101
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Kane PM, Murtagh FEM, Ryan KR, Brice M, Mahon NG, McAdam B, McQuillan R, O'Gara G, Raleigh C, Tracey C, Howley C, Higginson IJ, Daveson BA. Strategies to address the shortcomings of commonly used advanced chronic heart failure descriptors to improve recruitment in palliative care research: A parallel mixed-methods feasibility study. Palliat Med 2018; 32:517-524. [PMID: 28488925 PMCID: PMC5788074 DOI: 10.1177/0269216317706426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recruitment challenges contribute to the paucity of palliative care research with advanced chronic heart failure patients. AIM To describe the challenges and outline strategies of recruiting advanced chronic heart failure patients. DESIGN A feasibility study using a pre-post uncontrolled design. SETTING Advanced chronic heart failure patients were recruited at two nurse-led chronic heart failure disease management clinics in Ireland Results: Of 372 patients screened, 81 were approached, 38 were recruited (46.9% conversion to consent) and 25 completed the intervention. To identify the desired population, a modified version of the European Society of Cardiology definition was used together with modified New York Heart Association inclusion criteria to address inter-study site New York Heart Association classification subjectivity. These modifications substantially increased median monthly numbers of eligible patients approached (from 8 to 20) and median monthly numbers recruited (from 4 to 9). Analysis using a mortality risk calculator demonstrated that recruited patients had a median 1-year mortality risk of 22.7 and confirmed that the modified eligibility criteria successfully identified the population of interest. A statistically significant difference in New York Heart Association classification was found in recruited patients between study sites, but no statistically significant difference was found in selected clinical parameters between these patients. CONCLUSION Clinically relevant modifications to the European Society of Cardiology definition and strategies to address New York Heart Association subjectivity may help to improve advanced chronic heart failure patient recruitment in clinical settings, thereby helping to address the paucity of palliative care research this population.
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Affiliation(s)
- Pauline M Kane
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Fliss E M Murtagh
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Karen R Ryan
- 2 St Francis Hospice, Dublin, Ireland.,3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall G Mahon
- 3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Regina McQuillan
- 2 St Francis Hospice, Dublin, Ireland.,5 Beaumont Hospital, Dublin, Ireland
| | | | | | - Cecelia Tracey
- 3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Irene J Higginson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Barbara A Daveson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
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102
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Emami A, Ebner N, von Haehling S. Publishing in a heart failure journal-where lies the scientific interest? ESC Heart Fail 2017; 4:389-401. [PMID: 29131547 PMCID: PMC5695188 DOI: 10.1002/ehf2.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Amir Emami
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany
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103
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Abstract
Heart failure is common in adults, accounting for substantial morbidity and mortality worldwide. Its prevalence is increasing because of ageing of the population and improved treatment of acute cardiovascular events, despite the efficacy of many therapies for patients with heart failure with reduced ejection fraction, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β blockers, and mineralocorticoid receptor antagonists, and advanced device therapies. Combined angiotensin receptor blocker neprilysin inhibitors (ARNIs) have been associated with improvements in hospital admissions and mortality from heart failure compared with enalapril, and guidelines now recommend substitution of ACE inhibitors or ARBs with ARNIs in appropriate patients. Improved safety of left ventricular assist devices means that these are becoming more commonly used in patients with severe symptoms. Antidiabetic therapies might further improve outcomes in patients with heart failure. New drugs with novel mechanisms of action, such as cardiac myosin activators, are under investigation for patients with heart failure with reduced left ventricular ejection fraction. Heart failure with preserved ejection fraction is a heterogeneous disorder that remains incompletely understood and will continue to increase in prevalence with the ageing population. Although some data suggest that spironolactone might improve outcomes in these patients, no therapy has conclusively shown a significant effect. Hopefully, future studies will address these unmet needs for patients with heart failure. Admissions for acute heart failure continue to increase but, to date, no new therapies have improved clinical outcomes.
