51
|
Rana K, Jay J, Patel S, Sueta C, Deyo Z. A Retrospective Cohort Evaluation of a Pharmacist-Led Approach for Transitioning Patients to an Angiotensin Receptor-Neprilysin Inhibitor. J Pharm Pract 2023; 36:1061-1067. [PMID: 35392695 DOI: 10.1177/08971900221087087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Heart failure guidelines recommend replacing an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) with an angiotensin receptor neprilysin inhibitor (ARNI) to reduce morbidity and mortality in NYHA Class II-III patients with reduced ejection fraction (HFrEF). Objective: This study aims to determine if a pharmacist-led outpatient ARNI replacement and titration program led to more patients achieving target doses of ARNI compared to usual care. Methods: A single health system, retrospective electronic medical record review identified 791 patients with active ARNI prescriptions and at least two outpatient cardiology visits with a pharmacist or usual care provider between January 2015 through September 2018. The primary outcome was the percentage of patients who achieved a target ARNI dose of 97/103 mg twice daily. The secondary outcomes were the median dose achieved, number of visits required to achieve target dose, hospitalizations, and all-cause death. Results: ARNI was initiated and continued by a pharmacist in 64 patients and 727 by usual care. More patients in the pharmacist group, 60.9% (n = 39), achieved target dose vs. 18.0% (n = 131) of patients managed by usual care (95% CI, 0.31-0.55, p < 0.0001). The pharmacist group also had higher median total daily dose of ARNI (200 mg (IQR = 300) vs 100 mg (IQR = 100), p < 0.0001) and more likely to achieve a higher total daily dose in fewer visits. Conclusions: An advanced practice provider pharmacist-led outpatient ARNI replacement and titration program was more effective in achieving target doses of ARNI in HFrEF patients as compared to usual care.
Collapse
Affiliation(s)
- Krishna Rana
- Department of Pharmacy, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jessica Jay
- Virginia Commonwealth University, Richmond, VA, USA
| | - Sonalie Patel
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Carla Sueta
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Zack Deyo
- Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| |
Collapse
|
52
|
Tah S, Valderrama M, Afzal M, Iqbal J, Farooq A, Lak MA, Gostomczyk K, Jami E, Kumar M, Sundaram A, Sharifa M, Arain M. Heart Failure With Preserved Ejection Fraction: An Evolving Understanding. Cureus 2023; 15:e46152. [PMID: 37900404 PMCID: PMC10613100 DOI: 10.7759/cureus.46152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have signs and symptoms of HF due to high left ventricular (LV) filling pressure despite normal or near normal LV ejection fraction. It is more common than HF with reduced ejection fraction (HFrEF), and its diagnosis and treatment are more challenging than HFrEF. Although hypertension is the primary risk factor, coronary artery disease and other comorbidities, such as atrial fibrillation (AF), diabetes, chronic kidney disease (CKD), and obesity, also play an essential role in its formation. This review summarizes current knowledge about HFpEF, its pathophysiology, clinical presentation, diagnostic challenges, current treatments, and promising novel treatments. It is essential to continue to be updated on the latest treatments for HFpEF so that patients always receive the most therapeutic treatments. The use of GnRH agonists in the management of HFpEF, infusion of Apo a-I nanoparticle, low-level transcutaneous vagal stimulation (LLTS), and estrogen only in post-menopausal women are promising strategies to prevent diastolic dysfunction and HFpEF; however, there is still no proven curative treatment for HFpEF yet.
Collapse
Affiliation(s)
- Sunanda Tah
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
- Surgery, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Maham Afzal
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | | | - Aisha Farooq
- Internal Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK
| | | | - Karol Gostomczyk
- Medicine, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, POL
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | | | | | - Mustafa Arain
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
| |
Collapse
|
53
|
Abdeen HA, Helmy ZM, Elnaggar MI, Aldhahi MI, Taha MM, Marques-Sule E, Amin DI, Ibrahim BS, Abdel Aziz A, Castiglione V, Atef H. Different Continuous Training Intensities Improve Echocardiographic Parameters, Quality of Life, and Functional Capacity in Heart Failure Patients with Reduced Ejection Fraction. Int J Gen Med 2023; 16:3933-3945. [PMID: 37670928 PMCID: PMC10475351 DOI: 10.2147/ijgm.s420933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
Background Multiple comorbidities and physiological changes play a role in a range of heart failure conditions and influence the most effective approach to exercise-based rehabilitation. This research aimed to examine and compare the outcomes of continuous training at three different intensities, focusing on left ventricular (LV) remodeling, functional capacity, and quality of life among patients with heart failure with reduced ejection fraction (HFrEF). Methods In this randomized control trial, a total of 60 male patients (average age: 54.33 ±2.35 years) with HFrEF were randomly allocated into three groups: 1) High-intensity continuous training group (HICT), 2) Moderate-intensity continuous training group (MICT), and 3) Low-intensity continuous training group (LICT). All the training was performed on a bicycle ergometer 3 times/week for 12 weeks. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, N-terminal pro-B-type natriuretic peptide (NT-proBNP), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walking test) were assessed before and the end of the study. Results The HICT group demonstrated the greatest improvements in all measured variables when compared to the other two groups (P < 0.05). These findings were consistent across all measured outcomes. Conclusion It was determined that HICT appears to yield the most favorable outcomes in enhancing echocardiographic measures, NT-proBNP levels, quality of life, and functional capacity among HFrEF patients.
Collapse
Affiliation(s)
- Heba A Abdeen
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, 11432, Egypt
| | - Zeinab M Helmy
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, 11432, Egypt
| | - Moustafa I Elnaggar
- Faculty of Physical Therapy, Heliopolis University for Sustainable Development, Giza, Egypt
| | - Monira I Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Mona Mohamed Taha
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Doaa I Amin
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | | | | | - Vincenzo Castiglione
- Fondazione Toscana Gabriele Monasterio; “Health Science” Interdisciplinary Research Center, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Hady Atef
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, 11432, Egypt
- School of Allied Health Professions (SAHP), Keele University, Staffordshire, UK
| |
Collapse
|
54
|
Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 240] [Impact Index Per Article: 240.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | | | | | | | | |
Collapse
|
55
|
Liu XL, Wang GZ, Rui MP, Fan D, Zhang J, Zhu ZH, Perez R, Wang T, Yang LC, Lyu L, Zheng J, Wang G. Imaging characterization of myocardial function, fibrosis, and perfusion in a nonhuman primate model with heart failure-like features. Front Cardiovasc Med 2023; 10:1214249. [PMID: 37663419 PMCID: PMC10471131 DOI: 10.3389/fcvm.2023.1214249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The availability of a human-like chronic heart failure (HF) animal model was critical for affiliating development of novel therapeutic drug treatments. With the close physiology relatedness to humans, the non-human primate (NHP) HF model would be valuable to better understand the pathophysiology and pharmacology of HF. The purpose of this work was to present preliminary cardiac image findings using echocardiography and cardiovascular magnetic resonance (CMR) in a HF-like cynomolgus macaque model. Methods The NHP diet-induced model developed cardiac phenotypes that exhibited diastolic dysfunction with reduced left ventricular ejection fraction (LVEF) or preserved LVEF. Twenty cynomolgus monkeys with cardiac dysfunction were selected by echocardiography and subsequently separated into two groups, LVEF < 65% (termed as HFrEF, n = 10) and LVEF ≥ 65% with diastolic dysfunction (termed as HFpEF, n = 10). Another group of ten healthy monkeys was used as the healthy control. All monkeys underwent a CMR study to measure global longitudinal strain (GLS), myocardial extracellular volume (ECV), and late gadolinium enhancement (LGE). In healthy controls and HFpEF group, quantitative perfusion imaging scans at rest and under dobutamine stress were performed and myocardial perfusion reserve (MPR) was subsequently obtained. Results No LGE was observed in any monkey. Monkeys with HF-like features were significantly older, compared to the healthy control group. There were significant differences among the three groups in ECV (20.79 ± 3.65% in healthy controls; 27.06 ± 3.37% in HFpEF group, and 31.11 ± 4.50% in HFrEFgroup, p < 0.001), as well as for stress perfusion (2.40 ± 0.34 ml/min/g in healthy controls vs. 1.28 ± 0.24 ml/min/g in HFpEF group, p < 0.01) and corresponding MPR (1.83 ± 0.3 vs. 1.35 ± 0.29, p < 0.01). After adjusting for age, ECV (p = 0.01) and MPR (p = 0.048) still showed significant differences among the three groups. Conclusion Our preliminary imaging findings demonstrated cardiac dysfunction, elevated ECV, and/or reduced MPR in this HF-like NHP model. This pilot study laid the foundation for further mechanistic research and the development of a drug testing platform for distinct HF pathophysiology.
Collapse
Affiliation(s)
- Xing-Li Liu
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Guan-Zhong Wang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Mao-Ping Rui
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Dong Fan
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jie Zhang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Zheng-Hua Zhu
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Rosario Perez
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Tony Wang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Li-Chuan Yang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Liang Lyu
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, MO, United States
| | - Gang Wang
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| |
Collapse
|
56
|
Yang HR, Xu XD, Shaikh AS, Zhou BT. Efficacy and Safety of Sacubitril/Valsartan Compared With ACEI/ARB on Health-Related Quality of Life in Heart Failure Patients: A Meta-Analysis. Ann Pharmacother 2023; 57:907-917. [PMID: 36475871 DOI: 10.1177/10600280221140575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Data on the effects of sacubitril/valsartan compared with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) on health-related quality of life (HRQoL) are limited. OBJECTIVE To evaluate the comparative effects between sacubitril/valsartan and ACEI/ARB on HRQoL, a systematic review and meta-analysis were performed. METHODS PubMed, EMBASE, Web of Science, and ClinicalTrials.gov were searched from inception to March 2, 2022 for randomized controlled trials that compared the HRQoL scores, including Kansas City Cardiomyopathy Questionnaire (KCCQ), Minnesota Living with Heart Failure Questionnaire (MLHFQ), or Medical Outcomes Study Short-Form Health Survey 12 or 36 (SF-12/36), between sacubitril/valsartan and ACEI/ARB. After screening, studies that met the inclusion criteria were eventually included and analyzed. RESULTS A total of 8 studies with 17 390 patients (8693 patients used sacubitril/valsartan, and 8697 patients used ACEI/ARB) were included in this study. Five of these studies used KCCQ, 1 used SF-12/36, 1 used MLHFQ, and 1 used both KCCQ and SF-12/36. The KCCQ overall summary score and its subscales were significantly higher in sacubitril/valsartan compared with ACEI/ARB in heart failure patients with reduced ejection fraction, but were similar in heart failure patients with preserved ejection fraction. Sacubitril/valsartan conferred similar HRQoL scores in MLHFQ and SF-12/36 to ACEI/ARB. The most frequently reported adverse event for sacubitril/valsartan is hypotension and the risk is higher than for ACEI/ARB. CONCLUSIONS Sacubitril/valsartan may have the potential to improve HRQoL in heart failure patients with reduced ejection fraction compared with ACEI/ARB. Hypotension is the most common adverse event with sacubitril/valsartan compared with ACEI/ARB. The results of this study may contribute to the rational use of sacubitril/valsartan.
Collapse
Affiliation(s)
- Hua-Rong Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-di Xu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, China
| | - Abdul Sami Shaikh
- Department of Pharmacy, Shah Abdul Latif University, Khairpur, Pakistan
| | - Bo-Ting Zhou
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
57
|
Liu E, Nahid M, Musse M, Chen L, Hilmer SN, Zullo A, Kwak MJ, Lachs M, Levitan EB, Safford MM, Goyal P. Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure. BMC Cardiovasc Disord 2023; 23:372. [PMID: 37495948 PMCID: PMC10373421 DOI: 10.1186/s12872-023-03401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Older adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden. METHODS We used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003-2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003-2017. We determined FRIDs -cardiovascular (CV) and non-cardiovascular (non-CV) medications - at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors. RESULTS Among 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14). CONCLUSIONS FRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls.
Collapse
Affiliation(s)
- Esther Liu
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Mahad Musse
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Ligong Chen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah N Hilmer
- The University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia
| | - Andrew Zullo
- Brown University School of Public Health, Providence, USA
| | | | - Mark Lachs
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | | | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA.
| |
Collapse
|
58
|
Mizoguchi T, Sugiura T, Kawada Y, Yamamoto J, Yokoi M, Nakasuka K, Mori K, Kikuchi S, Ito T, Kitada S, Goto T, Seo Y. Association Between Aortic Stiffness and Exercise Tolerance in Patients at the Risk Stage of Heart Failure. Circ J 2023; 87:1075-1084. [PMID: 36948631 DOI: 10.1253/circj.cj-22-0772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND The number of patients with heart failure (HF) has increased, and it is crucial to prevent the development of HF in patients at risk of HF. The present study aimed to risk stratify patients in Stage A and B HF based on associations between exercise-induced changes in aortic stiffness and exercise tolerance. METHODS AND RESULTS Patients in Stage A and B HF who performed a cardiopulmonary exercise test were enrolled in the study (n=106; median age 65.0 years [interquartile range 52.8-73.0 years]). Exercise tolerance was examined by the percentage of predicted peak oxygen consumption (%V̇O2peak). The ascending aortic pressure waveform was estimated non-invasively. Aortic stiffness was assessed using the augmentation index (AIx) and reflection magnitude (RM). Multivariable regression analysis showed that AIx measured both before and after exercise was significantly associated with %V̇O2peak (β=-0.221 [P=0.049] and β=-0.342 [P=0.003], respectively). When participants were divided into %V̇O2peak subgroups using a cut-off value of 60%, RM decreased immediately after exercise and remained lower 5 min after exercise in the group with preserved exercise tolerance, but recovered to baseline levels 5 min after exercise in the group with reduced exercise tolerance. CONCLUSIONS Exercise-induced increases in aortic stiffness were associated with exercise tolerance in patients at risk of HF, suggesting that exercise-induced changes in aortic stiffness may be useful to stratify high-risk patients.
