.16; median, $40.27). By comparison, median out-of-pocket costs were $2 to $3 for lisinopril, losartan, carvedilol, and spironolactone. Overall, 59.1% of patients were adherent to sacubitril/valsartan. Refill patterns suggested that nearly half of nonadherent patients discontinued sacubitril/valsartan within 180 days of starting. CONCLUSIONS Adoption of sacubitril/valsartan after Food and Drug Administration approval has been slow and may be associated with the high cost.
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Affiliation(s)
- Lindsey R Sangaralingham
- From the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery (L.R.S., N.D.S., X.Y.), Department of Cardiovascular Medicine (S.J.S., S.M.D.), and Department of Health Sciences Research (N.D.S., X.Y., S.M.D.), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - S Jeson Sangaralingham
- From the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery (L.R.S., N.D.S., X.Y.), Department of Cardiovascular Medicine (S.J.S., S.M.D.), and Department of Health Sciences Research (N.D.S., X.Y., S.M.D.), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - Nilay D Shah
- From the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery (L.R.S., N.D.S., X.Y.), Department of Cardiovascular Medicine (S.J.S., S.M.D.), and Department of Health Sciences Research (N.D.S., X.Y., S.M.D.), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - Xiaoxi Yao
- From the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery (L.R.S., N.D.S., X.Y.), Department of Cardiovascular Medicine (S.J.S., S.M.D.), and Department of Health Sciences Research (N.D.S., X.Y., S.M.D.), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - Shannon M Dunlay
- From the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery (L.R.S., N.D.S., X.Y.), Department of Cardiovascular Medicine (S.J.S., S.M.D.), and Department of Health Sciences Research (N.D.S., X.Y., S.M.D.), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.).
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Izumaru K, Hata J, Nakano T, Nakashima Y, Nagata M, Fukuhara M, Oda Y, Kitazono T, Ninomiya T. Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study. Am J Kidney Dis 2019; 74:373-381. [PMID: 31036390 DOI: 10.1053/j.ajkd.2019.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/02/2019] [Indexed: 12/18/2022]
Abstract
RATIONALE & OBJECTIVE Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation. STUDY DESIGN Population-based cross-sectional study of deceased patients undergoing autopsy. SETTING & PARTICIPANTS 334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease. EXPOSURE eGFR. OUTCOMES The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples. ANALYTICAL APPROACH Generalized estimating equations. RESULTS Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3mm, respectively (P for trend<0.05). Lower eGFRs were also significantly associated with greater mean values of cardiac cell size in the left ventricular wall after adjusting for confounders: 15.3, 16.1, 16.4, and 17.4μm for eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 (P for trend<0.01). Patients with lower eGFRs had significantly higher multivariable-adjusted geometric mean values for fibrosis percentage in the left ventricular wall: 3.22%, 4.33%, 3.83%, and 6.14% for eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 (P for trend<0.001). The negative association of eGFR with multivariable-adjusted mean values of cardiac cell width was stronger among patients with than those without anemia. LIMITATIONS Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use. CONCLUSIONS These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.