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Affiliation(s)
- Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - John R Teerlink
- School of Medicine, University of California, San Francisco, CA, USA; Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
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104
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Lund LH. Optimizing outcomes after heart transplantation. Eur J Heart Fail 2017; 20:395-397. [DOI: 10.1002/ejhf.1026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/31/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lars H. Lund
- Department of Medicine, Karolinska Institute; Stockholm Sweden
- Heart and Vascular Theme; Karolinska University Hospital; Stockholm Sweden
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105
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Kamiya K, Hamazaki N, Matsue Y, Mezzani A, Corrà U, Matsuzawa R, Nozaki K, Tanaka S, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease. Eur J Prev Cardiol 2017; 25:212-219. [DOI: 10.1177/2047487317735715] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Although gait speed and six-minute walk distance are used to assess functional capacity in older patients with cardiovascular disease, their prognostic capabilities have not been directly compared. Methods The study population was identified from the Kitasato University Cardiac Rehabilitation Database and consisted of 1474 patients ≥60 years old with a mean age of 72.2 ± 7.1 years that underwent evaluation of both usual gait speed and six-minute walk distance in routine geriatric assessment between 1 June 2008–30 September 2015. Both gait speed and six-minute walk distance were determined on the same day at hospital discharge. Results Mean gait speed and six-minute walk distance in the whole population were 1.04 m/s and 381 m, respectively, and were strongly positively correlated ( r = 0.80, p < 0.001). A total of 180 deaths occurred during a follow-up of 2.3 ± 1.9 years. After adjusting for confounding factors, both gait speed (adjusted hazard ratio per 0.1 m/s increase: 0.87, 95% confidence interval: 0.81–0.93, p < 0.001) and six-minute walk distance (adjusted hazard ratio per 10-metre increase: 0.96, 95% confidence interval: 0.94–0.97, p < 0.001) were independent predictors of all-cause mortality. There was no significant difference in prognostic capability between gait speed and six-minute walk distance (c-index: 0.64 (95% confidence interval: 0.60–0.69) and 0.66 (95% confidence interval: 0.61–0.70), respectively, p = 0.357). Conclusions Gait speed and six-minute walk distance showed similar prognostic predictive ability for all-cause mortality in older cardiovascular disease patients, indicating the potential utility of gait speed as a simple risk stratification tool in older cardiovascular disease patients.
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Affiliation(s)
- Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Japan
| | - Nobuaki Hamazaki
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Japan
- Department of Rehabilitation, Kitasato University Hospital, Japan
| | - Yuya Matsue
- Department of Cardiology, Kameda Medical Center, Japan
- Department of Cardiology, University Medical Center Groningen, the Netherlands
| | - Alessandro Mezzani
- Department of Cardiac Rehabilitation, Salvatore Maugeri Foundation, Italy
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, Salvatore Maugeri Foundation, Italy
| | - Ryota Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Japan
| | - Shinya Tanaka
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Japan
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Japan
| | - Takashi Masuda
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Japan
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106
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Namukwaya E, Murray SA, Downing J, Leng M, Grant L. 'I think my body has become addicted to those tablets'. Chronic heart failure patients' understanding of and beliefs about their illness and its treatment: A qualitative longitudinal study from Uganda. PLoS One 2017; 12:e0182876. [PMID: 28957338 PMCID: PMC5619713 DOI: 10.1371/journal.pone.0182876] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/26/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with heart failure in Uganda present for health care with advanced structural heart disease, have repeated hospitalizations and poorly controlled disease symptoms. The reasons for these are unclear. Literature from other settings shows that patients' understanding of their illness and their beliefs influence their health related behaviour. The study aimed to explore the beliefs of patients with heart failure, their understanding of their illness and its treatment, and how this influenced their health related behaviour to inform future health education programs, information and palliative care services. METHODS Serial qualitative in-depth interviews were conducted with Heart Failure patients who were purposively sampled and recruited in Mulago National Referral Hospital until thematic saturation was reached. In-depth interviews were conducted at three time points over the course of their illness with intervals of 3 months between interviews. A grounded theory approach was used in data analysis. The University of Edinburgh ethics committee, Mulago Hospital Research Ethics committee and the Uganda National Council of Science and Technology (Reference numbers D/GC/178; MREC 33, SS 3083 respectively) approved the research. RESULTS A total of 40 face to face qualitative longitudinal interviews (36-patient alone, 4 paired-patient and family carer), were conducted with 21 patients. The findings revealed that heart failure patients were unaware of the symptoms of the illness and their definition of illness differed from that of health professionals. Patients understood their diagnosis, cause of illness, prognosis and the importance of the medicines differently from health professionals, and had insufficient information on self-care. Lay beliefs were used to explain many aspects of the illness and treatments. All these influenced where patients sought care and their adherence to treatment, self-care and follow up leading to uncontrolled disease. CONCLUSION There is a high level of health illiteracy among heart failure patients in Uganda. Patients rely on lay beliefs to make health decisions and medical information is often miscomprehended. There is an urgent need for health education using culturally appropriate information.