Collapse
Affiliation(s)
- Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yu Kawada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Kosuke Nakasuka
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Kento Mori
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| |
Collapse
|
59
|
Bogle C, Colan SD, Miyamoto SD, Choudhry S, Baez-Hernandez N, Brickler MM, Feingold B, Lal AK, Lee TM, Canter CE, Lipshultz SE. Treatment Strategies for Cardiomyopathy in Children: A Scientific Statement From the American Heart Association. Circulation 2023; 148:174-195. [PMID: 37288568 DOI: 10.1161/cir.0000000000001151] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This scientific statement from the American Heart Association focuses on treatment strategies and modalities for cardiomyopathy (heart muscle disease) in children and serves as a companion scientific statement for the recent statement on the classification and diagnosis of cardiomyopathy in children. We propose that the foundation of treatment of pediatric cardiomyopathies is based on these principles applied as personalized therapy for children with cardiomyopathy: (1) identification of the specific cardiac pathophysiology; (2) determination of the root cause of the cardiomyopathy so that, if applicable, cause-specific treatment can occur (precision medicine); and (3) application of therapies based on the associated clinical milieu of the patient. These clinical milieus include patients at risk for developing cardiomyopathy (cardiomyopathy phenotype negative), asymptomatic patients with cardiomyopathy (phenotype positive), patients with symptomatic cardiomyopathy, and patients with end-stage cardiomyopathy. This scientific statement focuses primarily on the most frequent phenotypes, dilated and hypertrophic, that occur in children. Other less frequent cardiomyopathies, including left ventricular noncompaction, restrictive cardiomyopathy, and arrhythmogenic cardiomyopathy, are discussed in less detail. Suggestions are based on previous clinical and investigational experience, extrapolating therapies for cardiomyopathies in adults to children and noting the problems and challenges that have arisen in this experience. These likely underscore the increasingly apparent differences in pathogenesis and even pathophysiology in childhood cardiomyopathies compared with adult disease. These differences will likely affect the utility of some adult therapy strategies. Therefore, special emphasis has been placed on cause-specific therapies in children for prevention and attenuation of their cardiomyopathy in addition to symptomatic treatments. Current investigational strategies and treatments not in wide clinical practice, including future direction for investigational management strategies, trial designs, and collaborative networks, are also discussed because they have the potential to further refine and improve the health and outcomes of children with cardiomyopathy in the future.
Collapse
|
60
|
Jordan ES, Grover PL, Lin J, Starkey CA, Finley EA, Ni H, Hershberger RE. The DCM Project Portal: A direct-to-participant platform of The DCM Research Project. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.22.23291764. [PMID: 37425710 PMCID: PMC10327249 DOI: 10.1101/2023.06.22.23291764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Study Objective To develop a digital platform to conduct family-based, dilated cardiomyopathy (DCM) genetic research. Design Innovative approaches are needed to achieve large family enrollment targets. The DCM Project Portal, a direct-to-participant electronic recruitment, consent, and communication tool, was designed using prior experience with traditional enrollment methods, characteristics and feedback of current participants, and internet access of the US population. Participants DCM patients (probands) and their family members. Results The portal was designed as a self-guided, three module (registration, eligibility, and consent) process with internally created supporting informational and messaging resources integrated throughout. The experience can be tailored to user type and the format adapted with programmatic growth. Characteristics of participants of the recently completed DCM Precision Medicine Study were assessed as an exemplary user population. A majority of the diverse (34% non-Hispanic Black (NHE-B), 9.1% Hispanic; 53.6% female) proband (n=1223) and family members (n=1781) participants aged ≥18 years reported not at all or rarely having problems learning about their health from written information (81%) and a high confidence in completing medical forms (77.2% very much or often confident). A majority of participants across age and race-ethnicity groups reported internet access, with highest rates of no reported access in those ≥77 years, NHE-B, and Hispanic, which reflects patterns similar to rates reported by the US Census Bureau as of 2021. Conclusions Digital enrollment tools offer opportunity to improve access and efficiency. The portal is an example of a digital approach to family-based genetic research.
Collapse
Affiliation(s)
- Elizabeth S Jordan
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Phoenix L Grover
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jay Lin
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Carl A Starkey
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Elizabeth A Finley
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Hanyu Ni
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Ray E Hershberger
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| |
Collapse
|
61
|
Echouffo‐Tcheugui JB, Zhang S, Daya N, McEvoy JW, Tang O, Juraschek SP, Ndumele CE, Coresh J, Christenson RH, Selvin E. NT-proBNP and All-Cause and Cardiovascular Mortality in US Adults: A Prospective Cohort Study. J Am Heart Assoc 2023; 12:e029110. [PMID: 37232235 PMCID: PMC10382006 DOI: 10.1161/jaha.122.029110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 05/27/2023]
Abstract
Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle-aged and older populations, have suggested that NT-proBNP has prognostic value in ambulatory adults. Methods and Results We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT-proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT-proBNP with all-cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self-reported history of CVD). There were 3155 deaths (1009 CVD-related) over a median 17.3 years of follow-up. Among individuals without prior CVD, elevated NT-proBNP (≥75th percentile [81.5 pg/mL] versus <25th percentile [20.5 pg/mL]) was associated with a significantly higher risk of all-cause (hazard ratio [HR], 1.67 [95% CI, 1.39-2.00]) and CVD mortality (HR, 2.87 [95% CI, 1.61-5.11]). Associations of NT-proBNP with all-cause and CVD mortality were generally similar across subgroups defined by age, sex, race and ethnicity, or body mass index (all P interaction >0.05). Conclusions In a representative sample of the US adult population, NT-proBNP was an important independent risk factor for all-cause and CVD mortality. NT-proBNP may be useful for monitoring risk in the general adult population.
Collapse
Affiliation(s)
- Justin B. Echouffo‐Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Sui Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Natalie Daya
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - John W. McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland
| | - Olive Tang
- Johns Hopkins School of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| |
Collapse
|
62
|
Kamel AM, Ismail B, Abdel Hafiz G, Sabry N, Farid S. Total Antioxidant Capacity and Prediabetes Are Associated with Left Ventricular Geometry in Heart-Failure Patients with Reduced Ejection Fraction: A Cross-Sectional Study. Metab Syndr Relat Disord 2023. [PMID: 37220008 DOI: 10.1089/met.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Introduction: Few studies explored the association between total antioxidant capacity (TAC) and left ventricular (LV) geometry in patients with heart failure and reduced ejection fraction (HFrEF). The current study aimed to assess factors associated with LV geometry in HFrEF patients with particular emphasis on oxidative stress and glycemic status. Methods: A cross-sectional study was conducted from July 2021 to September 2022. All consecutive patients with HFrEF who were stabilized on optimal or maximally tolerated heart failure medications were recruited. Patients were classified into tertiles based on TAC and malondialdehyde for correlation with other parameters. Results: TAC was significantly associated with LV geometry (P = 0.01), with higher TAC levels observed in patients with normal LV geometry (0.95 ± 0.08) and concentric hypertrophy (1.01 ± 0.14) than in patients with eccentric hypertrophy (EH) (0.90 ± 0.10). There was a significant positive trend in the association between glycemic state and LV geometry (P = 0.002). TAC showed a statistically significant positive correlation with EF (r = 0.29, P = 0.0064) and a negative correlation with LV internal diameter at end diastole (r = -0.26, P = 0.014), LV mass index (r = -0.25, P = 0.016), and LV mass (r = -0.27, P = 0.009). After adjusting for multiple confounders, prediabetes [odds ratio (OR) = 4.19, P = 0.032] and diabetes (OR = 7.47, P = 0.008) were associated with higher odds of EH than normoglycemic patients. A significant inverse trend was also observed in the association between TAC tertile and the odds of LV geometry (OR = 0.51, P = 0.046). Conclusions: TAC and prediabetes are significantly associated with LV geometry. TAC can be used as an additional marker in HFrEF patients to reflect the severity of the disease. Interventions aimed at managing oxidative stress might be useful in HFrEF patients to reduce oxidative stress and improve LV geometry and quality of life. Trial Registration Number: This study is part of an ongoing randomized clinical trial (ClinicalTrials.gov identifier NCT05177588).
Collapse
Affiliation(s)
- Ahmed M Kamel
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Batool Ismail
- Ministry of Interior, Agouza Police Hospital, Cairo, Egypt
| | | | - Nirmeen Sabry
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Samar Farid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| |
Collapse
|
63
|
Iyngkaran P, Hanna F, Andrew S, Horowitz JD, Battersby M, De Courten MP. Comparison of short and long forms of the Flinders program of chronic disease SELF-management for participants starting SGLT-2 inhibitors for congestive heart failure (SELFMAN-HF): protocol for a prospective, observational study. Front Med (Lausanne) 2023; 10:1059735. [PMID: 37305115 PMCID: PMC10255353 DOI: 10.3389/fmed.2023.1059735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/31/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Congestive heart failure (CHF) causes significant morbidity and mortality. It is an epidemic, and costs are escalating. CHF is a chronic disease whose trajectory includes stable phases, periods of decompensation, and finally palliation. Health services and medical therapies must match the various patient needs. Chronic disease self-management (CDSM) programmes that are patient-focused, identify problems and set actionable goals that appear as a logical, cost-friendly method to navigate patient journeys. There have been challenges in standardising and implementing CHF programmes. Methods and analysis SELFMAN-HF is a prospective, observational study to evaluate the feasibility and validity of the SCRinHF tool, a one-page self-management and readmission risk prediction tool for CHF, with an established, comprehensive CDSM tool. Eligible patients will have CHF with left ventricular ejection fraction <40% and commenced sodium glucose co-transporter-2 inhibitors (SGLT2-i) within 6 months of recruitment. The primary endpoint is the 80% concordance in readmission risk predicted by the SCRinHF tool. The study will recruit >40 patients and is expected to last 18 months. Ethics and dissemination This study has been approved by the St Vincent's ethics committee (approval no. LRR 177/21). All participants will complete a written informed consent prior to enrolment in the study. The study results will be disseminated widely via local and international health conferences and peer-reviewed publications.
Collapse
Affiliation(s)
- Pupalan Iyngkaran
- Heart Failure & Cardiac Imaging, Torrens University, Melbourne, VIC, Australia
- Werribee Mercy Sub School, School of Medicine, University of Notre Dame, Werribee, VIC, Australia
| | - Fahad Hanna
- Public Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Sharon Andrew
- Institute of Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - John David Horowitz
- Basil Hetzel Institute for Translational Health Research, University of Adelaide, Adelaide, SA, Australia
| | - Malcolm Battersby
- Flinders Health and Medical Research Institute, Southern Adelaide Local Health Network Mental Health Service, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | |
Collapse
|
64
|
DeRemer DL, Nguyen NK, Guha A, Ahmad FS, Cooper-DeHoff RM, Pepine CJ, Fradley MG, Gong Y. Racial and Ethnic Differences in Cardiac Surveillance Evaluation of Patients Treated With Anthracycline-Based Chemotherapy. J Am Heart Assoc 2023; 12:e027981. [PMID: 37158063 DOI: 10.1161/jaha.122.027981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background Anthracyclines remain a key treatment for many malignancies but can increase the risk of heart failure or cardiomyopathy. Specific guidelines recommend echocardiography and serum cardiac biomarkers such as BNP (B-type natriuretic peptide) or NT-proBNP (N-terminal proBNP) evaluation before and 6 to 12 months after treatment. Our objective was to evaluate associations between racial and ethnic groups in cardiac surveillance of survivors of cancer after exposure to anthracyclines. Methods and Results Adult patients in the OneFlorida Consortium without prior cardiovascular disease who received at least 2 cycles of anthracyclines were included in the analysis. Multivariable logistic regression was performed to estimate the odds ratios (ORs) and 95% CIs for receiving cardiac surveillance at baseline before anthracycline therapy, 6 months after, and 12 months after anthracycline exposure among different racial and ethnic groups. Among the entire cohort of 5430 patients, 63.4% had a baseline echocardiogram, with 22.3% receiving an echocardiogram at 6 months and 25% at 12 months. Non-Hispanic Black (NHB) patients had a lower likelihood of receiving a baseline echocardiogram than Non-Hispanic White (NHW) patients (OR, 0.75 [95% CI, 0.63-0.88]; P=0.0006) or any baseline cardiac surveillance (OR, 0.76 [95% CI, 0.64-0.89]; P=0.001). Compared with NHW patients, Hispanic patients received significantly less cardiac surveillance at the 6-month (OR, 0.84 [95% CI, 0.72-0.98]; P=0.03) and 12-month (OR, 0.85 [95% CI, 0.74-0.98]; P=0.03) time points, respectively. Conclusions There were significant racial and ethnic differences in cardiac surveillance among survivors of cancer at baseline and following anthracycline-based treatment in NHB and Hispanic cohorts. Health care providers need to be cognizant of these social inequities and initiate efforts to ensure recommended cardiac surveillance occurs following anthracyclines.
Collapse
Affiliation(s)
- David L DeRemer
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy University of Florida Gainesville FL USA
- University of Florida Health Cancer Center Gainesville FL USA
| | - Nam K Nguyen
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy University of Florida Gainesville FL USA
| | - Avirup Guha
- Cardio-Oncology Program, Georgia Cancer Center Medical College of Georgia at Augusta, University Augusta GA USA
| | - Faraz S Ahmad
- Department of Medicine, Division of Cardiology Northwestern Memorial Hospital Chicago IL USA
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine, Department of Medicine University of Florida Gainesville FL USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine University of Florida Gainesville FL USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy University of Florida Gainesville FL USA
- University of Florida Health Cancer Center Gainesville FL USA
| |
Collapse
|
65
|
Mubashir T, Zaki J, Yeong An S, Salas De Armas IA, Liang Y, Markham T, Feng H, Akay MH, Nascimbene A, Akkanti B, Williams GW, Zasso F, Aponte MP, Gregoric ID, Kar B. Does the Type of Chronic Heart Failure Impact In-Hospital Outcomes for Aortic Valve Replacement Procedures? Tex Heart Inst J 2023; 50:493363. [PMID: 37270296 DOI: 10.14503/thij-21-7775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study assessed in-hospital outcomes of patients with chronic systolic, diastolic, or mixed heart failure (HF) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). METHODS The Nationwide Inpatient Sample database was used to identify patients with aortic stenosis and chronic HF who underwent TAVR or SAVR between 2012 and 2015. Propensity score matching and multivariate logistic regression were used to determine outcome risk. RESULTS A cohort of 9,879 patients with systolic (27.2%), diastolic (52.2%), and mixed (20.6%) chronic HF were included. No statistically significant differences in hospital mortality were noted. Overall, patients with diastolic HF had the shortest hospital stays and lowest costs. Compared with patients with diastolic HF, the risk of acute myocardial infarction (TAVR odds ratio [OR], 1.95; 95% CI, 1.20-3.19; P = .008; SAVR OR, 1.38; 95% CI, 0.98-1.95; P = .067) and cardiogenic shock (TAVR OR, 2.15; 95% CI, 1.43-3.23; P < .001; SAVR OR, 1.89; 95% CI, 1.42-2.53; P ≤ .001) was higher in patients with systolic HF, whereas the risk of permanent pacemaker implantation (TAVR OR, 0.58; 95% CI, 0.45-0.76; P < .001; SAVR OR, 0.58; 95% CI, 0.40-0.84; P = .004) was lower following aortic valve procedures. In TAVR, the risk of acute deep vein thrombosis and kidney injury was higher, although not statistically significant, in patients with systolic HF than in those with diastolic HF. CONCLUSION These outcomes suggest that chronic HF types do not incur statistically significant hospital mortality risk in patients undergoing TAVR or SAVR.