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Affiliation(s)
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Masayo Fukuhara
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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87
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Mogos MF, Piano MR, McFarlin BL, Salemi JL, Liese KL, Briller JE. Heart Failure in Pregnant Women: A Concern Across the Pregnancy Continuum. Circ Heart Fail 2019; 11:e004005. [PMID: 29330153 DOI: 10.1161/circheartfailure.117.004005] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) is a leading cause of maternal morbidity and mortality in the United States, but prevalence, correlates, and outcomes of HF-related hospitalization during antepartum, delivery, and postpartum periods remain unknown. The objective was to examine HF prevalence, correlates, and outcomes among pregnancy-related hospitalizations among women 13 to 49 years of age. METHODS AND RESULTS We used the 2001 to 2011 Nationwide Inpatient Sample. Rates of HF were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios representing the association between HF and each outcome, stratified by antepartum, delivery, and postpartum periods. Joinpoint regression was used to describe temporal trends in HF and in-hospital mortality. Over 50 million pregnancy-related hospitalizations were analyzed. The overall rate of HF was 112 cases per 100 000 pregnancy-related hospitalizations. Although postpartum encounters represented only 1.5% of pregnancy-related hospitalizations, ≈60% of HF cases occurred postpartum, followed by delivery (27.3%) and antepartum (13.2%). Among postpartum hospitalizations, there was a significant 7.1% (95% confidence interval, 4.4-9.8) annual increase in HF from 2001 to 2006, followed by a steady rate through 2011. HF rates among antepartum hospitalizations increased on average 4.9% (95% confidence interval, 3.0-6.8) annually from 2001 to 2011. Women with a diagnosis of HF were more likely to experience adverse maternal outcomes, as reflected by outcome-specific adjusted odds ratios during antepartum (2.7-25), delivery (6-195), and postpartum (1.5-6.6) periods. CONCLUSIONS HF is associated with increased risk of maternal mortality and morbidities. During hospitalization, high-risk mothers need to be identified and surveillance programs developed before discharge.
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Affiliation(s)
- Mulubrhan F Mogos
- From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.).
| | - Mariann R Piano
- From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.)
| | - Barbara L McFarlin
- From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.)
| | - Jason L Salemi
- From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.)
| | - Kylea L Liese
- From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.)
| | - Joan E Briller
- From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.)
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88
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Detection of Congestive Heart Failure Based on LSTM-Based Deep Network via Short-Term RR Intervals. SENSORS 2019; 19:s19071502. [PMID: 30925693 PMCID: PMC6480269 DOI: 10.3390/s19071502] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022]
Abstract
Congestive heart failure (CHF) refers to the inadequate blood filling function of the ventricular pump and it may cause an insufficient heart discharge volume that fails to meet the needs of body metabolism. Heart rate variability (HRV) based on the RR interval is a proven effective predictor of CHF. Short-term HRV has been used widely in many healthcare applications to monitor patients’ health, especially in combination with mobile phones and smart watches. Inspired by the inception module from GoogLeNet, we combined long short-term memory (LSTM) and an Inception module for CHF detection. Five open-source databases were used for training and testing, and three RR segment length types (N = 500, 1000 and 2000) were used for the comparison with other studies. With blindfold validation, the proposed method achieved 99.22%, 98.85% and 98.92% accuracy using the Beth Israel Deaconess Medical Center (BIDMC) CHF, normal sinus rhythm (NSR) and the Fantasia database (FD) databases and 82.51%, 86.68% and 87.55% accuracy using the NSR-RR and CHF-RR databases, with N = 500, 1000 and 2000 length RR interval segments, respectively. Our end-to-end system can help clinicians to detect CHF using short-term assessment of the heartbeat. It can be installed in healthcare applications to monitor the status of human heart.