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Affiliation(s)
- Elizabeth Namukwaya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Scott A. Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences & Informatics, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Julia Downing
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mhoira Leng
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Liz Grant
- Global Health Academy, The Usher Institute of Population Health Sciences & Informatics, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
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107
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Lund LH, Trochu JN, Meyns B, Caliskan K, Shaw S, Schmitto JD, Schibilsky D, Damme L, Heatley J, Gustafsson F. Screening for heart transplantation and left ventricular assist system: results from the ScrEEning for advanced Heart Failure treatment (SEE-HF) study. Eur J Heart Fail 2017; 20:152-160. [PMID: 28960673 DOI: 10.1002/ejhf.975] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart transplantation (HTx) and implantable left ventricular assist systems (LVAS) improve outcomes in advanced heart failure but may be underutilized. We hypothesized that screening can identify appropriate candidates. METHODS AND RESULTS The ScrEEning for advanced Heart Failure treatment (SEE-HF) study was a multicentre prospective study screening patients with existing cardiac resynchronization therapy (CRT) and/or implantable cardioverter-defibrillator (ICD) for ejection fraction ≤40% and New York Heart Association (NYHA) class III-IV, and subsequently for guideline-based HTx and LVAS indication. Of 1722 (mean age 64 ± 14 years, 26% women) patients screened at eight centres in seven European countries, 121 (7.0%) were eligible and 99 (5.7%; mean age 61 ± 10 years, 19% women) patients were enrolled for detailed assessment. Twenty-six of the 99 enrolled patients (26%) were eligible for either HTx or LVAD (18 eligible for HTx; 7 eligible for LVAD; and 1 eligible for both). Eleven patients were listed for HTx and three received an LVAS. Eligible patients were 61 ± 8 years and 19% women, whereas those actually receiving intervention were 56 ± 8 years and 8% women. CONCLUSIONS Among patients with CRT and/or ICD, a minority have NYHA class III-IV heart failure and ejection fraction ≤40%. Among these, however, more than one-quarter have an unrecognized need for HTx or LVAS. When patients are offered intervention based on screening, many decline. Discrepancies exist between clinical and patient equipoise. Clinical Trial Registration ClinicalTrials.gov Unique Identifier: NCT00894387.
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Affiliation(s)
- Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-Noel Trochu
- Institut du Thorax, Inserm UMR 1087-CIC1413, Centre Hospitalier Universaire de Nantes, Nantes, France
| | | | - Kadir Caliskan
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Steven Shaw
- University Hospital of S. Manchester NHS Trust, Manchester, UK
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - David Schibilsky
- German Heart Competance Center, University Clinical Center Tuebingen, Tuebingen, Germany
| | | | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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108
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Kane PM, Daveson BA, Ryan K, Ellis-Smith CI, Mahon NG, McAdam B, McQuilllan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Koffman J, Murtagh FEM. Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure. BMJ Support Palliat Care 2017; 7:470-479. [PMID: 28864449 DOI: 10.1136/bmjspcare-2017-001355] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/06/2017] [Accepted: 07/26/2017] [Indexed: 11/04/2022]
Abstract
Patients with chronic heart failure (CHF) have symptoms and concerns which are inadequately addressed. Patient-reported outcome measures (PROMs) can potentially improve the identification and management of advanced symptoms and palliative concerns. However, these have not been used in CHF. OBJECTIVES To examine the feasibility and acceptability of using a PROM-the Integrated Palliative care Outcome Scale (IPOS)-together with heart failure nurse education and training to improve the identification and management of symptoms and concerns among patients with CHF. METHODS A parallel, mixed methods design with an embedded qualitative component was used to examine the feasibility of recruitment, retention, intervention adherence/compliance and follow-up assessment completion (symptom burden, quality of life, psychological well-being). Patient and nurse qualitative semistructured interviews explored intervention and study design feasibility and its acceptability. RESULTS Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). 66% of patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (non-response). Over two-thirds (65.6%) of these missing items related to three patients. No item was consistently missing; appetite was the most frequent missing item (1.4%). 92% of participants who completed the IPOS completed all follow-up assessments (1-2 days, 1-2 weeks and 4-6 weeks post-IPOS completion) with no missing data. The a priori feasibility objectives were met. Patients and nurses reported the intervention and study design feasible and acceptable. CONCLUSIONS A palliative-specific PROM-based intervention is feasible and acceptable to both patients with CHF and nurses in nurse-led disease management clinics for the purposes of both clinical care and research.
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Affiliation(s)
- Pauline M Kane
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Barbara A Daveson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Karen Ryan
- Palliative Care, St. Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Clare I Ellis-Smith
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Niall G Mahon
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Cecelia Tracey
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Christine Howley
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
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109
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Abstract
This article seeks to evaluate current practices in heart transplantation. The goals of this article were to review current practices for heart transplantation and its anesthesia management. The article reviews current demographics and discusses the current criteria for candidacy for heart transplantation. The process for donor and receipt selection is reviewed. This is followed by a review of mechanical circulatory support devices as they pertain to heart transplantation. The preanesthesia and intraoperative considerations are also discussed. Finally, management after transplantation is also reviewed.