Collapse
Affiliation(s)
- Talha Mubashir
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John Zaki
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sin Yeong An
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Ismael A Salas De Armas
- Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Yafen Liang
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Travis Markham
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Han Feng
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Mehmet H Akay
- Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Angelo Nascimbene
- Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Bindu Akkanti
- Department of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - George W Williams
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Fabricio Zasso
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, Toronto, Canada
| | - Maria Patarroyo Aponte
- Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Igor D Gregoric
- Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Biswajit Kar
- Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
66
|
Fudim M, Yazdi D, Egolum U, Haghighat A, Kottam A, Sauer AJ, Shah H, Kumar P, Rakita V, Centen C, Ozonat K, Smith S, DeVore AD. Use of a Cardiac Scale to Predict Heart Failure Events: Design of SCALE-HF 1. Circ Heart Fail 2023; 16:e010012. [PMID: 37192288 DOI: 10.1161/circheartfailure.122.010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/23/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND There is a need for simple, noninvasive solutions to remotely monitor and predict worsening heart failure (HF) events. SCALE-HF 1 (Surveillance and Alert-Based Multiparameter Monitoring to Reduce Worsening Heart Failure Events) is a prospective, multicenter study that will develop and assess the accuracy of the heart function index-a composite algorithm of noninvasive hemodynamic biomarkers from a cardiac scale-in predicting worsening HF events. METHODS Approximately 300 patients with chronic HF and recent decompensation will be enrolled in this observational study for model development. Patients will be encouraged to take daily cardiac scale measurements. RESULTS Approximately 50 HF events, defined as an urgent, unscheduled clinic, emergency department, or hospitalization for worsening HF will be used for model development. The composite index will be developed from hemodynamic biomarkers derived from ECG, ballistocardiogram, and impedance plethysmogram signals measured from the cardiac scale. Biomarkers of interest include weight, peripheral impedance, pulse rate and variability, and estimates of stroke volume, cardiac output, and blood pressure captured through the cardiac scale. The sensitivity, unexplained alert rate, and alerting time of the index in predicting worsening HF events will be evaluated and compared with the performance of simple weight-based rule-of-thumb algorithms (eg, weight increase of 3 lbs in 1 day or 5 lbs in 7 days) that are often used in practice. CONCLUSIONS SCALE-HF 1 is the first study to develop and evaluate the performance of a composite index derived from noninvasive hemodynamic biomarkers measured from a cardiac scale in predicting worsening HF events. Subsequent studies will validate the heart function index and assess its ability to improve patient outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04882449.
Collapse
Affiliation(s)
- Marat Fudim
- Duke Clinical Research Institute (M.F., A.D.D.), Duke University School of Medicine, Durham, NC
- Department of Medicine (M.F., A.D.D.), Duke University School of Medicine, Durham, NC
| | - Daniel Yazdi
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles (D.Y.)
- Bodyport Inc, San Francisco, CA (D.Y., C.C., K.O., S.S.)
| | - Ugochukwu Egolum
- The Heart Center of Northeast Georgia Medical Center, Gainesville (U.E.)
| | - Amir Haghighat
- Cardiovascular Institute of Northwest Florida, Panama City (A.H.)
| | - Anupama Kottam
- Division of Cardiology, Wayne State University, Detroit, MI (A.K.)
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City (A.J.S.)
| | - Hirak Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City (H.S.)
| | - Priya Kumar
- Division of Cardiology, Self Regional Healthcare, Greenwood, SC (P.K.)
| | - Val Rakita
- Section of Advanced Heart Failure and Transplant, Temple Heart and Vascular Institute, Temple University, Philadelphia, PA (V.R.)
| | - Corey Centen
- Bodyport Inc, San Francisco, CA (D.Y., C.C., K.O., S.S.)
| | - Kivanc Ozonat
- Bodyport Inc, San Francisco, CA (D.Y., C.C., K.O., S.S.)
| | - Sarah Smith
- Bodyport Inc, San Francisco, CA (D.Y., C.C., K.O., S.S.)
| | - Adam D DeVore
- Duke Clinical Research Institute (M.F., A.D.D.), Duke University School of Medicine, Durham, NC
- Department of Medicine (M.F., A.D.D.), Duke University School of Medicine, Durham, NC
| |
Collapse
|
67
|
Skogestad J, Albert I, Hougen K, Lothe GB, Lunde M, Eken OS, Veras I, Huynh NTT, Børstad M, Marshall S, Shen X, Louch WE, Robinson EL, Cleveland JC, Ambardekar AV, Schwisow JA, Jonas E, Calejo AI, Morth JP, Taskén K, Melleby AO, Lunde PK, Sjaastad I, Carlson CR, Aronsen JM. Disruption of Phosphodiesterase 3A Binding to SERCA2 Increases SERCA2 Activity and Reduces Mortality in Mice With Chronic Heart Failure. Circulation 2023; 147:1221-1236. [PMID: 36876489 DOI: 10.1161/circulationaha.121.054168] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Increasing SERCA2 (sarco[endo]-plasmic reticulum Ca2+ ATPase 2) activity is suggested to be beneficial in chronic heart failure, but no selective SERCA2-activating drugs are available. PDE3A (phosphodiesterase 3A) is proposed to be present in the SERCA2 interactome and limit SERCA2 activity. Disruption of PDE3A from SERCA2 might thus be a strategy to develop SERCA2 activators. METHODS Confocal microscopy, 2-color direct stochastic optical reconstruction microscopy, proximity ligation assays, immunoprecipitations, peptide arrays, and surface plasmon resonance were used to investigate colocalization between SERCA2 and PDE3A in cardiomyocytes, map the SERCA2/PDE3A interaction sites, and optimize disruptor peptides that release PDE3A from SERCA2. Functional experiments assessing the effect of PDE3A-binding to SERCA2 were performed in cardiomyocytes and HEK293 vesicles. The effect of SERCA2/PDE3A disruption by the disruptor peptide OptF (optimized peptide F) on cardiac mortality and function was evaluated during 20 weeks in 2 consecutive randomized, blinded, and controlled preclinical trials in a total of 148 mice injected with recombinant adeno-associated virus 9 (rAAV9)-OptF, rAAV9-control (Ctrl), or PBS, before undergoing aortic banding (AB) or sham surgery and subsequent phenotyping with serial echocardiography, cardiac magnetic resonance imaging, histology, and functional and molecular assays. RESULTS PDE3A colocalized with SERCA2 in human nonfailing, human failing, and rodent myocardium. Amino acids 277-402 of PDE3A bound directly to amino acids 169-216 within the actuator domain of SERCA2. Disruption of PDE3A from SERCA2 increased SERCA2 activity in normal and failing cardiomyocytes. SERCA2/PDE3A disruptor peptides increased SERCA2 activity also in the presence of protein kinase A inhibitors and in phospholamban-deficient mice, and had no effect in mice with cardiomyocyte-specific inactivation of SERCA2. Cotransfection of PDE3A reduced SERCA2 activity in HEK293 vesicles. Treatment with rAAV9-OptF reduced cardiac mortality compared with rAAV9-Ctrl (hazard ratio, 0.26 [95% CI, 0.11 to 0.63]) and PBS (hazard ratio, 0.28 [95% CI, 0.09 to 0.90]) 20 weeks after AB. Mice injected with rAAV9-OptF had improved contractility and no difference in cardiac remodeling compared with rAAV9-Ctrl after aortic banding. CONCLUSIONS Our results suggest that PDE3A regulates SERCA2 activity through direct binding, independently of the catalytic activity of PDE3A. Targeting the SERCA2/PDE3A interaction prevented cardiac mortality after AB, most likely by improving cardiac contractility.
Collapse
Affiliation(s)
- Jonas Skogestad
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Ingrid Albert
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Karina Hougen
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Gustav B Lothe
- Department of Pharmacology, Oslo University Hospital, Norway (G.B.L.)
- Bjørknes College, Oslo, Norway (G.B.L., J.M.A.)
| | - Marianne Lunde
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Olav Søvik Eken
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
- Department of Molecular Medicine, University of Oslo, Norway (O.S.E., I.V., N.T.T.-H., A.O.M., J.M.A.)
| | - Ioanni Veras
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
- Department of Molecular Medicine, University of Oslo, Norway (O.S.E., I.V., N.T.T.-H., A.O.M., J.M.A.)
| | - Ngoc Trang Thi Huynh
- Department of Molecular Medicine, University of Oslo, Norway (O.S.E., I.V., N.T.T.-H., A.O.M., J.M.A.)
| | - Mira Børstad
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Serena Marshall
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Xin Shen
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - William E Louch
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Emma Louise Robinson
- Division of Cardiology, Department of Medicine (E.L.R., A.V.A., J.A.S., E.J.), University of Colorado Anschutz Medical Campus, Aurora
| | - Joseph C Cleveland
- Department of Surgery (J.C.C.), University of Colorado Anschutz Medical Campus, Aurora
| | - Amrut V Ambardekar
- Division of Cardiology, Department of Medicine (E.L.R., A.V.A., J.A.S., E.J.), University of Colorado Anschutz Medical Campus, Aurora
| | - Jessica A Schwisow
- Division of Cardiology, Department of Medicine (E.L.R., A.V.A., J.A.S., E.J.), University of Colorado Anschutz Medical Campus, Aurora
| | - Eric Jonas
- Division of Cardiology, Department of Medicine (E.L.R., A.V.A., J.A.S., E.J.), University of Colorado Anschutz Medical Campus, Aurora
| | - Ana I Calejo
- Centre for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership (A.I.C.C., J.P.M., K.T.), Oslo University Hospital and University of Oslo, Norway
| | - Jens Preben Morth
- Centre for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership (A.I.C.C., J.P.M., K.T.), Oslo University Hospital and University of Oslo, Norway
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby (J.P.M.)
| | - Kjetil Taskén
- Centre for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership (A.I.C.C., J.P.M., K.T.), Oslo University Hospital and University of Oslo, Norway
- Institute for Cancer Research, Oslo University Hospital and Institute for Clinical Medicine, University of Oslo, Norway (K.T.)
| | - Arne Olav Melleby
- Department of Molecular Medicine, University of Oslo, Norway (O.S.E., I.V., N.T.T.-H., A.O.M., J.M.A.)
| | - Per Kristian Lunde
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Cathrine Rein Carlson
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
| | - Jan Magnus Aronsen
- Institute for Experimental Medical Research (J.S., I.A., K.H., M.L., O.S.E., I.V., M.B., S.M., X.S., W.E.L., P.K.L., I.S., C.R.C., J.M.A.), Oslo University Hospital and University of Oslo, Norway
- Bjørknes College, Oslo, Norway (G.B.L., J.M.A.)
- Department of Molecular Medicine, University of Oslo, Norway (O.S.E., I.V., N.T.T.-H., A.O.M., J.M.A.)
| |
Collapse
|
68
|
Ivey-Miranda JB, Rao VS, Cox ZL, Moreno-Villagomez J, Mahoney D, Maulion C, Bellumkonda L, Turner JM, Collins S, Wilson FP, Krumholz HM, Testani JM. In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility. Circ Heart Fail 2023; 16:e010206. [PMID: 36896716 PMCID: PMC10186250 DOI: 10.1161/circheartfailure.122.010206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/12/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Following treatment for acute decompensated heart failure, in-hospital observation on oral diuretics (OOD) is recommended, assuming it provides actionable information on discharge diuretic dosing and thus reduces readmissions. METHODS In the Mechanisms of Diuretic Resistance (MDR) cohort, we analyzed in-hospital measures of diuretic response, provider's decisions, and diuretic response ≈30 days postdischarge. In a Yale multicenter cohort, we assessed if in-hospital OOD was associated with 30-day readmission risk. The main objective of this study was to evaluate the utility of in-hospital OOD. RESULTS Of the 468 patients in the MDR cohort, 57% (N=265) underwent in-hospital OOD. During the OOD, weight change and net fluid balance correlated poorly with each other (r=0.36). Discharge diuretic dosing was similar between patients who had increased, stable, or decreased weight (decreased discharge dose from OOD dose in 77% versus 72% versus 70%, respectively), net fluid status (decreased discharge dose from OOD dose in 100% versus 69% versus 74%, respectively), and urine output (decreased discharge dose from OOD dose in 69% versus 79% versus 72%, respectively) during the 24-hour OOD period (P>0.27 for all). In participants returning at 30 days for formal quantification of outpatient diuretic response (n=98), outpatient and inpatient OOD natriuresis was poorly correlated (r=0.26). In the Yale multicenter cohort (n=18 454 hospitalizations), OOD occurred in 55% and was not associated with 30-day hospital readmission (hazard ratio, 0.98 [95% CI, 0.93-1.05]; P=0.51). CONCLUSIONS In-hospital OOD did not provide actionable information on diuretic response, was not associated with outpatient dose selection, did not predict subsequent outpatient diuretic response, and was not associated with lower readmission rate. Additional research is needed to replicate these findings and understand if these resources could be better allocated elsewhere. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02546583.