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89
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Lindmark K, Boman K, Olofsson M, Törnblom M, Levine A, Castelo-Branco A, Schlienger R, Bruce Wirta S, Stålhammar J, Wikström G. Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clin Epidemiol 2019; 11:231-244. [PMID: 30962724 PMCID: PMC6435223 DOI: 10.2147/clep.s170873] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden. Methods Adults with incident HF (≥2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005-2013) and electronic medical records (cohort 2, 2010-2015; primary/secondary care patients from Uppsala and Västerbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed. Results Baseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged ≥85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06-1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02-1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997-2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time). Conclusion The annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine and Heart Centre, Umeå University Hospital, Umeå, Sweden,
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Aaron Levine
- Real-World & Analytics Solutions, IQVIA, Solna, Sweden
| | | | - Raymond Schlienger
- Quantitative Safety & Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | - Sara Bruce Wirta
- Global RWE Cardio-Metabolics, Novartis Sweden AB, Stockholm, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Gerhard Wikström
- Department for Medical Sciences, Uppsala University, Uppsala, Sweden
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90
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Moshki M, Khajavi A, Hashemizadeh H, Vakilian F, Minaee S, Martin SS. Dark or Bright Half of the Moon: A Qualitative Study Exploring the Experience of Iranian Heart Failure Patients Regarding their Quality of Life. Open Access Maced J Med Sci 2019; 7:824-830. [PMID: 30962847 PMCID: PMC6447335 DOI: 10.3889/oamjms.2019.189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major public health problem in different societies and has numerous impacts on quality of life (QOL). AIM The present study was carried out with the aim to explore the experience of HF patients regarding the negative effects of the disease on their QOL. METHODS In this qualitative exploratory study data collection was performed through face-to-face, semi-structured, in-depth interviews with 19 patients with HF, who were selected through purposive sampling method from April to September 2017. Data analysis was carried out based on the framework analysis method. RESULTS The negative consequences of HF on QOL emerged in the form of 6 main themes including symptoms, disease complications, cognitive impairment, psychological distress, functional limitations and economic problems. Most of the participants (14 out of 19) assessed their QOL as well or very well. CONCLUSION The majority of the patients in this study, despite the many negative impacts of HF, had a high QOL that could indicate their satisfaction and effective coping with HF by creating a positive outlook and the perceived positive effects of the disease.
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Affiliation(s)
- Mahdi Moshki
- Department of Health Education and Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Abdoljavad Khajavi
- Department of Community Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Haydeh Hashemizadeh
- PhD Candidate of Health Promotion, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Farveh Vakilian
- Department of Cardiology, Fellowship in Heart Failure and Transplantation, Preventive Atherosclerotic Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Minaee
- Fellowship in Heart Failure and Transplantation, Department of Cardiovascular Diseases, Razavi Hospital, Mashhad, Iran
| | - Shadi S Martin
- Hartford Foundation Scholar, University of Nevada, School of Social Work
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91
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Goff DC, Buxton DB, Pearson GD, Wei GS, Gosselin TE, Addou EA, Stoney CM, Desvigne-Nickens P, Srinivas PR, Galis ZS, Pratt C, Kit KBK, Maric-Bilkan C, Nicastro HL, Wong RP, Sachdev V, Chen J, Fine L. Implementing the National Heart, Lung, and Blood Institute's Strategic Vision in the Division of Cardiovascular Sciences. Circ Res 2019; 124:491-497. [PMID: 31031412 PMCID: PMC6481301 DOI: 10.1161/circresaha.118.314338] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As we commemorate the 70th Anniversary of the National Heart, Lung, and Blood Institute (NHLBI) and celebrate important milestones that have been achieved by the Division of Cardiovascular Sciences (DCVS), it is imperative that DCVS and the Extramural Research community at-large continue to address critical public health challenges that persist within the area of Cardiovascular Diseases (CVD). The NHLBI's Strategic Vision, developed with extensive input from the extramural research community and published in 2016, included overarching goals and strategic objectives that serve to provide a general blueprint for sustaining the legacy of the Institute by leveraging opportunities in emerging scientific areas (e.g., regenerative medicine, omics technology, data science, precision medicine, and mobile health), finding new ways to address enduring challenges (e.g., social determinants of health, health inequities, prevention, and health promotion), and training the next generation of heart, lung, blood, and sleep researchers. DCVS has developed a strategic vision implementation plan to provide a cardiovascular framing for the pursuit of the Institute's overarching goals and strategic objectives garnered from the input of the broader NHLBI community. This plan highlights six scientific focus areas that demonstrate a cross-cutting and multifaceted approach to addressing cardiovascular sciences, including 1) addressing social determinants of cardiovascular health (CVH) and health inequities, 2) enhancing resilience, 3) promoting CVH and preventing CVD Across the lifespan, 4) eliminating hypertension-related CVD, 5) reducing the burden of heart failure, and 6) preventing vascular dementia. These priorities will guide our efforts in Institute-driven activities in the coming years but will not exclude development of other novel ideas or the support of investigator-initiated grant awards. The DCVS Strategic Vision implementation plan is a living document that will evolve with iterative dialogue with the NHLBI community and adapt as the dynamic scientific landscape changes to seize emerging opportunities.