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Affiliation(s)
- Davinder Ramsingh
- Department of Anesthesiology, Loma Linda Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA.
| | - Reed Harvey
- Department of Anesthesiology, Ronald Reagan UCLA Medical Center, University of California at Los Angeles, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA
| | - Alec Runyon
- Department of Anesthesiology, Loma Linda Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA
| | - Michael Benggon
- Department of Anesthesiology, Loma Linda Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA
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Wang K, Li HL, Bei WJ, Guo XS, Chen SQ, Islam SMS, Chen JY, Liu Y, Tan N. Association of left ventricular ejection fraction with contrast-induced nephropathy and mortality following coronary angiography or intervention in patients with heart failure. Ther Clin Risk Manag 2017; 13:887-895. [PMID: 28769566 PMCID: PMC5529088 DOI: 10.2147/tcrm.s137654] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Left ventricular ejection fraction (LVEF) is the most widely used parameter to evaluate the cardiac function in patients with heart failure (HF). However, the association between LVEF and contrast-induced nephropathy (CIN) is still controversial. Therefore, the aim of this study is to evaluate the association of LVEF with CIN and long-term mortality following coronary angiography (CAG) or intervention in patients with HF. Methods We analyzed 1,647 patients with HF (New York Heart Association [NYHA] or Killip class >1) undergoing CAG or intervention, including 207 (12.57%) patients with reduced LVEF (HFrEF), 238 (14.45%) with mid-range LVEF (HFmrEF) and 1,202 (72.98%) with preserved LVEF (HFpEF). CIN was defined as an absolute increase of ≥0.5 mg/dL or a relative increase of ≥25% from baseline serum creatinine within 48–72 h after contrast medium exposure. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify the association between LVEF, CIN and long-term mortality, respectively. Results Overall, 225 patients (13.7%) developed CIN. Individuals with lower LVEF were more likely to develop CIN (HFrEF, HFmrEF and HFpEF: 18.4%, 21.8% and 11.2%, respectively; P<0.001), but without a significant trend after adjusting for the confounding factors (HFrEF vs HFpEF: odds ratio [OR] =1.01; HFmrEF vs HFpEF: OR =1.31; all P>0.05). However, advanced HF (NYHA class >2 or Killip class >1) was an independent predictor of CIN (adjusted OR =1.54, 95% confidence interval [CI], 1.07–2.22; P=0.019). During the mean follow-up of 2.3 years, reduced LVEF (HFrEF group) was significantly associated with increased mortality (HFrEF vs HFpEF: adjusted hazard ratio =2.88, 95% CI, 1.77–4.69; P<0.001). Conclusion In patients with HF undergoing CAG or intervention, not worsened LVEF but advanced HF was associated with an increased risk of CIN. In addition, reduced LVEF was an independent predictor of long-term mortality following cardiac catheterization.
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Affiliation(s)
- Kun Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Hua-Long Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Wei-Jie Bei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Xiao-Sheng Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Shi-Qun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | | | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.,School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
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111
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The Effect of Left Ventricular Assist Device Implantation on Serum Albumin, Total Protein and Body Mass: A Short-Term, Longitudinal Follow-Up Study. Heart Lung Circ 2017; 26:702-708. [DOI: 10.1016/j.hlc.2016.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 12/21/2022]
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112
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Schmidt T, Bjarnason-Wehrens B, Bartsch P, Deniz E, Schmitto J, Schulte-Eistrup S, Willemsen D, Reiss N. Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation. Artif Organs 2017. [DOI: 10.1111/aor.12936] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Thomas Schmidt
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Petra Bartsch
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Ezin Deniz
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Schmitto
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Detlev Willemsen
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Nils Reiss
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
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113
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Kalogeropoulos AP, Samman-Tahhan A, Hedley JS, McCue AA, Bjork JB, Markham DW, Bhatt KN, Georgiopoulou VV, Smith AL, Butler J. Progression to Stage D Heart Failure Among Outpatients With Stage C Heart Failure and Reduced Ejection Fraction. JACC-HEART FAILURE 2017. [PMID: 28624484 DOI: 10.1016/j.jchf.2017.02.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study sought to estimate the rate of progression to Stage D heart failure (HF) among outpatients with Stage C HF and to identify risk factors for progression. BACKGROUND The pool of patients who may be candidates for advanced HF therapies is growing. METHODS We estimated 3-year progression to clinically determined Stage D HF and competing mortality among 964 outpatients with Stage C heart failure with reduced ejection fraction (HFrEF), where ejection fraction is ≤40%. RESULTS The mean age of patients was 62 ± 15 years; 35% were women; 47% were white; 46% were black, and 7% were of other races; median baseline ejection fraction was 28% (25th to 75th percentile: 20% to 35%); and 47% had ischemic heart disease. After 3.0 years (25th to 75th percentile: 1.7 to 3.2 years), 112 patients progressed to Stage D (3-year incidence: 12.2%; 95% confidence interval [CI]: 10.2% to 14.6%; annualized: 4.5%; 95% CI: 3.8% to 5.5%), and 116 patients died before progression (3-year competing mortality: 12.9%; annualized: 4.7%; 95% CI: 3.9% to 5.6%). By 3 years, 25.1% of patients (95% CI: 22.2% to 28.1%) had either progressed to Stage D or died (annualized: 9.2%; 95% CI: 8.1% to 10.5%). Annualized progression rates were higher in black versus white patients (6.3% vs. 2.7%, respectively; p < 0.001), nonischemic versus ischemic patients (6.1% vs. 2.9%, respectively; p < 0.001), and in New York Heart Association functional class III to IV versus I to II patients (7.5% vs. 1.9%, respectively; p < 0.001) but were similar for men and women (4.7% vs. 4.2%, respectively; p = 0.53). Lower ejection fraction and blood pressure, renal and hepatic dysfunction, and chronic lung disease rates were additional predictors of progression. Predictors of competing mortality were different from those of disease progression. CONCLUSIONS Among patients with Stage C HFrEF receiving care in a referral center, 4.5% progressed to Stage D HF each year, with earlier progression among black and nonischemic patients. These findings have implications for healthcare planning and resource allocation for these patients.