Collapse
Affiliation(s)
- Juan B. Ivey-Miranda
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
- Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, México
| | - Veena S. Rao
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Zachary L. Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | - Julieta Moreno-Villagomez
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
- Universidad Nacional Autónoma de México, México City, México
| | - Devin Mahoney
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Christopher Maulion
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Lavanya Bellumkonda
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeffrey M. Turner
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven CT
| | - Sean Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - F. Perry Wilson
- Clinical and translational research accelerator, Yale University School of Medicine, New Haven, CT
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation. Yale-New Haven Hospital, New Haven, CT
| | - Jeffrey M. Testani
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
69
|
Hwang J, Lyu B, Ballew S, Coresh J, Grams ME, Couper D, Lutsey P, Shin JI. The association between socioeconomic status and use of potentially inappropriate medications in older adults. J Am Geriatr Soc 2023; 71:1156-1166. [PMID: 36511705 PMCID: PMC10089965 DOI: 10.1111/jgs.18165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is an important public health problem, particularly among older adults who may need multiple pharmacologic therapies for various chronic conditions. As socioeconomic status (SES) affects the quality of healthcare that individuals receive, SES may be associated with the use of PIM in older adults. This study aimed to determine whether low SES is associated with increased use of PIM. METHODS We studied 4927 participants (aged 66-90 years) who were on at least one medication at visit five (2011-2013) of the Atherosclerosis Risk in Communities Study. We created a cumulative SES score categorized as high (7-9), middle (3-6), and low (0-2) based on education, income, and area deprivation index. We use multivariable logistic regression to examine the associations between SES and use of two or more PIM for older adults, defined by the 2019 Beers Criteria. RESULTS A total of 31.0% and 6.9% of the participants used one or more PIM and two or more PIM, respectively. After adjusting for demographic characteristics and insurance type, low cumulative SES score was associated with significantly greater use of two or more PIM (odds ratio [OR] = 1.83 [95% confidence interval (CI) 1.18-2.86]), as was middle cumulative SES score (OR = 1.40 [95% CI 1.06-1.83]), compared to high cumulative SES score. The results remained significant after further adjusting for comorbidities and medication burden for low cumulative SES score (OR = 1.66 [95%CI 1.02-2.71]). CONCLUSIONS We found that lower SES was associated with greater use of PIM among older adults independent of their medication burden and comorbidities, suggesting socioeconomic disparities in quality of medication management. Focused efforts targeting older adults with low SES to reduce PIM use may be needed to prevent adverse drug events.
Collapse
Affiliation(s)
- Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Beini Lyu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Pamela Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
70
|
Yan T, Zhu S, Yin X, Xie C, Xue J, Zhu M, Weng F, Zhu S, Xiang B, Zhou X, Liu G, Ming Y, Zhu K, Wang C, Guo C. Burden, Trends, and Inequalities of Heart Failure Globally, 1990 to 2019: A Secondary Analysis Based on the Global Burden of Disease 2019 Study. J Am Heart Assoc 2023; 12:e027852. [PMID: 36892088 PMCID: PMC10111559 DOI: 10.1161/jaha.122.027852] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/01/2023] [Indexed: 03/10/2023]
Abstract
Background Heart failure is a public health issue worldwide. However, no comprehensive study on the global burden of heart failure and its contributing causes has been reported. The present study aimed to quantify the burden, trends, and inequalities of heart failure globally. Methods and Results Heart failure data were extracted from the Global Burden of Diseases 2019 study. The number of cases, age-standardized prevalence, and years lived with disability in different locations from 1990 to 2019 were presented and compared. Joinpoint regression analysis was performed to assess trends in heart failure from 1990 to 2019. In 2019, the global age-standardized prevalence and years lived with disability rates for heart failure were 711.90 (95% uncertainty interval [UI], 591.15-858.29) and 63.92 (95% UI, 41.49-91.95) per 100 000 population, respectively. In general, the age-standardized rate decreased globally at an average annual percentage change of 0.3% (95% UI, 0.2-0.3). However, the rate increased at an average annual percentage change of 0.6% (95% UI, 0.4-0.8) from 2017 to 2019. Several nations and territories demonstrated an increased trend from 1990 to 2019, especially in less-developed countries. Ischemic heart disease and hypertensive heart disease accounted for the highest proportion of heart failure in 2019. Conclusions Heart failure remains a major health problem, with increased trends possible in the future. Efforts for prevention and control of heart failure should focus more on less-developed regions. It is essential to prevent and treat primary diseases such as ischemic heart disease and hypertensive heart disease for the control of heart failure.
Collapse
Affiliation(s)
- Tao Yan
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Shijie Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Xiujie Yin
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Changming Xie
- Department of CardiologyThe Eighth Affiliated Hospital, Sun Yat‐sen UniversityShenzhenGuangdongChina
| | - Junqiang Xue
- Department of CardiologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Miao Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Fan Weng
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Shichao Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Bitao Xiang
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Xiaonan Zhou
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Gang Liu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yang Ming
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Kai Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Chunsheng Wang
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Changfa Guo
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| |
Collapse
|
71
|
Piragauta Ardila LA, Echavarría Calderón M, Cardenas Cerón R. Capacidad física de trabajo y composición corporal. REPERTORIO DE MEDICINA Y CIRUGÍA 2023. [DOI: 10.31260/repertmedcir.01217372.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Introducción: la capacidad física de trabajo (CFT) se describe como el conjunto de tareas utilizadas para llevar a cabo las actividades de la vida diaria comparada con individuos sanos; incluye fuerzas de agarre y de abdomen, equilibrio, flexibilidad, velocidad de marcha y capacidad aeróbica. Por eso la CFT y el índice de masa muscular esquelético (IMME) tienen relación entre sí y son susceptibles de mejorar si se realiza entrenamiento físico. Objetivo: determinar si un programa de entrenamiento supervisado y controlado una vez a la semana durante seis meses es efectivo para cambiar la CFT y el IMME en sujetos mayores de 18 años. Métodos: estudio observacional, analítico, de cohorte retrospectiva, de 565 pacientes que asistieron a un programa de entrenamiento supervisado y controlado una vez a la semana durante seis meses. Resultados: hay mejoría de la media de la CFT en -8.59 puntos al finalizar la intervención (P=0.000) y aumento del IMME en -0.06 puntos (P=0.002). Conclusiones: este estudio sugiere que una intervención de una hora guiada y supervisada una vez a la semana durante seis meses brinda beneficios en variables de la CFT con mejoría del IMME, que se explica por cambios en la microestructura muscular (mejoría en la capacidad de realizar un trabajo por unidad de masa muscular).
Collapse
|
72
|
Fernandes J, Costa R, Guerreiro R, Bonifácio D, Rodrigues A, Henriques C, Branco P, Araújo I, Fonseca C. Co-Administration of Albumin and Furosemide in Acute Heart Failure with Diuretics Resistance. ACTA MEDICA PORT 2023; 36:193-201. [PMID: 36762993 DOI: 10.20344/amp.17714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 10/11/2022] [Indexed: 02/11/2023]
Abstract
Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute heart failure are caused by congestive conditions, not all patients have a congestive phenotype, reflecting the complexity of a process with multiple pathophysiological pathways. The use of diuretics, usually loop diuretics, is the mainstay of treatment for congestion. However, many patients develop resistance, thus constituting a challenge with no consensual solution to date, despite extensive debate over the years. Despite its frequent use in clinical practice, the co-administration of albumin and furosemide remains controversial in the management of patients with acute heart failure, hypoalbuminemia, and diuretic resistance. This review addresses the pathophysiological mechanisms of congestion in patients with acute heart failure and explores the theoretical basis that supports the co-administration of albumin and furosemide in this clinical context. It is intended to clarify the potential benefit of the combined approach in this specific population and identify possible gaps in the literature that could be the subject of future studies.
Collapse
Affiliation(s)
- Jorge Fernandes
- Unidade Funcional de Medicina Interna 7.2. Hospital Curry Cabral. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Rita Costa
- Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia..
| | - Renato Guerreiro
- Serviço de Medicina Interna. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Dulce Bonifácio
- Serviço de Medicina Interna. Hospital Distrital de Torres Vedras. Centro Hospitalar do Oeste. Torres Vedras. Portugal
| | - Ana Rodrigues
- Serviço de Medicina Interna. Unidade Local de Saúde do Norte Alentejano. Hospital Santa Luzia de Elvas. Elvas. Portugal
| | - Célia Henriques
- Clínica de Insuficiência Cardíaca. Serviço de Medicina III. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Patrícia Branco
- NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa; Serviço de Nefrologia. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugalm
| | - Inês Araújo
- Clínica de Insuficiência Cardíaca. Serviço de Medicina III. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Cândida Fonseca
- Clínica de Insuficiência Cardíaca. Serviço de Medicina III. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal
| |
Collapse
|
73
|
Daya NR, McEvoy JW, Christenson R, Tang O, Foti K, Juraschek SP, Selvin E, Tcheugui JBE. Prevalence of Elevated NT-proBNP and its Prognostic Value by Blood Pressure Treatment and Control- National Health and Nutrition Examination Survey, 1999-2004. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.20.23286211. [PMID: 36865209 PMCID: PMC9980258 DOI: 10.1101/2023.02.20.23286211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background The prognostic utility of NT-proBNP in the setting of hypertension has not been well-characterized in the general US adult population. Methods We measured NT-proBNP among adults aged 20 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. In adults without a history of cardiovascular disease, we assessed the prevalence of elevated NT-pro-BNP by blood pressure (BP) treatment and control categories. We examined the extent to which NT-proBNP identifies participants at higher risk for mortality across BP treatment and control categories. Results The number of US adults without CVD with elevated NT-proBNP (≥125 pg/ml) was 6.2 million among those with untreated hypertension, 4.6 million among those with treated controlled hypertension, and 5.4 million among those with treated uncontrolled hypertension. After adjusting for age, sex, body mass index, and race/ethnicity, participants with treated controlled hypertension and elevated NT-proBNP had increased risk of all-cause mortality (HR 2.29, 95% CI 1.79, 2.95) and increased risk of cardiovascular mortality (HR 3.83, 95% CI: 2.34, 6.29), compared to those without hypertension and with low levels of NT-proBNP (<125 pg/ml). Among those on antihypertensive medication, those with SBP 130-139 mm Hg and elevated NT-proBNP had increased risk of all-cause mortality, compared to those with SBP<120 mm Hg and low levels of NT-proBNP. Conclusions Among a general population of adults free of cardiovascular disease, NT-proBNP can provide additional prognostic information within and across categories of BP. Measurement of NT-proBNP may have potential for clinical use to optimize hypertension treatment.
Collapse
Affiliation(s)
- Natalie R Daya
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John W McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Olive Tang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Foti
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin B Echouffo Tcheugui
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
74
|
The Efficacy and Safety of a Qiliqiangxin Capsule Combined with Sacubitril/Valsartan in the Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:2701314. [PMID: 36777628 PMCID: PMC9918363 DOI: 10.1155/2023/2701314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/06/2022] [Accepted: 08/20/2022] [Indexed: 02/05/2023]
Abstract
Background Qiliqiangxin (QLQX) capsules are a commonly used proprietary Chinese medicine for the adjuvant treatment of chronic heart failure (CHF) in China. In recent years, several randomized controlled trials (RCTs) have reported on the efficacy and safety of QLQX combined with sacubitril/valsartan for CHF. Objective The purpose of this study was to systematically analyze the clinical efficacy and safety of QLQX combined with sacubitril/valsartan in the management of CHF and to provide clinicians as well as scientists with optimal evidence-based medical evidence. Methods We searched RCTs to evaluate the efficacy and safety of QLQX combined with sacubitril/valsartan in the treatment of CHF in the Wanfang Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, PubMed, Embase, and Cochrane Library databases from their inception until January 8, 2022. RCTs on QLQX in combination with sacubitril/valsartan for CHF were included. The outcome measures considered were total effective rate, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), 6-minute walking distance (6-MWD), and adverse events. The quality of the included RCTs was assessed thereafter using the Cochrane risk of bias tool. RevMan 5.3 software was used to conduct the meta-analysis. Results The meta-analysis included 17 trials involving 1427 CHF patients. The results indicated that with sacubitril/valsartan administration combined with QLQX treatment, the total effective rate (relative risk (RR) = 1.24; 95% confidence interval (CI) (1.17, 1.31); p < 0.01), LVEF (mean difference (MD) = 6.20; 95% CI (5.36, 7.05; p < 0.01)), and 6-MWD (MD = 55.87; 95% CI (40.66, 71.09); p < 0.01) of CHF patients were significantly increased, and the LVEDD value of CHF patients was noted to be significantly reduced (MD = -3.98; 95% CI (-4.47, -3.48); p < 0.01). Moreover, there was no increase in the number of adverse events during treatment (RR = 0.67; 95% CI (0.33, 1.34); p < 0.01). Conclusions This study indicated that in CHF patients, on the basis of sacubitril/valsartan treatment, combination with QLQX can potentially enhance the total effective rate, improve LVEF and 6-MWD, and reduce LVEDD values, with good safety. However, considering the poor quality of the included studies, a multicenter, randomized, double-blind controlled study is needed for further confirmation.
Collapse
|
75
|
Gilstrap L, Cohen A, Ouellet GM, Goyal P, Gladders B, Flint D, Skinner J. The association between beta-blockers and outcomes in patients with heart failure and concurrent Alzheimer's disease and related dementias. J Am Geriatr Soc 2023; 71:404-413. [PMID: 36240493 DOI: 10.1111/jgs.18086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Contemporary patients with heart failure with reduced ejection fraction (HFrEF) are older and have a higher prevalence of cognitive impairment than those studied in trials. The risk/benefit trade-off of routine beta-blocker (BB) use in patients with HFrEF and Alzheimer's disease and related dementias (ADRD) has not been explored. This study aimed to determine the association between BB use and outcomes among patients with HFrEF and ADRD. METHODS Using a random 40% sample of Medicare Parts A, B, and D data we identified patients with ≥1 hospitalization for HFrEF between 2008 and 2018. Each patient was classified based on BB use prior to admission and after discharge. Outcomes include 90-day and 1-year mortality and readmission. RESULTS Between 2008 and 2018, we identified 357,030 patients hospitalized with HFrEF; 12.7% had ADRD. Patients with HFrEF and ADRD had higher 90-day and 1-year mortality compared to patients with HFrEF-only. Among patients admitted on a BB, 60.5% of patients with HFrEF-only were continued on therapy after discharge, compared to 56.8% of patients with HFrEF and ADRD. Discontinuing BB was associated with a 2.2-fold higher risk of 90-day mortality (p < 0.001) among patients with HF-only and a 2.- fold higher risk of 90-day mortality (p < 0.001) among patients with HFrEF + ADRD. Not starting a BB was associated with a 1.8-fold higher risk of 90-day mortality (p < 0.001) among patients with HFrEF-only and a 1.7-fold higher risk of 90-day mortality (p < 0.001) among patients with HFrEF + ADRD. Similar risks were seen at 1 year. CONCLUSIONS BB therapy is associated with significantly lower short and long-term mortality rates among all patients with HFrEF; the magnitude of these associated benefits appear at least as large in patients with HFrEF and ADRD compared to patients with HFrEF-only.