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Affiliation(s)
- David C Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Denis B Buxton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Gina S Wei
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Teri E Gosselin
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Ebyan A Addou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Catherine M Stoney
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Pothur R Srinivas
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Zorina S Galis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Kit Brian K Kit
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Christine Maric-Bilkan
- Currently with the Division of Urology, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 6707 Democracy Boulevard, Bethesda MD 20892
| | - Holly L Nicastro
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Renee P Wong
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Vandana Sachdev
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Jue Chen
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Lawrence Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
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Gernhofer YK, Braun OO, Brambatti M, Bui QM, Silva Enciso J, Greenberg BH, Adler E, Pretorius V. Which advanced heart failure therapy strategy is optimal for patients over 60 years old? THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:251-258. [DOI: 10.23736/s0021-9509.18.10593-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Jackson SL, Tong X, King RJ, Loustalot F, Hong Y, Ritchey MD. National Burden of Heart Failure Events in the United States, 2006 to 2014. Circ Heart Fail 2018; 11:e004873. [PMID: 30562099 PMCID: PMC6424109 DOI: 10.1161/circheartfailure.117.004873] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/19/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Heart failure (HF)-a serious and costly condition-is increasingly prevalent. We estimated the US burden including emergency department (ED) visits, inpatient hospitalizations and associated costs, and mortality. METHODS AND RESULTS We analyzed 2006 to 2014 data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample, the Healthcare Cost and Utilization Project National (nationwide) Inpatient Sample, and the National Vital Statistics System. International Classification of Disease codes identified HF and comorbidities. Burden was estimated separately for ED visits, hospitalizations, and mortality. In addition, criteria were applied to identify total unique acute events. Rates of primary HF (primary diagnosis or underlying cause of death) and comorbid HF (comorbid diagnosis or contributing cause of death) were calculated, age standardized to the 2010 US population. In 2014, there were an estimated 1 068 412 ED visits, 978 135 hospitalizations, and 83 705 deaths with primary HF. There were 4 071 546 ED visits, 3 370 856 hospitalizations, and 230 963 deaths with comorbid HF. Between 2006 and 2014, the total unique acute event rate for primary HF declined from 536 to 449 per 100 000 (relative percent change of -16%; P for trend, <0.001) but increased for comorbid HF from 1467 to 1689 per 100 000 (relative percentage change, 15%; P for trend, <0.001). HF-related mortality decreased significantly from 2006 to 2009 but did not change meaningfully after 2009. For hospitalizations with primary HF, the estimated mean cost was $11 552 in 2014, totaling an estimated $11 billion. CONCLUSIONS Given substantial healthcare and mortality burden of HF, rising healthcare costs, and the aging US population, continued improvements in HF prevention, management, and surveillance are important.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Raymond J King
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
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Wagenaar KP, Broekhuizen BDL, Jaarsma T, Kok I, Mosterd A, Willems FF, Linssen GCM, Agema WRP, Anneveldt S, Lucas CMHB, Mannaerts HFJ, Wajon EMCJ, Dickstein K, Cramer MJ, Landman MAJ, Hoes AW, Rutten FH. Effectiveness of the European Society of Cardiology/Heart Failure Association website 'heartfailurematters.org' and an e-health adjusted care pathway in patients with stable heart failure: results of the 'e-Vita HF' randomized controlled trial. Eur J Heart Fail 2018; 21:238-246. [PMID: 30485612 PMCID: PMC6607483 DOI: 10.1002/ejhf.1354] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/18/2018] [Accepted: 10/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Efficient incorporation of e‐health in patients with heart failure (HF) may enhance health care efficiency and patient empowerment. We aimed to assess the effect on self‐care of (i) the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters.org’ on top of usual care, and (ii) an e‐health adjusted care pathway leaving out ‘in person’ routine HF nurse consultations in stable HF patients. Methods and results In a three‐group parallel‐randomized trial in stable HF patients from nine Dutch outpatient clinics, we compared two interventions (