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Affiliation(s)
| | | | | | - Andrew A McCue
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | | | - Kunal N Bhatt
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Andrew L Smith
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Javed Butler
- Department of Medicine, Stony Brook University, Stony Brook, New York
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Namukwaya E, Grant L, Downing J, Leng M, Murray SA. Improving care for people with heart failure in Uganda: serial in-depth interviews with patients' and their health care professionals. BMC Res Notes 2017; 10:184. [PMID: 28545502 PMCID: PMC5445313 DOI: 10.1186/s13104-017-2505-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The short prognosis of patients with advanced heart failure (HF) and the associated multidimensional distress as illustrated in literature from high income countries necessitates the integration of palliative care into the care of advanced HF patients to address these needs and improve their quality of life. These needs, which are subjective, have not been described from the patients' and health care professionals'(HPs) view point in the Ugandan setting, a low income country with a different socio-cultural context. This study aimed at bridging this gap in knowledge by eliciting patients' and HPs' views of HF patients' needs over the course of their illness to enable generalists, cardiologists and palliative care clinicians to develop guidelines to provide patient-centred realistic care in Uganda. METHODS Serial qualitative in-depth interviews were conducted with HF patients who were purposively sampled and recruited in Mulago National Referral Hospital (MNRH) until thematic saturation. In-depth interviews were conducted at three time points with intervals of 3 month between interviews over the course of their illness in the hospital and their home context. One-off interviews were conducted with HPs that manage HF in MNRH. We used a grounded theory approach in data analysis. The Uganda National Council of science and technology approved the research. RESULTS Forty-eight interviews were conducted with 21 patients and their carers and eight interviews with their HPs. Multidimensional needs including physical, psychological, social, spiritual and information needs were identified. These highlighted the underpinning need to have normal functioning, control, to cope and adapt to a changed life and to find meaning. Spiritual needs were less recognised by HPs than the other multidimensional needs. Information needs were commonly unmet. Patients and HPs suggested improvements in care that were congruent with the recommendations in chronic disease care and the six pillars of the WHO health systems strengthening approach. CONCLUSION Management of HF in Uganda requires an approach that targets multidimensional needs, embraces multidisciplinary care and strengthens health systems which are all important tenets of palliative care.
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Affiliation(s)
- Elizabeth Namukwaya
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Liz Grant
- Global Health Academy, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Julia Downing
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Mhoira Leng
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Scott A. Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
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115
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Pölzl G, Altenberger J, Baholli L, Beltrán P, Borbély A, Comin-Colet J, Delgado JF, Fedele F, Fontana A, Fruhwald F, Giamouzis G, Giannakoulas G, Garcia-González MJ, Gustafsson F, Kaikkonen K, Kivikko M, Kubica J, von Lewinski D, Löfman I, Malfatto G, Manito N, Martínez-Sellés M, Masip J, Merkely B, Morandi F, Mølgaard H, Oliva F, Pantev E, Papp Z, Perna GP, Pfister R, Piazza V, Bover R, Rangel-Sousa D, Recio-Mayoral A, Reinecke A, Rieth A, Sarapohja T, Schmidt G, Seidel M, Störk S, Vrtovec B, Wikström G, Yerly P, Pollesello P. Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy. Int J Cardiol 2017; 243:389-395. [PMID: 28571618 DOI: 10.1016/j.ijcard.2017.05.081] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 10/19/2022]
Abstract
Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life. However, previous clinical studies of intermittent infusions of levosimendan were not powered to show statistical significance on key outcome parameters. A panel of 45 expert clinicians from 12 European countries met in Rome on November 24-25, 2016 to review the literature and envision an appropriately designed clinical trial addressing these needs. In the earlier FIGHT trial (daily subcutaneous injection of liraglutide in heart failure patients with reduced ejection fraction) a composite Global Rank Score was used as primary end-point where death, re-hospitalization, and change in N-terminal-prohormone-brain natriuretic peptide level were considered in a hierarchical order. In the present study, we tested the same end-point post hoc in the PERSIST and LEVOREP trials on oral and repeated i.v. levosimendan, respectively, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite end-point in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.