Collapse
Affiliation(s)
- Lauren Gilstrap
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Andrew Cohen
- Section of Geriatrics, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Gregory M Ouellet
- Section of Geriatrics, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Parag Goyal
- Department of Medicine, Weil Cornell Medicine, New York, New York, USA
| | - Barbara Gladders
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, New Hampshire, USA
| | - Danette Flint
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Jonathan Skinner
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA.,Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| |
Collapse
|
76
|
Adekkanattu P, Rasmussen LV, Pacheco JA, Kabariti J, Stone DJ, Yu Y, Jiang G, Luo Y, Brandt PS, Xu Z, Vekaria V, Xu J, Wang F, Benda NC, Peng Y, Goyal P, Ahmad FS, Pathak J. Prediction of left ventricular ejection fraction changes in heart failure patients using machine learning and electronic health records: a multi-site study. Sci Rep 2023; 13:294. [PMID: 36609415 PMCID: PMC9822934 DOI: 10.1038/s41598-023-27493-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Left ventricular ejection fraction (EF) is a key measure in the diagnosis and treatment of heart failure (HF) and many patients experience changes in EF overtime. Large-scale analysis of longitudinal changes in EF using electronic health records (EHRs) is limited. In a multi-site retrospective study using EHR data from three academic medical centers, we investigated longitudinal changes in EF measurements in patients diagnosed with HF. We observed significant variations in baseline characteristics and longitudinal EF change behavior of the HF cohorts from a previous study that is based on HF registry data. Data gathered from this longitudinal study were used to develop multiple machine learning models to predict changes in ejection fraction measurements in HF patients. Across all three sites, we observed higher performance in predicting EF increase over a 1-year duration, with similarly higher performance predicting an EF increase of 30% from baseline compared to lower percentage increases. In predicting EF decrease we found moderate to high performance with low confidence for various models. Among various machine learning models, XGBoost was the best performing model for predicting EF changes. Across the three sites, the XGBoost model had an F1-score of 87.2, 89.9, and 88.6 and AUC of 0.83, 0.87, and 0.90 in predicting a 30% increase in EF, and had an F1-score of 95.0, 90.6, 90.1 and AUC of 0.54, 0.56, 0.68 in predicting a 30% decrease in EF. Among features that contribute to predicting EF changes, baseline ejection fraction measurement, age, gender, and heart diseases were found to be statistically significant.
Collapse
Affiliation(s)
| | - Luke V. Rasmussen
- grid.16753.360000 0001 2299 3507Northwestern University, Chicago, IL USA
| | | | - Joseph Kabariti
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| | - Daniel J. Stone
- grid.66875.3a0000 0004 0459 167XThe Mayo Clinic, Rochester, MN USA
| | - Yue Yu
- grid.66875.3a0000 0004 0459 167XThe Mayo Clinic, Rochester, MN USA
| | - Guoqian Jiang
- grid.66875.3a0000 0004 0459 167XThe Mayo Clinic, Rochester, MN USA
| | - Yuan Luo
- grid.16753.360000 0001 2299 3507Northwestern University, Chicago, IL USA
| | - Pascal S. Brandt
- grid.34477.330000000122986657University of Washington, Seattle, WA USA
| | - Zhenxing Xu
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| | - Veer Vekaria
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| | - Jie Xu
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA ,grid.15276.370000 0004 1936 8091University of Florida, Gainesville, FL USA
| | - Fei Wang
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| | - Natalie C. Benda
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| | - Yifan Peng
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| | - Parag Goyal
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| | - Faraz S. Ahmad
- grid.16753.360000 0001 2299 3507Northwestern University, Chicago, IL USA
| | - Jyotishman Pathak
- grid.5386.8000000041936877XWeill Cornell Medicine, New York City, NY USA
| |
Collapse
|
77
|
Lava SAG, Zollinger C, Chehade H, Schaffner D, Sekarski N, Di Bernardo S. Diuretics in pediatrics. Eur J Pediatr 2023; 182:2077-2088. [PMID: 36595088 DOI: 10.1007/s00431-022-04768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023]
Abstract
UNLABELLED Diuretics are frequently prescribed drugs and help managing several pathological conditions, including acute and chronic kidney disease, nephrotic syndrome, congestive heart failure, ascites, systemic and pulmonary hypertension. Diuretic classes include among others osmotic diuretics and carboanhydrase inhibitors, loop diuretics, thiazides, and potassium-sparing diuretics. In this educational article, we aim at reviewing indications, mechanisms of action, and side effects, as well as basic pharmacokinetics considerations and data on diuretics in children, supporting practicing clinicians in choosing (and understanding the background of) the best-suited diuretic regimen for the individual patient. Newer diuretic classes like vaptans and sodium glucose type 2 cotransporter inhibitors, the recent controversies on hydrochlorothiazide, and the issue of diuretic resistance, will also be briefly addressed. CONCLUSION This educational review offers a didactical overview of diuretics in Pediatrics. WHAT IS KNOWN • Diuretics are frequently prescribed drugs in both adults and children. • They increase water and sodium excretion, reducing fluid overload. WHAT IS NEW • This article reviews indications, mechanisms of action, side effects, and basic pharmacokinetics facts on diuretics in Paediatrics. • It also addresses current issues, like the management of diuretic resistance, the recent controversy on hydrochlorothiazide, and the novel classes vaptans and gliflozins.
Collapse
Affiliation(s)
- Sebastiano A G Lava
- Pediatric Cardiology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. .,Heart Failure and Transplantation, Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK. .,Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | - Chiara Zollinger
- Pediatric Cardiology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hassib Chehade
- Pediatric Nephrology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Damien Schaffner
- Pediatric Cardiology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicole Sekarski
- Pediatric Cardiology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stefano Di Bernardo
- Pediatric Cardiology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
78
|
Abukhalil AD, Al Sheikh T, Muallem S, Al-Shami N, Naseef HA. Prevalence and Safety of Prescribing PPIs with Clopidogrel in Palestine. Patient Prefer Adherence 2023; 17:749-759. [PMID: 36970301 PMCID: PMC10038207 DOI: 10.2147/ppa.s404139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are commonly prescribed medications that are thought to increase the risk of cardiovascular events because they reduce the effectiveness of clopidogrel via shared hepatic pathways. OBJECTIVE This study examined the prevalence of concomitant prescribing of clopidogrel/PPI among patients diagnosed with acute coronary syndrome and the adverse cardiovascular event associated with this interaction. METHODS A retrospective cohort study was conducted by retrieving patient data from the Nat Health Insurance claims processor database in Palestine. Adults diagnosed with Acute Coronary Syndrome (ACS) from 2019 through 2021 who were prescribed clopidogrel or clopidogrel in combination with a PPI were included in the study. Endpoints were adverse cardiac events, including readmission for revascularization during the first year of treatment. RESULTS The study included 443 patients; the prevalence of prescribing concomitant clopidogrel with a PPI was 74.7%, whereas 49.2% were prescribed interacting PPI (omeprazole, esomeprazole, and lansoprazole). 59 (13.3%) of participants experienced a cardiovascular event within 1 year of starting therapy, including 27 (12.4%) patients who had a cardiovascular event while taking an interacting PPI. No significant association was found between PPI administration and increased CV event risk in patients receiving concomitant clopidogrel and PPIs therapy (p = 0.579). CONCLUSION In this study, we observed a high prevalence of prescribing a PPI in combination with clopidogrel, regardless of the FDA recommendations. No significant increase in cardiovascular events was observed in patients receiving concomitant clopidogrel and PPI therapy.
Collapse
Affiliation(s)
- Abdallah Damin Abukhalil
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
- Correspondence: Abdallah Damin Abukhalil; Ni’meh Al-Shami, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine, Tel/Fax +970-2-2982017, Email ;
| | - Tala Al Sheikh
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Sandra Muallem
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Ni’meh Al-Shami
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Hani A Naseef
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| |
Collapse
|
79
|
Cosiano MF, Vista A, Sun JL, Alhanti B, Harrington J, Butler J, Starling RC, Mentz RJ, Greene SJ. Comparing New York Heart Association Class and Patient-Reported Outcomes Among Patients Hospitalized for Heart Failure. Circ Heart Fail 2023; 16:e010107. [PMID: 36314126 DOI: 10.1161/circheartfailure.122.010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Alignment between clinician-reported New York Heart Association (NYHA) class compared and patient-reported outcomes among patients hospitalized for heart failure is unclear. METHODS ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) was a global randomized trial comparing nesiritide versus placebo among patients hospitalized for heart failure, irrespective of ejection fraction. Among patients with complete baseline data for NYHA class and the patient-reported EuroQOL-5 dimensions ([EQ-5D], both utility index and visual analog scale), levels of each scale were mapped across 4 prespecified categories "best" to "worst." Minor and moderate-severe discordance were defined as NYHA class and EQ-5D differing by 1 level and ≥2 levels, respectively. Multivariable models assessed factors independently associated with moderate-severe discordance, and associations between discordance and clinical outcomes. RESULTS Among 5741 patients, concordance, minor discordance, and moderate-severe discordance between NYHA class and EQ-5D utility index occurred in 22%, 40%, and 38% of patients, respectively. For NYHA class and EQ-5D visual analog scale, this categorization occurred in 29%, 48%, and 23%. Discordance was more often due to disproportionately higher EQ-5D score (78% of discordance cases with utility index, and 70% with visual analog scale). NYHA class IV, higher EQ-5D scores, race, and geographic region were among patient factors independently associated with moderate-severe discordance. Magnitude of discordance was not associated with clinical outcomes; however, EQ-5D utility index disproportionately worse than NYHA class was associated with increased 180-day mortality (adjusted hazard ratio 1.27 [95% CI, 1.01-1.60]; P=0.04). CONCLUSIONS In a global trial cohort of patients hospitalized for heart failure, the majority of patients exhibited discordance between clinician-reported NYHA class and patient-reported health status. Multiple patient factors were independently associated with moderate-severe discordance, and patients who perceived their health status as worse than the clinician's perception had higher mortality. Registration: URL: http://www. CLINICALTRIALS gov; Unique identifier: NCT00475852.
Collapse
Affiliation(s)
- Michael F Cosiano
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.F.C., A.V., J.H., R.J.M., S.J.G.)
| | - Andrew Vista
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.F.C., A.V., J.H., R.J.M., S.J.G.)
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, NC (J.-L.S., B.A., R.J.M., S.J.G.)
| | - Brooke Alhanti
- Duke Clinical Research Institute, Durham, NC (J.-L.S., B.A., R.J.M., S.J.G.)
| | - Josephine Harrington
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.F.C., A.V., J.H., R.J.M., S.J.G.)
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B.).,Baylor Scott and White Research Institute, Dallas, TX (J.B.)
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, OH (R.C.S.)
| | - Robert J Mentz
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.F.C., A.V., J.H., R.J.M., S.J.G.).,Duke Clinical Research Institute, Durham, NC (J.-L.S., B.A., R.J.M., S.J.G.)
| | - Stephen J Greene
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.F.C., A.V., J.H., R.J.M., S.J.G.).,Duke Clinical Research Institute, Durham, NC (J.-L.S., B.A., R.J.M., S.J.G.)
| |
Collapse
|
80
|
Bagheri I, Yousefi H, Bahrami M, Shafie D. Quality of Palliative Care Guidelines in Patients with Heart Failure: A Systematic Review of Quality Appraisal using AGREE II Instrument. Indian J Palliat Care 2023; 29:7-14. [PMID: 36846280 PMCID: PMC9943939 DOI: 10.25259/ijpc_46_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives While the principles for developing clinical practice guidelines (CPGs) are well established, the quality of published guidelines is very diverse. The present study was conducted to evaluate the quality of existing CPGs in palliative care for heart failure patients. Material and Methods The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses. A systematic search was conducted in the Excerpta Medica Database, MEDLINE/PubMed, CINAHL databases and Guideline internet sites: National Institute for Clinical Excellence, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, Guidelines International Network and National Health and Medical Research Council for CPGs published through April 2021. Criteria for including CPGs were: Containing palliative measures for patients with heart failure over 18 years old and preferably interprofessional guidelines that focus on only one dimension of palliative care or focus on diagnosis, definition and treatment were excluded from the study. After initial screening, five appraisers rated the quality of the final selection of CPGs using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Results From 1501 records, seven guidelines were selected for analysis. The 'scope and purpose' and 'clarity of presentation' domains obtained the highest mean and 'rigor of development' and 'applicability' domains obtained the lowest mean scores. Three categories of recommendations were: (1) Strongly recommended (guidelines 1, 3, 6 and 7); (2) recommended with modifications (guideline 2) and (3) not recommended (guidelines 4 and 5). Conclusion Clinical guidelines for palliative care in patients with heart failure were of moderate-to-high quality, with the main deficiencies occurring in the rigor of development and applicability domains. The results inform clinicians and guideline developers of the strengths and weaknesses of each CPG. To improve the quality of palliative care CPGs in the future, it is recommended that developers pay detailed attention to all domains of the AGREE II criteria. Funding agent: Isfahan University of Medical Sciences. (IR.MUI.NUREMA.REC.1400.123).