heartfailurematters.org website and an e‐health adjusted care pathway) to usual care. The primary outcome was self‐care measured with the European Heart Failure Self‐care Behaviour Scale. Secondary outcomes were health status, mortality, and hospitalizations. In total, 450 patients were included. The mean age was 66.8 ± 11.0 years, 74.2% were male, and 78.8% classified themselves as New York Heart Association I or II at baseline. After 3 months of follow‐up, the mean score on the self‐care scale was significantly higher in the groups using the website and the adjusted care pathway compared to usual care (73.5 vs. 70.8, 95% confidence interval 0.6–6.2; and 78.2 vs. 70.8, 95% confidence interval 3.8– 9.4, respectively). The effect attenuated, until no differences after 1 year between the groups. Quality of life showed a similar pattern. Other secondary outcomes did not clearly differ between the groups. Conclusions Both the heartfailurematters.org website and an e‐health adjusted care pathway improved self‐care in HF patients on the short term, but not on the long term. Continuous updating of e‐health facilities could be helpful to sustain effects. Clinical Trial registration: ClinicalTrials.gov ID NCT01755988.
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Affiliation(s)
- Kim P Wagenaar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Berna D L Broekhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Ilse Kok
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Kenneth Dickstein
- Stavanger University Hospital, University of Bergen, Stavanger, Norway
| | - Maarten J Cramer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marcel A J Landman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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Sokolska JM, Sokolski M, Zymliński R, Biegus J, Siwołowski P, Nawrocka‐Millward S, Jankowska EA, Todd J, Banasiak W, Ponikowski P. Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications. ESC Heart Fail 2018; 6:16-26. [PMID: 30426729 PMCID: PMC6351893 DOI: 10.1002/ehf2.12371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/21/2022] Open
Abstract
Aims Despite attempts to improve the management of patients with acute heart failure (HF), virtually all therapeutic agents investigated in large clinical trials failed to show any consistent reduction in mortality and morbidity. Complexity of the clinical syndrome of acute HF seems to be likely an underlying explanation. Traditionally, clinical trials studied mixed patient populations with acute HF, and only recently, better clinical characterization of patients has been proposed. Dyspnoea is the most common presenting symptom related to hospital admission for acute HF. Whether in patients with acute HF, the pattern of symptoms onset preceding hospital admission is associated with clinical characteristics, and the outcomes have not yet been established. Methods and results We investigated 137 patients (mean age: 65 ± 13 years; 80% men) hospitalized due to acute HF with dyspnoea as major reported symptom, who were divided according to the time of its onset into those with acute (n = 98) vs. subacute (n = 39) onset (i.e. within 7 days vs. >7 days preceding hospital admission, respectively). On admission, the former group presented higher blood pressure (138 ± 33 vs. 121 ± 32 mmHg), more often moderate–severe pulmonary congestion (33 vs. 8%), and lower bilirubin level [1.07 (0.72–1.60) vs. 1.27 (0.87–2.06); P < 0.05 in all comparisons]. There were no other differences in baseline clinical characteristics and laboratory indices. Higher percentage of patients with an acute dyspnoea onset reported marked/moderate dyspnoea relief after 6 (18% vs. 7%), 24 (59% vs. 24%), and 48 h (80% vs. 46% assessed as an improvement of at least 5 points in self‐reported 10‐point Likert scale; P < 0.05 in all time points). In patients with an acute onset of dyspnoea after 48 h, a decrease of N‐terminal pro BNP was more frequently observed (83% vs. 65%), and the levels of endothelin‐1 were more reduced [−1.1 (−2.9–0.03) vs 0.4 (−2.2–1.4); all P < 0.05]. Patients with acute onset experienced less in‐hospital HF worsening (13% vs. 40%, P = 0.001), and 1 year cardiovascular mortality was significantly lower (20% vs. 41%, P = 0.01). On the multivariable analysis, subacute pattern of dyspnoea was independent predictor of 12 month cardiovascular mortality in patients with acute HF after adjusting for other prognostic factors: systolic blood pressure, urea, and HF de novo [hazard ratio (95% confidence interval): 2.32 (1.13–4.75), P = 0.02]. Conclusions In patients with acute HF, the pattern of symptoms onset is associated with baseline differences in clinical characteristics, biomarker profile, response to standard treatment, and the long‐term outcomes. This is relevant information for planning future clinical trials.