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Affiliation(s)
| | | | | | | | - Attila Borbély
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | - Gregory Giamouzis
- University of Thessaly, Larissa University Hospital, Larissa, Greece
| | | | | | | | | | | | - Jacek Kubica
- Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Ida Löfman
- Karolinska Univ Sjukhus Huddinge, Huddinge, Sweden
| | | | | | | | | | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | | | | | | | - Zoltán Papp
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gian Piero Perna
- Dipartimento di Scienze Cardiologiche Medico-Chirurgiche, Ospedali Riuniti, Ancona, Italy
| | - Roman Pfister
- Klinik III fuer Innere Medizin, Herzzentrum der Universität zu Köln, Germany
| | - Vito Piazza
- Azienda ospedaliera San Camillo-Forlanini, Rome, Italy
| | | | | | | | | | | | | | | | - Mirko Seidel
- Klinik für innere Medizin, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg, Germany
| | | | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Patrik Yerly
- Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
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Aspromonte N, Gulizia MM, Di Lenarda A, Mortara A, Battistoni I, De Maria R, Gabriele M, Iacoviello M, Navazio A, Pini D, Di Tano G, Marini M, Ricci RP, Alunni G, Radini D, Metra M, Romeo F. ANMCO/SIC Consensus Document: cardiology networks for outpatient heart failure care. Eur Heart J Suppl 2017; 19:D89-D101. [PMID: 28751837 PMCID: PMC5520754 DOI: 10.1093/eurheartj/sux009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Changing demographics and an increasing burden of multiple chronic comorbidities in Western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of- hospital phases of HF. In Italy, as well as in other countries, needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for acute hospitalized HF and those followed-up at HF clinics. The Italian Working Group on Heart Failure has drafted a guidance document for the organisation of a national HF care network. Aims of the document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among health-care professionals. The document classifies HF outpatient clinics in three groups: (i) community HF clinics, devoted to management of stable patients in strict liaison with primary care, periodic re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, (ii) hospital HF clinics, that target both new onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for general internal medicine units and community clinics, and (iii) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. Those different types of HF clinics are integrated in a dedicated network for management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multi-professional providers to ensure continuity of care and patient empowerment. In conclusion, This guidance document details roles and interactions of cardiology specialists, so as to best exploit the added value of their input in the care of HF patients and is intended to promote a more efficient and effective organization of HF services.
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Affiliation(s)
- Nadia Aspromonte
- CCU-Cardiology Department, Presidio Ospedaliero San Filippo Neri, Via G. Martinotti, 20, 00135 Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Andrea Mortara
- Clinical Cardiology and Heart Failure Unit, Policlinico di Monza, Monza, Italy
| | - Ilaria Battistoni
- CCU-Cardiology Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Renata De Maria
- Institute of Clinical Physiology of the CNR, ASST Grande Ospedale Metropolitano Niguarda, ilano, Italy
| | - Michele Gabriele
- Cardiology Department, Ospedale Ajello c/o Ospedale Vittorio Emanuele I, Castelvetrano (TP), Italy
| | | | | | - Daniela Pini
- Clinical Cardiology Unit, Istituto Clinico Humanitas, Rozzano (MI), Italy
| | | | - Marco Marini
- CCU-Cardiology Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Renato Pietro Ricci
- CCU-Cardiology Department, Presidio Ospedaliero San Filippo Neri, Via G. Martinotti, 20, 00135 Rome, Italy
| | - Gianfranco Alunni
- Integrated Heart Failure Unit, Ospedale di Assisi, Assisi (PG), Italy
| | - Donatella Radini
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Marco Metra
- Cardiology Unit, Spedali Civili, Brescia, Italy
| | - Francesco Romeo
- Cardiology and Interventional Cardiology Department, Policlinico "Tor Vergata", Roma, Italy
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Sánchez-Enrique C, Jorde UP, González-Costello J. Trasplante cardiaco y soporte circulatorio mecánico para pacientes con insuficiencia cardiaca avanzada. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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118
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Sánchez-Enrique C, Jorde UP, González-Costello J. Heart Transplant and Mechanical Circulatory Support in Patients With Advanced Heart Failure. ACTA ACUST UNITED AC 2017; 70:371-381. [DOI: 10.1016/j.rec.2016.12.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/28/2016] [Indexed: 12/27/2022]
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119
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Baumwol J. “I Need Help”—A mnemonic to aid timely referral in advanced heart failure. J Heart Lung Transplant 2017; 36:593-594. [DOI: 10.1016/j.healun.2017.02.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 12/22/2022] Open
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González-Robledo G, León J, Buitrago AF, Carvajalino S, Abril D, González V, Morales D, Parra J, Santacruz JG. Cuidado paliativo en falla cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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121