Collapse
Affiliation(s)
- Imane Bagheri
- Department of Adult Health Nursing, College of Nursing and Midwifery, Isfahan, Iran
| | - Hojatollah Yousefi
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Isfahan, Iran
| | - Masoud Bahrami
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Isfahan, Iran
| | - Davood Shafie
- Department of Cardiology, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
81
|
Md MA, Parrott CF, Ph D MJH, Ph D PHB, Md FY, Md BU. Skeletal muscle abnormalities in heart failure with preserved ejection fraction. Heart Fail Rev 2023; 28:157-168. [PMID: 35353269 DOI: 10.1007/s10741-022-10219-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 02/07/2023]
Abstract
Almost half of all heart failure (HF) disease burden is due to HF with preserved ejection fraction (HFpEF). The primary symptom in patients with HFpEF, even when well compensated, is severe exercise intolerance and is associated with their reduced quality of life. Recently, studies showed that HFpEF patients have multiple skeletal muscle (SM) abnormalities, and these are associated with decreased exercise intolerance. The SM abnormalities are likely intrinsic to the HFpEF syndrome, not a secondary consequence of an epiphenomenon. These abnormalities are decreased muscle mass, reduced type I (oxidative) muscle fibers, and reduced type I-to-type II fiber ratio as well as a reduced capillary-to-fiber ratio, abnormal fat infiltration into the thigh SM, increased levels of atrophy genes and proteins, reduction in mitochondrial content, and rapid depletion of high-energy phosphate during exercise with markedly delayed repletion of high-energy phosphate during recovery in mitochondria. In addition, patients with HFpEF have impaired nitric oxide bioavailability, particularly in the microvasculature. These SM abnormalities may be responsible for impaired diffusive oxygen transport and/or impaired SM oxygen extraction. To date, exercise training (ET) and caloric restriction are some of the interventions shown to improve outcomes in HFpEF patients. Improvements in exercise tolerance following aerobic ET are largely mediated through peripheral SM adaptations with minimal change in central hemodynamics and highlight the importance of targeting SM to improve exercise intolerance in HFpEF. Focusing on the abnormalities mentioned above may improve the clinical condition of patients with HFpEF.
Collapse
Affiliation(s)
- Matthew Anderson Md
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA
| | - Clifton Forrest Parrott
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA
| | - Mark J Haykowsky Ph D
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Peter H Brubaker Ph D
- Department of Health and Exercise Science, Wake Forest School of Medicine, Winston-Salem, USA
| | - Fan Ye Md
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA
| | - Bharathi Upadhya Md
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA.
| |
Collapse
|
82
|
Cascino TM, Colvin M, Lanfear DE, Richards B, Khalatbari S, Mann DL, Taddei-Peters WC, Jeffries N, Watkins DC, Stewart GC, Aaronson KD. Racial Inequities in Access to Ventricular Assist Device and Transplant Persist After Consideration for Preferences for Care: A Report From the REVIVAL Study. Circ Heart Fail 2023; 16:e009745. [PMID: 36259388 PMCID: PMC9851944 DOI: 10.1161/circheartfailure.122.009745] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/24/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Racial disparities in access to advanced therapies for heart failure (HF) patients are well documented, although the reasons remain uncertain. We sought to determine the association of race on utilization of ventricular assist device (VAD) and transplant among patients with access to care at VAD centers and if patient preferences impact the effect. METHODS We performed an observational cohort study of ambulatory chronic systolic HF patients with high-risk features and no contraindication to VAD enrolled at 21 VAD centers and followed for 2 years in the REVIVAL study (Registry Evaluation of Vital Information for VADs in Ambulatory Life). We used competing events cause-specific proportional hazard methodology with multiple imputation for missing data. The primary outcomes were (1) VAD/transplant and (2) death. The exposures of interest included race (Black or White), additional demographics, captured social determinants of health, clinician-assessed HF severity, patient-reported quality of life, preference for VAD, and desire for therapies. RESULTS The study included 377 participants, of whom 100 (26.5%) identified as Black. VAD or transplant was performed in 11 (11%) Black and 62 (22%) White participants, although death occurred in 18 (18%) Black and 36 (13%) White participants. Black race was associated with reduced utilization of VAD and transplant (adjusted hazard ratio, 0.45 [95% CI, 0.23-0.85]) without an increase in death. Preferences for VAD or life-sustaining therapies were similar by race and did not explain racial disparities. CONCLUSIONS Among patients receiving care by advanced HF cardiologists at VAD centers, there is less utilization of VAD and transplant for Black patients even after adjusting for HF severity, quality of life, and social determinants of health, despite similar care preferences. This residual inequity may be a consequence of structural racism and discrimination or provider bias impacting decision-making. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01369407.
Collapse
Affiliation(s)
- Thomas M. Cascino
- University of Michigan, Division of Cardiovascular Disease, Ann Arbor, MI
| | - Monica Colvin
- University of Michigan, Division of Cardiovascular Disease, Ann Arbor, MI
| | | | - Blair Richards
- University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI
| | - Shokoufeh Khalatbari
- University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI
| | | | | | - Neal Jeffries
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | | | | | - Keith D. Aaronson
- University of Michigan, Division of Cardiovascular Disease, Ann Arbor, MI
| |
Collapse
|
83
|
Mishra D, Shankar O, Aggarwal V. Varied Presentation of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C): A Case Series. Cureus 2023; 15:e33883. [PMID: 36819412 PMCID: PMC9934937 DOI: 10.7759/cureus.33883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is a genetically predisposed form of cardiomyopathy that mainly affects young individuals resulting in fatal ventricular arrhythmias leading to sudden cardiac death. ARVD has 50% of cases that involve both the right ventricle (RV) and left ventricle (LV), but only a small number of cases involve an isolated left ventricle. In this case series, five patients (four males and one female) with a diagnosis of ARVD presented to our center with varied clinical presentations across a wide range of age groups. The MRI of all five cases showed dilated right atrium (RA)/RV with right ventricular free wall dyskinesia. Two-dimensional (2D) MRI showed aneurysmal outpouching with diffuse free wall enhancement. Automated implantable cardioverter defibrillator (AICD) was implanted uneventfully in all five patients, and the patients were discharged with oral medications such as low-dose diuretics, beta-blockers, spironolactone, angiotensin-converting enzymes (ACE) inhibitors, amiodarone, and anxiolytics. Until now, the patients were doing well on follow-up visits. The therapeutic management of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) has evolved over the years and continues to be an important challenge. To further improve risk stratification and treatment of patients, more information is needed on natural history, long-term prognosis, and risk assessment. Special attention should be focused on the identification of patients who would benefit from implantable cardioverter-defibrillator (ICD) implantation in comparison to pharmacological and other nonpharmacological approaches.
Collapse
Affiliation(s)
- Dhananjay Mishra
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| | - Om Shankar
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| | - Vikas Aggarwal
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| |
Collapse
|
84
|
Umeh CA, Torbela A, Saigal S, Kaur H, Kazourra S, Gupta R, Shah S. Telemonitoring in heart failure patients: Systematic review and meta-analysis of randomized controlled trials. World J Cardiol 2022; 14:640-656. [PMID: 36605424 PMCID: PMC9808028 DOI: 10.4330/wjc.v14.i12.640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Home telemonitoring has been used as a modality to prevent readmission and improve outcomes for patients with heart failure. However, studies have produced conflicting outcomes over the years. AIM To determine the aggregate effect of telemonitoring on all-cause mortality, heart failure-related mortality, all-cause hospitalization, and heart failure-related hospitalization in heart failure patients. METHODS We conducted a systematic review and meta-analysis of 38 home telemonitoring randomized controlled trials involving 14993 patients. We also conducted a sensitivity analysis to examine the effect of telemonitoring duration, recent heart failure hospitalization, and age on telemonitoring outcomes. RESULTS Our study demonstrated that home telemonitoring in heart failure patients was associated with reduced all-cause [relative risk (RR) = 0.83, 95% confidence interval (CI): 0.75-0.92, P = 0.001] and cardiovascular mortality (RR = 0.66, 95%CI: 0.54-0.81, P < 0.001). Additionally, telemonitoring decreased the all-cause hospitalization (RR = 0.87, 95%CI: 0.80-0.94, P = 0.002) but did not decrease heart failure-related hospitalization (RR = 0.88, 95%CI: 0.77-1.01, P = 0.066). However, prolonged home telemonitoring (12 mo or more) was associated with both decreased all-cause and heart failure hospitalization, unlike shorter duration (6 mo or less) telemonitoring. CONCLUSION Home telemonitoring using digital/broadband/satellite/wireless or blue-tooth transmission of physiological data reduces all-cause and cardiovascular mortality in heart failure patients. In addition, prolonged telemonitoring (≥ 12 mo) reduces all-cause and heart failure-related hospitalization. The implication for practice is that hospitals considering telemonitoring to reduce heart failure readmission rates may need to plan for prolonged telemonitoring to see the effect they are looking for.
Collapse
Affiliation(s)
| | - Adrian Torbela
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Shipra Saigal
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Harpreet Kaur
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Shadi Kazourra
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Rahul Gupta
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Shivang Shah
- Department of Cardiology, Loma Linda University School of Medicine, Loma Linda, CA 92350, United States
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA 92507, United States
| |
Collapse
|
85
|
Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia. Int J Chronic Dis 2022; 2022:9673653. [PMID: 36590698 PMCID: PMC9798104 DOI: 10.1155/2022/9673653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/03/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. Purpose To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Methods Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. Results In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56-8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. Conclusion This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.
Collapse
|
86
|
Chaudhry S, DeVore AD, Vidula H, Nassif M, Mudy K, Birati EY, Gong T, Atluri P, Pham D, Sun B, Bansal A, Najjar SS. Left Ventricular Assist Devices: A Primer For the General Cardiologist. J Am Heart Assoc 2022; 11:e027251. [PMID: 36515226 PMCID: PMC9798797 DOI: 10.1161/jaha.122.027251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Durable implantable left ventricular assist devices (LVADs) have been shown to improve survival and quality of life for patients with stage D heart failure. Even though LVADs remain underused overall, the number of patients with heart failure supported with LVADs is steadily increasing. Therefore, general cardiologists will increasingly encounter these patients. In this review, we provide an overview of the field of durable LVADs. We discuss which patients should be referred for consideration of advanced heart failure therapies. We summarize the basic principles of LVAD care, including medical and surgical considerations. We also discuss the common complications associated with LVAD therapy, including bleeding, infections, thrombotic issues, and neurologic events. Our goal is to provide a primer for the general cardiologist in the recognition of patients who could benefit from LVADs and in the principles of managing patients with LVAD. Our hope is to "demystify" LVADs for the general cardiologist.
Collapse
Affiliation(s)
- Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIN,Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIN
| | - Adam D. DeVore
- Department of Medicine and Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Himabindu Vidula
- Division of Heart Failure and TransplantUniversity of Rochester School of Medicine and DentistryRochesterNY
| | - Michael Nassif
- Division of Heart failure and TransplantSaint Luke’s Mid America Heart InstituteKansas CityMO
| | - Karol Mudy
- Division of Cardiothoracic SurgeryMinneapolis Heart InstituteMinneapolisMN
| | - Edo Y. Birati
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and SurgeryPadeh‐Poriya Medical Center, Bar Ilan UniversityPoriyaIsrael
| | - Timothy Gong
- Center for Advanced Heart and Lung DiseaseBaylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical CenterDallasTX
| | - Pavan Atluri
- Division of Cardiovascular SurgeryUniversity of PennsylvaniaPhiladelphiaPA
| | - Duc Pham
- Center for Advanced Heart FailureBluhm Cardiovascular Institute, Northwestern University, Feinberg School of MedicineChicagoIL
| | - Benjamin Sun
- Division of Cardiothoracic Surgery, Abbott Northwestern HospitalMinneapolisMN
| | - Aditya Bansal
- Division of Cardiothoracic Surgery, Department of SurgeryOchsner Clinic FoundationNew OrleansLA
| | - Samer S. Najjar
- Division of Cardiology, MedStar Heart and Vascular InstituteMedstar Medical GroupBaltimoreMD
| | | |
Collapse
|
87
|
Wang B, Lei L, Zhang H, Miao F, Zhang L, Tian A, Li J. Change in Depressive Symptoms During the First Month of Discharge and 1-Year Clinical Outcomes in Patients Hospitalized for Heart Failure. J Am Heart Assoc 2022; 11:e027438. [PMID: 36515248 PMCID: PMC9798811 DOI: 10.1161/jaha.122.027438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The patterns of depressive symptom change during the first month after discharge, as well as their prognostic implications, and predictors of persistent or new-onset depressive symptoms are not well characterized. Methods and Results We included patients hospitalized for heart failure undergoing Patient Health Questionnaire-2 before discharge and at 1 month after discharge in a multicenter prospective cohort. We characterized 4 patterns of change in depressive symptoms-persistent, new-onset, remitted depressive symptoms, and no depressive symptom-and examined the associations between the 4 patterns and 1-year clinical outcomes. We analyzed the factors associated with persistent or new-onset depressive symptoms. A total of 4130 patients were included. Among 1175 (28.5%) symptomatic patients and 2955 (71.5%) symptom-free patients before discharge, 817 (69.5%) had remission, and 366 (12.2%) had new-onset depressive symptoms, respectively. Compared with no depressive symptom, persistent depressive symptoms were associated with an increased risk of cardiovascular death (hazard ratio [HR], 2.10 [95% CI, 1.59-2.79]) and heart failure rehospitalization (HR, 1.56 [95% CI, 1.30-1.87]); new-onset depressive symptoms were associated with an increased risk of cardiovascular death (HR, 1.78 [95%CI, 1.32-2.40]) and heart failure rehospitalization (HR, 1.54 [95% CI, 1.29-1.83]). Remitted depressive symptoms were associated with a slightly increased risk of cardiovascular death but had no significant association with heart failure rehospitalization. Patients who were female or had poor socioeconomic status, stroke history, renal dysfunction, or poor health status had a higher risk of persistent or new-onset depressive symptoms. Conclusions Sex, socioeconomic status, clinical characteristics, and health status help identify patients with high risks of depressive symptoms at 1 month after discharge. Dynamic capture of depressive symptom change during this period informs long-term risk stratifications and targets patients who require psychological interventions and social support to improve clinical outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier (NCT02878811).