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Affiliation(s)
- Justyna Maria Sokolska
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Mateusz Sokolski
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Robert Zymliński
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Jan Biegus
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Paweł Siwołowski
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | | | - Ewa Anita Jankowska
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
| | - John Todd
- Singulex, California Inc.AlamedaCAUSA
| | - Waldemar Banasiak
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Piotr Ponikowski
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
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96
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Taiwo AA, Khush KK, Stedman MR, Zheng Y, Tan JC. Longitudinal changes in kidney function following heart transplantation: Stanford experience. Clin Transplant 2018; 32:e13414. [PMID: 30240515 PMCID: PMC6265058 DOI: 10.1111/ctr.13414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/08/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
Many heart transplant recipients experience declining kidney function following transplantation. We aimed to quantify change in kidney function in heart transplant recipients stratified by pre-transplant kidney function. A total of 230 adult heart transplant recipients between May 1, 2008, and December 31, 2014, were evaluated for up to 5 years post-transplant (median 1 year). Using 19 398 total estimated glomerular filtration rate (eGFR) assessments, we evaluated trends in eGFR in recipients with normal/near-normal (eGFR ≥45 mL/min/1.73 m2 ) vs impaired (eGFR <45 mL/min/1.73 m2 ) kidney function and the likelihood of reaching an eGFR of 20 mL/min/1.73 m2 after heart transplant. Baseline characteristics were similar. Immediately following heart transplant, the impaired pre-transplant kidney function group showed a mean eGFR gain of 9.5 mL/min/1.73 m2 (n = 193) vs a mean decline of 4.9 mL/min/1.73 m2 (n = 37) in the normal/near-normal group. Subsequent rates of eGFR decline were 2.2 mL/min/1.73 m2 /y vs 2.9 mL/min/1.73 m2 /y, respectively. The probability of reaching an eGFR of 20 mL/min/1.73 m2 or less at 1, 5, and 10 years following heart transplant was 1%, 4%, and 30% in the impaired group, and <1%, <1%, and 10% in the normal/near-normal group. Estimates of expected recovery in kidney function and its decline over time will help inform decision making about kidney care after heart transplantation.
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Affiliation(s)
- Adetokunbo A Taiwo
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Hospital & Clinics, Palo Alto, California
| | - Margaret R Stedman
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Yuanchao Zheng
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Jane C Tan
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
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97
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Werner RA, Chen X, Rowe SP, Lapa C, Javadi MS, Higuchi T. Moving into the next era of PET myocardial perfusion imaging: introduction of novel 18F-labeled tracers. Int J Cardiovasc Imaging 2018; 35:569-577. [PMID: 30334228 PMCID: PMC6454078 DOI: 10.1007/s10554-018-1469-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/12/2018] [Indexed: 01/15/2023]
Abstract
The heart failure epidemic continues to rise with coronary artery disease as one of its main causes. Novel concepts for risk stratification to guide the referring cardiologist towards revascularization procedures are of significant value. Myocardial perfusion imaging using single-photon emission computed tomography (SPECT) agents has demonstrated high accuracy for the detection of clinically relevant stenoses. With positron emission tomography (PET) becoming more widely available, mainly due to its diagnostic performance in oncology, perfusion imaging with that modality is more practical than in the past and overcomes existing limitations of SPECT MPI. Advantages of PET include more reliable quantification of absolute myocardial blood flow, the routine use of computed tomography for attenuation correction, a higher spatiotemporal resolution and a higher count sensitivity. Current PET radiotracers such as rubidium-82 (half-life, 76 s), oxygen-15 water (2 min) or nitrogen-13 ammonia (10 min) are labeled with radionuclides with very short half-lives, necessitating that stress imaging is performed under pharmacological vasodilator stress instead of exercise testing. However, with the introduction of novel 18F-labeled MPI PET radiotracers (half-life, 110 min), the intrinsic advantages of PET can be combined with exercise testing. Additional advantages of those radiotracers include, but are not limited to: potentially improved cost-effectiveness due to the use of pre-existing delivery systems and superior imaging qualities, mainly due to the shortest positron range among available PET MPI probes. In the present review, widely used PET MPI radiotracers will be reviewed and potential novel 18F-labeled perfusion radiotracers will be discussed.