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Delgado JF, Oliva F, Reinecke A. The inodilator levosimendan in repetitive doses in the treatment of advanced heart failure. Eur Heart J Suppl 2017; 19:C8-C14. [PMID: 29249905 PMCID: PMC5932565 DOI: 10.1093/eurheartj/sux004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Inotropes may be an appropriate response for some patients with advanced heart failure who remain highly symptomatic despite optimization of evidence-based therapy. These patients need to be supported waiting for a heart transplant or ventricular assist device, or may be candidates for inotropy as an intervention in its own right to maintain a patient in the best achievable circumstances. Objectives in such a situation include relieving symptoms, improving quality of life and reducing unplanned hospitalizations and the costs associated with such admissions. Levosimendan, a calcium sensitizer and potassium channel opener with inotrope and vasodilator actions, has emerged as a potentially valuable addition to the armamentarium in this context, used in repeated or intermittent cycles of therapy. Detailed proposals and guidance are offered for the identification of candidate patients with good prospects of a beneficial response to levosimendan, and for the safe and effective implementation of a course of therapy.
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Affiliation(s)
- Juan F Delgado
- Unidad de Insuficiencia Cardiaca y Trasplante - Servicio de Cardiología, Hospital 12 de Octubre, Avda de Córdoba, Madrid, Spain
| | - Fabrizio Oliva
- Cardiac Center "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alexander Reinecke
- Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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122
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Nieminen MS, Fonseca C, Brito D, Wikström G. The potential of the inodilator levosimendan in maintaining quality of life in advanced heart failure. Eur Heart J Suppl 2017; 19:C15-C21. [PMID: 29249906 PMCID: PMC5932556 DOI: 10.1093/eurheartj/sux003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Maintaining adequate quality of life (QoL) is an important therapeutic objective for patients with advanced heart failure and, for some patients, may take precedence over prolonging life. Achieving good QoL in this context may involve aspects of patient care that lie outside the familiar limits of heart failure treatment. The inodilator levosimendan may be advantageous in this setting, not least because of its sustained duration of action, ascribed to a long-acting metabolite designated OR-1896. The possibility of using this drug in an outpatient setting is a notable practical advantage that avoids the need for patients to attend a clinic appointment. Intermittent therapy can be integrated into a wider system of outreach and patient monitoring. Practical considerations in the use of levosimendan as part of a palliative or end-of-life regimen focused on preserving QoL include the importance of starting therapy at low doses and avoiding bolus administration unless immediate effects are required and patients have adequate baseline arterial blood pressure.
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Affiliation(s)
- Markku S Nieminen
- Heart and Lung Center, Helsinki University Hospital, Meilahti Tower Hospital, PL 340, 00029 HUS Helsinki, Finland
| | - Cândida Fonseca
- Heart Failure Unit, Department of Internal Medicine, Hospital Sao Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal
| | - Dulce Brito
- Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Gerhard Wikström
- Department of Cardiology, Institute of Medical Sciences, Uppsala University, Akademiska sjukhuset, Ing.40, 5 tr, 751 85 Uppsala, Sweden
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Severe right ventricular dysfunction is an independent predictor of pre- and post-transplant mortality among candidates for heart transplantation. Arch Cardiovasc Dis 2017; 110:139-148. [DOI: 10.1016/j.acvd.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 11/24/2022]
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124
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Scrutinio D, Conserva F, Passantino A, Iacoviello M, Lagioia R, Gesualdo L. Circulating microRNA-150-5p as a novel biomarker for advanced heart failure: A genome-wide prospective study. J Heart Lung Transplant 2017; 36:616-624. [PMID: 28259597 DOI: 10.1016/j.healun.2017.02.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/26/2017] [Accepted: 02/08/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Circulating microRNAs (miRs) are promising biomarkers for heart failure (HF). Previous studies have provided inconsistent miR "signatures." The phenotypic and pathophysiologic heterogeneity of HF may have contributed to this inconsistency. In this study we assessed whether advanced HF (AHF) patients present a distinct miR signature compared with healthy subjects (HS) and mild to moderate HF (MHF) patients. METHODS The study consisted of 2 phases: a screening phase and a validation phase. In the screening phase, 752 miRs were profiled in HS and MHF and AHF patients (N = 15), using the real-time quantitative polymerase chain reaction (RT-qPCR) technique and global mean normalization. In the validation phase, the miRs found to be significantly dysregulated in AHF patients compared with both HS and MHF patients were validated in 15 HS, 25 patients with MHF and 29 with AHF, using RT-qPCR, and normalizing to exogenous (cel-miR-39) and endogenous controls. RESULTS In the screening phase, 5 miRs were found to be significantly dysregulated: -26a-5p; -145-3p; -150-5p; -485-3p; and -487b-3p. In the validation phase, miR-150-5p was confirmed to be significantly downregulated in AHF patients when compared with both HS and MHF patients, irrespective of the normalization method used. miR-26a-5p was confirmed to be significantly dysregulated only when normalized to cell-miR-39. Dysregulation of the other miRs could not be confirmed. miR-150-5p was significantly associated with maladaptive remodeling, disease severity and outcome. CONCLUSIONS Our data suggest miR-150-5p as a novel circulating biomarker for AHF. The association of miR-150-5p with maladaptive remodeling, disease severity and outcome supports the pathophysiologic relevance of downregulated miR-150-5p expression to AHF.