Collapse
Affiliation(s)
- Bin Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople’s Republic of China,Fuwai Hospital, Chinese Academy of Medical SciencesShenzhenPeople’s Republic of China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople’s Republic of China
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople’s Republic of China
| | - Fengyu Miao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople’s Republic of China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople’s Republic of China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople’s Republic of China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople’s Republic of China,Fuwai Hospital, Chinese Academy of Medical SciencesShenzhenPeople’s Republic of China,Central China Subcenter of the National Center for Cardiovascular DiseasesZhengzhouPeople’s Republic of China
| |
Collapse
|
88
|
Kyaw MT, Myint T, Lwin TZ. Acute myocarditis in a young male after gastroenteritis: A case report and literature review. Clin Case Rep 2022; 10:e6699. [PMID: 36483859 PMCID: PMC9723471 DOI: 10.1002/ccr3.6699] [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: 10/26/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
A 16-year-old patient presented with acute myocarditis after gastroenteritis. His ECGs showed STEMI-like evolutionary changes. Serial troponin measurement was maximum on 3rd day. Echocardiography showed a mildly reduced ejection fraction (45%). He made an uneventful recovery after appropriate treatment. After one-month follow-up, his ECG and echo returned to normal.
Collapse
Affiliation(s)
- May Thu Kyaw
- Heart and Vascular CenterVictoria HospitalYangonMyanmar
| | - Thein Myint
- Department of MedicineUniversity of Medicine (1)YangonMyanmar
| | - Thant Zaw Lwin
- Department of CardiologyUniversity of Medicine (2)YangonMyanmar
| |
Collapse
|
89
|
Elliott MK, de Vere F, Mehta VS, Wijesuriya N, Strocchi M, Rajani R, Niederer S, Rinaldi CA. Rate or Rhythm Control in CRT (RHYTHMIC): Study rationale and protocol. Heart Rhythm O2 2022; 3:681-687. [PMID: 36589918 PMCID: PMC9795294 DOI: 10.1016/j.hroo.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Atrial fibrillation (AF) has several detrimental effects on heart failure patients treated with cardiac resynchronization therapy (CRT). These include suboptimal biventricular pacing and the loss of atrioventricular (AV) synchrony. AV node ablation improves biventricular pacing and clinical outcomes in large observational studies. However, restoration of sinus rhythm with AF ablation may have additional benefits. Objectives To compare the effects of AV node ablation and AF ablation on echocardiographic and symptomatic outcomes in patients with CRT and suboptimal biventricular pacing. Methods RHYTHMIC is a multicenter prospective randomized controlled trial. Seventy patients will be recruited and randomized to each ablation strategy in a 1:1 ratio. Key inclusion criteria include a previous CRT implant (with atrial lead) for dyssynchronous heart failure, and biventricular pacing <95% secondary to AF. Patients with permanent AF will be excluded. Results Patients will undergo baseline assessment including transthoracic echocardiography (TTE), device check, blood tests, electrocardiogram (ECG), 6-minute walk test, and symptom questionnaire. They will then undergo either AV node ablation or AF ablation according to their allocated group. Follow-up will occur at 1 week (TTE and ECG) and at 6 months (repeat of baseline investigations). The primary endpoint will be change in left ventricular ejection fraction on TTE. Conclusion This is the first randomized controlled trial comparing AV node ablation and AF ablation in patients with CRT. We anticipate it will provide valuable insight into the management of this frequently encountered clinical scenario in a challenging patient cohort.
Collapse
Affiliation(s)
- Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Felicity de Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal S. Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
90
|
Ahmed H, Tadesse A, Alemu H, Abebe A, Tadesse M. Undernutrition was a prevalent clinical problem among older adult patients with heart failure in a hospital setting in Northwest Ethiopia. Front Nutr 2022; 9:962497. [DOI: 10.3389/fnut.2022.962497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
BackgroundUndernutrition is a frequently noticed medical problem in patients with heart failure. It is caused by poor nutrient intake, malabsorption, systemic inflammation, neurohumoral activation, oxidative stress, and hypermetabolic state. Undernutrition results in a decrease in the quality of life and the survival rate in patients with heart failure. There is a paucity of documentation on undernutrition among patients with heart failure in sub-Saharan African countries. The study aimed to determine the magnitude and associated factors of undernutrition among older adult patients with heart failure in the hospital setting in Northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia, between 1 June 2021 and 31 October 2021. A consecutive sampling method was used to recruit 262 study subjects. A Mini-nutritional assessment-full form (MNA-FL) Questionnaire was used to extract nutritional information among patients with heart failure. Patients with heart failure, who scored MNA-FL score <17, were declared to have undernutrition. The data were entered into EPI Info version 4.6.0.0 and then exported to SPSS version 26 for analysis. Explanatory variables associated with undernutrition in patients with heart failure were analyzed by applying a logistic regression model. A P-value of <0.05 was used to declare a significant association.ResultsA total of 262 patients with heart failure were included in the study. The mean age (± SD) of the study subjects was 64.6 (± 9.2) years. Hypertensive heart disease (111/262, 42%) was the most common cause of heart failure. Hypertension was the frequently observed comorbid disease. Based on the MNA-FL score for nutritional status, 75 out of 262 (28.6%, 95% CI: 22.9–34.4%) were undernourished (MNA-FL < 17), while 124 out of 262 (47.3%, CI: 41.5–53.1%) were at risk of undernutrition (MNA-FL = 17–23.5). The remaining 63 out of 262 (24.1%, 95% CI: 18.2–29.8%) study subjects were well nourished (MNA-FL > 24). On a multivariate analysis, patients with severe heart failure (New York Heart Association (NYHA) functional class III/IV) (AOR = 4.287, CI: 2.012–9.134, P-value < 0.001), with a duration of illness of 3–5 years (AOR = 3.225, CI: 1.138–9.137, P-value = 0.028), with a duration of illness of >5 years (AOR = 4.349, CI: 1.592–11.879, P-value = 0.001), presence of comorbidities (AOR = 2.29, CI: 1.06–4.96, P-value = 0.036), who underwent treatment with loop diuretics (AOR = 2.983, CI: 1.407–6.326, P-value = 0.040), and who reside in a rural area (AOR = 5.119, CI: 2.481–10.560, P-value < 0.001) were at risk of developing undernutrition.ConclusionUndernutrition was a significant clinical problem in older patients with heart failure. Nutritional interventions should be prioritized for patients with chronic and severe heart failure.
Collapse
|
91
|
Farsky PS, White J, Al-Khalidi HR, Sueta CA, Rouleau JL, Panza JA, Velazquez EJ, O'Connor CM. Optimal medical therapy with or without surgical revascularization and long-term outcomes in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2022; 164:1890-1899.e4. [PMID: 33610365 PMCID: PMC8260609 DOI: 10.1016/j.jtcvs.2020.12.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Optimal medical therapy in patients with heart failure and coronary artery disease is associated with improved outcomes. However, whether this association is influenced by the performance of coronary artery bypass grafting is less well established. Thus, the aim of this study was to determine the possible relationship between coronary artery bypass grafting and optimal medical therapy and its effect on the outcomes of patients with ischemic cardiomyopathy. METHODS The Surgical Treatment for Ischemic Heart Failure trial randomized 1212 patients with coronary artery disease and left ventricular ejection fraction 35% or less to coronary artery bypass grafting with medical therapy or medical therapy alone with a median follow-up over 9.8 years. For the purpose of this study, optimal medical therapy was collected at baseline and 4 months, and defined as the combination of 4 drugs: angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, statin, and 1 antiplatelet drug. RESULTS At baseline and 4 months, 58.7% and 73.3% of patients were receiving optimal medical therapy, respectively. These patients had no differences in important parameters such as left ventricular ejection fraction and left ventricular volumes. In a multivariable Cox model, optimal medical therapy at baseline was associated with a lower all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.66-0.91; P = .001). When landmarked at 4 months, optimal medical therapy was also associated with a lower all-cause mortality (hazard ratio, 0.82; 95% confidence interval, 0.62-0.99; P = .04). There was no interaction between the benefit of optimal medical therapy and treatment allocation. CONCLUSIONS Optimal medical therapy was associated with improved long-term survival and lower cardiovascular mortality in patients with ischemic cardiomyopathy and should be strongly recommended.
Collapse
Affiliation(s)
- Pedro S Farsky
- Instituto Dante Pazzanese de Cardiologia and Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
| | - Jennifer White
- Duke Clinical Research Institute and Department of Biostatics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute and Department of Biostatics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Carla A Sueta
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
| | - Jean L Rouleau
- Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Julio A Panza
- Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | | |
Collapse
|
92
|
Zhang XT, Ge N, Xiang ZJ, Liu T. Immune checkpoint inhibitor-related adverse cardiac events in patients with lung cancer: a systematic review and meta-analysis. Cancer Cell Int 2022; 22:363. [PMCID: PMC9675058 DOI: 10.1186/s12935-022-02760-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although people are more and more aware of the cardiotoxicity caused by immune checkpoint inhibitors (ICIs) in the treatment of lung cancer, its incidence rate has not been systematically analyzed. This study aims to evaluate the incidence of cardiotoxicity related to the ICI therapies for lung cancer, so as to enhance clinicians' attention to cardiotoxicity, implement proper prevention and intervention for high-risk patients, and minimize the risk of cardiac dysfunction during and after completion of therapy. Methods We conducted a systematic literature search for relevant publications in PubMed and Scopus from inception to 19 April 2022. Pooled incidence and risk ratios with 95% confidence intervals (95% CIs) for cardiotoxicity events were calculated. Results A total of 37 studies covering 38 trials, including 14,342 patients, were identified. The pooled risk ratios of incidence of any cardiac AEs were 1.944 [95% CI 0.8–4.725] (Single ICI versus chemotherapy), 1.677 [95% CI 1.065–2.64] (Single ICI plus chemotherapy versus chemotherapy), and 0.478 [95% CI 0.127–1.798] (Single ICI versus Dual ICI). The incidence of myocarditis and arrhythmia were 0.003[95%CI 0.002–0.006] and 0.014[95%CI 0–0.037], respectively. Conclusion Single ICI did not increase the risk of cardiotoxicity compared with chemotherapy, and single ICI plus chemotherapy increased the risk of cardiotoxicity by 67% compared with chemotherapy alone. Combination immunotherapy did not increase the risk of cardiotoxicity compared with single ICI. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-022-02760-2.
Collapse
Affiliation(s)
- Xiao-Tong Zhang
- grid.506261.60000 0001 0706 7839Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730 China
| | - Nan Ge
- grid.506261.60000 0001 0706 7839Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zi-Jian Xiang
- Beijing Zhiyun Data Technology Co. LTD, Beijing, China
| | - Tao Liu
- grid.506261.60000 0001 0706 7839Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730 China
| |
Collapse
|
93
|
Evbayekha EO, Okobi OE, Okobi T, Ibeson EC, Nwafor JN, Ozobokeme OE, Olawoye A, Ngoladi IA, Boms MG, Habib FA, Oyelade BO, Okoroafor CC, Chukwuma VN, Alex KB, Ohikhuai EE. The Evolution of Hypertension Guidelines Over the Last 20+ Years: A Comprehensive Review. Cureus 2022; 14:e31437. [DOI: 10.7759/cureus.31437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/15/2022] Open
|
94
|
Minja NW, Nakagaayi D, Aliku T, Zhang W, Ssinabulya I, Nabaale J, Amutuhaire W, de Loizaga SR, Ndagire E, Rwebembera J, Okello E, Kayima J. Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward. Front Cardiovasc Med 2022; 9:1008335. [PMID: 36440012 PMCID: PMC9686438 DOI: 10.3389/fcvm.2022.1008335] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.
Collapse
Affiliation(s)
- Neema W. Minja
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Doreen Nakagaayi
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Twalib Aliku
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Wanzhu Zhang
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nabaale
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Willington Amutuhaire
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Sarah R. de Loizaga
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Emma Ndagire
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
95
|
Gtif I, Abdelhedi R, Ouarda W, Bouzid F, Charfeddine S, Zouari F, Abid L, Rebai A, Kharrat N. Oxidative stress markers-driven prognostic model to predict post-discharge mortality in heart failure with reduced ejection fraction. Front Cardiovasc Med 2022; 9:1017673. [DOI: 10.3389/fcvm.2022.1017673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundCurrent predictive models based on biomarkers reflective of different pathways of heart failure with reduced ejection fraction (HFrEF) pathogenesis constitute a useful tool for predicting death risk among HFrEF patients. The purpose of the study was to develop a new predictive model for post-discharge mortality risk among HFrEF patients, based on a combination of clinical patients’ characteristics, N-terminal pro-B-type Natriuretic peptide (NT-proBNP) and oxidative stress markers as a potentially valuable tool for routine clinical practice.Methods116 patients with stable HFrEF were recruited in a prospective single-center study. Plasma levels of NT-proBNP and oxidative stress markers [superoxide dismutase (SOD), glutathione peroxidase (GPX), uric acid (UA), total bilirubin (TB), gamma-glutamyl transferase (GGT) and total antioxidant capacity (TAC)] were measured in the stable predischarge condition. Generalized linear model (GLM), random forest and extreme gradient boosting models were developed to predict post-discharge mortality risk using clinical and laboratory data. Through comprehensive evaluation, the most performant model was selected.ResultsDuring a median follow-up of 525 days (7–930), 33 (28%) patients died. Among the three created models, the GLM presented the best performance for post-discharge death prediction in HFrEF. The predictors included in the GLM model were age, female sex, beta blockers, NT-proBNP, left ventricular ejection fraction (LVEF), TAC levels, admission systolic blood pressure (SBP), angiotensin-converting enzyme inhibitors/angiotensin receptor II blockers (ACEI/ARBs) and UA levels. Our model had a good discriminatory power for post-discharge mortality [The area under the curve (AUC) = 74.5%]. Based on the retained model, an online calculator was developed to allow the identification of patients with heightened post-discharge death risk.ConclusionIn conclusion, we created a new and simple tool that may allow the identification of patients at heightened post-discharge mortality risk and could assist the treatment decision-making.
