Management of chronic heart failure in the older population

Examining Characteristics of Hospitalizations in Heart Failure Patients: Results from the 2009 All-payer Data

Heart failure (HF) is one of the most common chronic and disabling illnesses, resulting in high morbidity and mortality. Readmission rate, one key indicator of healthcare quality and healthcare utilization, is prevalent in HF patients. Inconsistent evidences exist about the impact of rural health disparities on HF patients' readmissions. The purpose of this explorative study was to examine the characteristics of hospitalized HF patients and factors related to readmissions in 2009. The results showed all-cause readmission rates were 13.6%, 23.6%, and 31.6% at 30-, 90- and 180-days respectively. The factors related readmissions included age, income, discharge/transfer status from index hospitalization, and comorbidity. Findings from this analysis suggested additional studies using multiple data sources are needed to have a comprehensive understanding of risk factors related HF patients' healthcare utilization.

Low serum calcium is associated with left ventricular systolic dysfunction in a Chinese population with coronary artery disease

Whether serum calcium is associated with heart systolic function in patients with established coronary artery disease (CAD) and acute myocardial infarction (AMI) remains to be elucidated. This study is aimed to assess the association between serum calcium and left ventricular systolic dysfunction in a Chinese population of CAD. The cross-sectional study included 5938 CAD patients with and without AMI in China. The factors associated with AMI and left ventricular ejection fraction (LVEF) were evaluated. The data showed that AMI patients had lower serum calcium levels (2.11 ± 0.13 vs 2.20 ± 0.10 mmol/l, P < 0.001) than those without AMI. Multiple logistic regression analysis exhibited that serum calcium (OR: 0.000, 95% CI: 0.000–0.001) was one of the independent factors correlated with AMI. CAD patients with and without AMI when LVEF <50% had lower serum calcium levels than those when LVEF ≥50% respectively. Serum calcium was independently associated with LVEF and LVEF <50% in CAD patients with and without AMI respectively using multivariate analysis. The independent association between serum calcium and LVEF still existed among CAD patients when LVEF ≥50%. Serum calcium levels are significantly decreased following AMI. Low serum calcium is independently correlated with left ventricular systolic dysfunction in CAD patients with and without AMI.

Brain mechanisms of sympathetic activation in heart failure: Roles of the renin‑angiotensin system, nitric oxide and pro‑inflammatory cytokines (Review)

Patients with chronic heart failure (CHF) have an insufficient perfusion to the peripheral tissues due to decreased cardiac output. The compensatory mechanisms are triggered even prior to the occurrence of clinical symptoms, which include activation of the sympathetic nervous system (SNS) and other neurohumoral factors. However, the long‑term activation of the SNS contributes to progressive cardiac dysfunction and has toxic effects on the cardiomyocytes. The mechanisms leading to the activation of SNS include changes in peripheral baroreceptor and chemoreceptor reflexes and the abnormal regulation of sympathetic nerve activity (SNA) in the central nervous system (CNS). Recent studies have focused on the role of brain mechanisms in the regulation of SNA and the progression of CHF. The renin‑angiotensin system, nitric oxide and pro‑inflammatory cytokines were shown to be involved in the abnormal regulation of SNA in the CNS. The alteration of these neurohumoral factors during CHF influences the activity of neurons in the autonomic regions and finally increase the sympathetic outflow. The present review summarizes the brain mechanisms contributing to sympathoexcitation in CHF.