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Affiliation(s)
- Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany.,Comprehensive Heart Failure Center, University of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - Xinyu Chen
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany.,Comprehensive Heart Failure Center, University of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - Steven P Rowe
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Constantin Lapa
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Mehrbod S Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany. .,Comprehensive Heart Failure Center, University of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. .,Department of Biomedical Imaging, National Cardiovascular and Cerebral Center, Suita, Japan.
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98
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Kalmanovich E, Audurier Y, Akodad M, Mourad M, Battistella P, Agullo A, Gaudard P, Colson P, Rouviere P, Albat B, Ricci JE, Roubille F. Management of advanced heart failure: a review. Expert Rev Cardiovasc Ther 2018; 16:775-794. [PMID: 30282492 DOI: 10.1080/14779072.2018.1530112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Heart failure (HF) has become a global pandemic. Despite recent developments in both medical and device treatments, HF incidences continues to increase. The current definition of HF restricts itself to stages at which clinical symptoms are apparent. In advanced heart failure (AdHF), it is universally accepted that all patients are refractory to traditional therapies. As the number of HF patients increase, so does the need for additional treatments, with an increased proportion of patients requiring advanced therapies. Areas covered: This review discusses extensive evidence for the effect of medical treatment on HF, although the data on the effect on AdHF is scare. Authors review the relevant literature for treating AdHF patients. Furthermore, mechanical circulatory devices (MCD) have emerged as an alternative to heart transplantation and have been shown to enhance quality of life and reduce mortality therefore authors also review the current literature on the different MCD and technologies. Expert commentary: More patients will need advanced therapies, as the access to heart transplantation is limited by the number of available donors. AdHF patients should be identified timely since the window of opportunities for advanced therapy is narrow as their morbidity is progressive and survival is often short.
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Affiliation(s)
- Eran Kalmanovich
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Yohan Audurier
- b Pharmacy Department , University Hospital of Montpellier , Montpellier , France
| | - Mariama Akodad
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Marc Mourad
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Pascal Battistella
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Audrey Agullo
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Philippe Gaudard
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Pascal Colson
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Philippe Rouviere
- e Department of Cardiovascular Surgery , University Hospital of Montpellier, University of Montpellier , Montpellier , France
| | - Bernard Albat
- e Department of Cardiovascular Surgery , University Hospital of Montpellier, University of Montpellier , Montpellier , France
| | - Jean-Etienne Ricci
- f Department of Cardiology , Nîmes University Hospital, University of Montpellier , Nîmes , France
| | - François Roubille
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
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99
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Yu C, Wang W, Jin X. Hirudin Protects Ang II-Induced Myocardial Fibroblasts Fibrosis by Inhibiting the Extracellular Signal-Regulated Kinase1/2 (ERK1/2) Pathway. Med Sci Monit 2018; 24:6264-6272. [PMID: 30194718 PMCID: PMC6140377 DOI: 10.12659/msm.909044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Myocardial fibrosis is closely related to all types of cardiovascular diseases. Hirudin is widely used in the prevention and treatment of cardiovascular diseases and cancers. In this study, we examined the potential role(s) and mechanism of hirudin in angiotensin II (Ang II)-induced myocardial fibrosis. MATERIAL AND METHODS The viability of myocardial fibroblasts, and reactive oxygen species (ROS) rates were measured respectively using cell