Collapse
|
96
|
Chen J, Xiao P, Song D, Song D, Chen Z, Li H. Growth stimulation expressed gene 2 (ST2): Clinical research and application in the cardiovascular related diseases. Front Cardiovasc Med 2022; 9:1007450. [PMID: 36407452 PMCID: PMC9671940 DOI: 10.3389/fcvm.2022.1007450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
As an interleukin (IL)-1 receptor family member, scientists found that when circulating soluble growth stimulation expressed gene 2 (sST2) is low, its ligand, IL-33, will bind to ST2L to exert protective effects on various types of cells. On the other hand, competitive binding of IL-33 occurs when sST2 concentrations are increased, followed by a reduction in the amount available for cell protection. Based on this mechanism, the usage of sST2 is to identify the population of high-risk patients with cardiovascular disease. In recent years, the role of serum sST2 in the occurrence, diagnosis, prognosis, and treatment of cardiovascular diseases has been gradually accepted by doctors. This manuscript systemically reviews the biological functions and applications of sST2 in disease diagnosis and treatment, especially for cardiovascular diseases. In clinical testing, since IL-33 can negatively impact sST2 measurement accuracy, the properties of current assay kits have been summarized and discussed to provide a clear view of the clinical chemistry results. Although sST2 is a promising biomarker, there are few quantitative approaches available for clinical testing. In this context, a mass spectrometry (MS)-based approach might be an option, as this is a powerful analytical tool to distinguish structurally related molecules in the matrix and decrease false-positive results in clinical testing. Moreover, approaches developed based on MS would be an ideal way to further study sST2 standardization.
Collapse
Affiliation(s)
- Jinchao Chen
- College of Materials and Chemistry, China Jiliang University, Hangzhou, China
- National Institute of Metrology, Beijing, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing, China
| | - Peng Xiao
- National Institute of Metrology, Beijing, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing, China
- *Correspondence: Peng Xiao,
| | - Dan Song
- National Institute of Metrology, Beijing, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing, China
| | - Dewei Song
- National Institute of Metrology, Beijing, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing, China
| | - Zhi Chen
- College of Materials and Chemistry, China Jiliang University, Hangzhou, China
| | - Hongmei Li
- National Institute of Metrology, Beijing, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, Beijing, China
- Hongmei Li,
| |
Collapse
|
97
|
Burgos LM, Baro Vila R, Goyeneche A, Muñoz F, Spaccavento A, Fasan MA, Ballari F, Vivas M, Riznyk L, Ghibaudo S, Trivi M, Ronderos R, Costabel JP, Botto F, Diez M. Design and rationale of the inferior vena CAVA and Lung UltraSound-guided therapy in Acute Heart Failure (CAVAL US-AHF Study): a randomised controlled trial. Open Heart 2022; 9:openhrt-2022-002105. [PMID: 36344108 PMCID: PMC9644364 DOI: 10.1136/openhrt-2022-002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
Background Between 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment. Objective To evaluate if inferior vena cava (IVC) and lung ultrasound (CAVAL US)-guided therapy for AHF patients reduces subclinical congestion at discharge. Methods CAVAL US-AHF is a single-centre, single-blind randomised controlled trial designed to evaluate if an IVC and lung ultrasound-guided healthcare strategy is superior to standard care to reduce subclinical congestion at discharge. Fifty-eight patients with AHF will be randomised using a block randomisation programme that will assign to either lung and IVC ultrasound-guided decongestion therapy (‘intervention group’) or clinical-guided decongestion therapy (‘control group’), using a quantitative protocol and will be classified in three groups according to the level of congestion observed: none or mild, moderate or severe. The treating physicians will know the result of the test and the subsequent adjustment of treatment in response to those findings guided by a customised therapeutic algorithm. The primary endpoint is the presence of more than five B-lines and/or an increase in the diameter of the IVC, with and without collapsibility. The secondary endpoints are the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days, variation of pro-B-type natriuretic peptide at discharge, length of hospital stay and diuretic dose at 90 days. Analyses will be conducted as between-group by intention to treat. Ethics and dissemination Ethical approval was obtained from the Institutional Review Board and registered in the PRIISA.BA platform of the Ministry of Health of the City of Buenos Aires. Trial registration number NCT04549701.
Collapse
Affiliation(s)
- Lucrecia Maria Burgos
- Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Rocio Baro Vila
- Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Ailin Goyeneche
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Florencia Muñoz
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Ana Spaccavento
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Martin Andres Fasan
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Franco Ballari
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Martin Vivas
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Laura Riznyk
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Sebastian Ghibaudo
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Trivi
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Ronderos
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pablo Costabel
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Botto
- Clinical Research, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Mirta Diez
- Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
98
|
Cascino TM, McCullough JS, Wu X, Pienta MJ, Stewart JW, Hawkins RB, Brescia AA, Abou el ala A, Zhang M, Noly PE, Haft JW, Cowger JA, Colvin M, Aaronson KD, Pagani FD, Likosky DS. Comparison of Evaluations for Heart Transplant Before Durable Left Ventricular Assist Device and Subsequent Receipt of Transplant at Transplant vs Nontransplant Centers. JAMA Netw Open 2022; 5:e2240646. [PMID: 36342716 PMCID: PMC9641540 DOI: 10.1001/jamanetworkopen.2022.40646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022] Open
Abstract
Importance In 2020, the Centers for Medicare & Medicaid Services revised its national coverage determination, removing the requirement to obtain review from a Medicare-approved heart transplant center to implant a durable left ventricular assist device (LVAD) for bridge-to-transplant (BTT) intent at an LVAD-only center. The association between center-level transplant availability and access to heart transplant, the gold-standard therapy for advanced heart failure (HF), is unknown. Objective To investigate the association of center transplant availability with LVAD implant strategies and subsequent heart transplant following LVAD implant before the Centers for Medicare & Medicaid Services policy change. Design, Setting, and Participants A retrospective cohort study of the Society of Thoracic Surgeons Intermacs multicenter US registry database was conducted from April 1, 2012, to June 30, 2020. The population included patients with HF receiving a primary durable LVAD. Exposures LVAD center transplant availability (LVAD/transplant vs LVAD only). Main Outcomes and Measures The primary outcomes were implant strategy as BTT and subsequent transplant by 2 years. Covariates that might affect listing strategy and outcomes were included (eg, patient demographic characteristics, comorbidities) in multivariable models. Parameters for BTT listing were estimated using logistic regression with center-level random effects and for receipt of a transplant using a Cox proportional hazards regression model with death as a competing event. Results The sample included 22 221 LVAD recipients with a median age of 59.0 (IQR, 50.0-67.0) years, of whom 17 420 (78.4%) were male and 3156 (14.2%) received implants at LVAD-only centers. Receiving an LVAD at an LVAD/transplant center was associated with a 79% increased adjusted odds of BTT LVAD designation (odds ratio, 1.79; 95% CI, 1.35-2.38; P < .001). The 2-year transplant rate following LVAD implant was 25.6% at LVAD/transplant centers and 11.9% at LVAD-only centers. There was an associated 33% increased rate of transplant at LVAD/transplant centers compared with LVAD-only centers (adjusted hazard ratio, 1.33; 95% CI, 1.17-1.51) with a similar hazard for death at 2 years (adjusted hazard ratio, 0.99; 95% CI, 0.90-1.08). Conclusions and Relevance Receiving an LVAD at an LVAD-transplant center was associated with increased odds of BTT intent at implant and subsequent transplant receipt for patients at 2 years. The findings of this study suggest that Centers for Medicare & Medicaid Services policy change may have the unintended consequence of further increasing inequities in access to transplant among patients at LVAD-only centers.
Collapse
Affiliation(s)
- Thomas M. Cascino
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Xiaoting Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Michael J. Pienta
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
| | - James W. Stewart
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
| | - Robert B. Hawkins
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
| | | | - Ashraf Abou el ala
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | | | - Jonathan W. Haft
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
| | - Jennifer A. Cowger
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Monica Colvin
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor
| | - Keith D. Aaronson
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
| |
Collapse
|
99
|
Schrutka L, Seirer B, Rettl R, Dachs TM, Binder C, Duca F, Dalos D, Badr-Eslam R, Kastner J, Hengstenberg C, Frommlet F, Bonderman D. Heart failure with preserved ejection fraction: Calculating the risk of future heart failure events and death. Front Cardiovasc Med 2022; 9:921132. [PMID: 36337874 PMCID: PMC9634582 DOI: 10.3389/fcvm.2022.921132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to develop a clinical model to identify heart failure patients with preserved ejection fraction (HFpEF) at highest risk for acute HF events or death. Methods and results Between 2010 and 2019, 422 patients with HFpEF were followed. Acute HF events occurred in 190 patients (45%), including 110 (58%) with recurrent hospitalizations. Those with recurrent events had worse 6-min walk test (p < 0.001), higher brain N-terminal prohormone natriuretic peptide (NT-proBNP, p < 0.001), and higher New York Heart Association functional class (NYHA, p < 0.001). Overall survival rates in patients with 1 HF event vs > 1 HF events were: at 1-year 91.6 vs. 91.8%, at 3-years 84.7 vs. 68.3% and at 5-years 67.4 vs. 42.7%, respectively (p < 0.04). The Hfpef survivAL hOspitalization (HALO) score revealed best predictive capability for all-cause mortality combining the variables age (p = 0.08), BMI (p = 0.124), NYHA class (p = 0.004), need for diuretic therapy (p = 0.06), left atrial volume index (p = 0.048), systolic pulmonary artery pressure (p = 0.013), NT-proBNP (p = 0.076), and number of prior hospitalizations (p = 0.006). HALO score predicted future HF hospitalizations in an ordinal logistic regression model (OR 3.24, 95% CI: 2.45–4.37, p < 0.001). The score performance was externally validated in 75 HFpEF patients, confirming a strong survival prediction (HR 2.13, 95% CI: 1.30–3.47, p = 0.002). Conclusions We developed a model to identify HFpEF patients at increased risk of death and HF hospitalization. NYHA class and recurrent HF hospitalizations were the strongest drivers of outcome.
Collapse
Affiliation(s)
- Lore Schrutka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Benjamin Seirer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - René Rettl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Roza Badr-Eslam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine V, Division of Cardiology, Clinic Favoriten, Vienna, Austria
- *Correspondence: Diana Bonderman,
| |
Collapse
|
100
|
Peng S, Huang J, Liu X, Deng J, Sun C, Tang J, Chen H, Cao W, Wang W, Duan X, Luo X, Peng S. Interpretable machine learning for 28-day all-cause in-hospital mortality prediction in critically ill patients with heart failure combined with hypertension: A retrospective cohort study based on medical information mart for intensive care database-IV and eICU databases. Front Cardiovasc Med 2022; 9:994359. [PMID: 36312291 PMCID: PMC9597462 DOI: 10.3389/fcvm.2022.994359] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heart failure (HF) combined with hypertension is an extremely important cause of in-hospital mortality, especially for the intensive care unit (ICU) patients. However, under intense working pressure, the medical staff are easily overwhelmed by the large number of clinical signals generated in the ICU, which may lead to treatment delay, sub-optimal care, or even wrong clinical decisions. Individual risk stratification is an essential strategy for managing ICU patients with HF combined with hypertension. Artificial intelligence, especially machine learning (ML), can develop superior models to predict the prognosis of these patients. This study aimed to develop a machine learning method to predict the 28-day mortality for ICU patients with HF combined with hypertension. Methods We enrolled all critically ill patients with HF combined with hypertension in the Medical Information Mart for IntensiveCare Database-IV (MIMIC-IV, v.1.4) and the eICU Collaborative Research Database (eICU-CRD) from 2008 to 2019. Subsequently, MIMIC-IV was divided into training cohort and testing cohort in an 8:2 ratio, and eICU-CRD was designated as the external validation cohort. The least absolute shrinkage and selection operator (LASSO) Cox regression with internal tenfold cross-validation was used for data dimension reduction and identifying the most valuable predictive features for 28-day mortality. Based on its accuracy and area under the curve (AUC), the best model in the validation cohort was selected. In addition, we utilized the Shapley Additive Explanations (SHAP) method to highlight the importance of model features, analyze the impact of individual features on model output, and visualize an individual’s Shapley values. Results A total of 3,458 and 6582 patients with HF combined with hypertension in MIMIC-IV and eICU-CRD were included. The patients, including 1,756 males, had a median (Q1, Q3) age of 75 (65, 84) years. After selection, 22 out of a total of 58 clinical parameters were extracted to develop the machine-learning models. Among four constructed models, the Neural Networks (NN) model performed the best predictive performance with an AUC of 0.764 and 0.674 in the test cohort and external validation cohort, respectively. In addition, a simplified model including seven variables was built based on NN, which also had good predictive performance (AUC: 0.741). Feature importance analysis showed that age, mechanical ventilation (MECHVENT), chloride, bun, anion gap, paraplegia, rdw (RDW), hyperlipidemia, peripheral capillary oxygen saturation (SpO2), respiratory rate, cerebrovascular disease, heart rate, white blood cell (WBC), international normalized ratio (INR), mean corpuscular hemoglobin concentration (MCHC), glucose, AIDS, mean corpuscular volume (MCV), N-terminal pro-brain natriuretic peptide (Npro. BNP), calcium, renal replacement therapy (RRT), and partial thromboplastin time (PTT) were the top 22 features of the NN model with the greatest impact. Finally, after hyperparameter optimization, SHAP plots were employed to make the NN-based model interpretable with an analytical description of how the constructed model visualizes the prediction of death. Conclusion We developed a predictive model to predict the 28-day mortality for ICU patients with HF combined with hypertension, which proved superior to the traditional logistic regression analysis. The SHAP method enables machine learning models to be more interpretable, thereby helping clinicians to better understand the reasoning behind the outcome and assess in-hospital outcomes for critically ill patients.
Collapse
Affiliation(s)
- Shengxian Peng
- Scientific Research Department, First People’s Hospital of Zigong City, Zigong, China
| | - Jian Huang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiewen Deng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Juan Tang
- Scientific Research Department, First People’s Hospital of Zigong City, Zigong, China
| | - Huaqiao Chen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenzhai Cao
- Department of Cardiology, First People’s Hospital of Zigong City, Zigong, China
| | - Wei Wang
- Department of Cardiology, First People’s Hospital of Zigong City, Zigong, China,Information Department, First People’s Hospital of Zigong City, Zigong, China
| | - Xiangjie Duan
- Department of Infectious Diseases, The First People’s Hospital of Changde City, Changde, China
| | - Xianglin Luo
- Information Department, First People’s Hospital of Zigong City, Zigong, China
| | - Shuang Peng
- General Affairs Section, The People’s Hospital of Tongnan District, Chongqing, China,*Correspondence: Shuang Peng,
| |
Collapse
|