counting kit-8 (CCK-8) and flow cytometry. Malondialdehyde (MDA) content, the activities of lactate dehydrogenase (LDH), and superoxide dismutase (SOD) were detected by the respective kits. The mRNA and protein levels of fibrosis-related factors were separately assessed by qRT-PCR and western blot. RESULTS Our data revealed that hirudin suppressed the viability of myocardial fibroblasts, and that it relieved the proliferation induced by Ang II in a dose-dependent manner. We also found that hirudin reduced ROS production, LDH activity, and MDA content; however, it enhanced SOD activity. Moreover, while hirudin significantly downregulated the levels of matrix metalloproteinase-2 (MMP-2), MMP-9, fibronectin (FN), transforming growth factor beta 1 (TGF-β1), collagen-I (COL-I), and COL-III, it upregulated the expression level of tissue inhibitor of metalloproteinases-2 (TIMP-2). Furthermore, phosphorylated extracellular signal-regulated kinase1/2 (p-ERK1/2) was decreased by hirudin, compared to the Ang-II group. CONCLUSIONS Hirudin depressed Ang II-induced myocardial fibroblasts via inhibiting oxidative stress, regulating fibrosis-related factors, and repressing the ERK1/2 pathway.
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Affiliation(s)
- Chunxia Yu
- Department of Cardiology, Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong, China (mainland)
| | - Weimin Wang
- Department of Electrocardiogram, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Xin Jin
- Department of Cardiology, Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong, China (mainland)
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100
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Tsao CW, Lyass A, Enserro D, Larson MG, Ho JE, Kizer JR, Gottdiener JS, Psaty BM, Vasan RS. Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction. JACC. HEART FAILURE 2018; 6:678-685. [PMID: 30007560 PMCID: PMC6076350 DOI: 10.1016/j.jchf.2018.03.006] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to determine temporal trends in the incidence of and mortality associated with heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart rate with preserved ejection fraction [HFpEF]) in the community. BACKGROUND Major shifts in cardiovascular disease risk factor prevalence and advances in therapies may have influenced HF incidence and mortality. METHODS In the FHS (Framingham Heart Study) and CHS (Cardiovascular Health Study), for participants who were ≥60 years of age and free of HF (n = 15,217; 60% women; 2,524 incident HF cases; 115,703 person-years of follow-up), we estimated adjusted incidence rate ratios of HF, HFrEF, and HFpEF from 1990 to 1999 and 2000 to 2009. We compared the cumulative incidence of and mortality associated with HFrEF versus HFpEF within and between decades. RESULTS Across the 2 decades, HF incidence rate ratio was similar (p = 0.13). The incidence rate ratio of HFrEF declined (p = 0.0029), whereas HFpEF increased (p < 0.001). Although HFrEF incidence declined more in men than in women, men had a higher incidence of HFrEF than women in each decade (p < 0.001). The incidence of HFpEF significantly increased over time in both men and women (p < 0.001 and p = 0.02, respectively). During follow-up after HF, 1,701 individuals died (67.4%; HFrEF, n = 557 [33%]; HFpEF, n = 474 [29%]). There were no significant differences in mortality rates (overall, cardiovascular disease, and noncardiovascular disease) across decades within HF subtypes or between HFrEF and HFpEF within decade. CONCLUSIONS In several U.S. community-based samples from 1990 to 2009, we observed divergent trends of decreasing HFrEF and increasing HFpEF incidence, with stable overall HF incidence and high risk for mortality. Our findings highlight the need to elucidate factors contributing to these observations.
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Affiliation(s)
- Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
| | - Asya Lyass
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Danielle Enserro
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts; Roswell Park Cancer Institute, Buffalo, New York
| | - Martin G Larson
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Jennifer E Ho
- Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - John S Gottdiener
- Division of Cardiology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington; Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Cardiology and Preventative Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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