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Affiliation(s)
- Domenico Scrutinio
- Department of Cardiology and Cardiac Rehabilitation. Scientific Clinical Institutes Maugeri, IRCCS Institute of Cassano Murge, Bari, Italy.
| | - Francesca Conserva
- Department of Cardiology and Cardiac Rehabilitation. Scientific Clinical Institutes Maugeri, IRCCS Institute of Cassano Murge, Bari, Italy; Division of Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Passantino
- Department of Cardiology and Cardiac Rehabilitation. Scientific Clinical Institutes Maugeri, IRCCS Institute of Cassano Murge, Bari, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Rocco Lagioia
- Department of Cardiology and Cardiac Rehabilitation. Scientific Clinical Institutes Maugeri, IRCCS Institute of Cassano Murge, Bari, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Affiliation(s)
- Jill Howie-Esquivel
- Department of Physiological Nursing, University of California, San Francisco, USA
| | - Kathleen Dracup
- Department of Physiological Nursing, University of California, San Francisco, USA
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Johnson MJ, MacCallum A, Butler J, Rogers A, Sam E, Fuller A, Beattie JM. Heart failure specialist nurses’ use of palliative care services: a comparison of surveys across England in 2005 and 2010. Eur J Cardiovasc Nurs 2017; 11:190-6. [DOI: 10.1016/j.ejcnurse.2011.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Miriam J Johnson
- Hull York Medical School, (University of Hull), St Catherine’s Hospice, Throxenby Lane, Scarborough, N Yorks, YO12 5RE, UK
- On behalf of the Heart Failure Group of the National Council for Palliative Care
| | - Annie MacCallum
- NHS Gloucestershire, Gloucestershire Care Services, Edward Jenner Court, 1010 Pioneer Avenue, Gloucester Business Park, Gloucestershire, GL3 4AW, UK
- On behalf of the Heart Failure Group of the National Council for Palliative Care
| | - Jane Butler
- London Chest Hospital, Barts and the London NHS Foundation Trust, Bethnal Green, London, E2 9JX, UK
- On behalf of the Heart Failure Group of the National Council for Palliative Care
| | - Angie Rogers
- National Council for Palliative Care, The Fitzpatrick Building, 188-94 York Way, London N7 9AS, UK
- On behalf of the Heart Failure Group of the National Council for Palliative Care
| | - Emily Sam
- National Council for Palliative Care, The Fitzpatrick Building, 188-94 York Way, London N7 9AS, UK
- On behalf of the Heart Failure Group of the National Council for Palliative Care
| | - Alice Fuller
- National Council for Palliative Care, The Fitzpatrick Building, 188-94 York Way, London N7 9AS, UK
- On behalf of the Heart Failure Group of the National Council for Palliative Care
| | - James M Beattie
- Heart of England NHS Foundation Trust, Birmingham, National Clinical Lead, NHS Improvement, UK
- On behalf of the Heart Failure Group of the National Council for Palliative Care
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127
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Ortis B, Villani A, Oldani M, Giglio A, Ciambellotti F, Facchini M, Parati G, Malfatto G. Intermittent levosimendan infusions in advanced heart failure: a real world experience. J Int Med Res 2017; 45:361-371. [PMID: 28222634 PMCID: PMC5536589 DOI: 10.1177/0300060516655244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To analyse the effects of levosimendan infusions in advanced heart failure. Methods Patients with advanced heart failure treated with repeated levosimendan infusions were retrospectively compared with controls. Clinical, blood and echocardiographic parameters were obtained at baseline and after 12 months, and before and after each levosimendan infusion. Hospitalizations for heart failure and in-hospital length of stay in the 6 months before enrolment and after 6 and 12 months were recorded, along with 1-year mortality. Results Twenty-five patients treated with levosimendan and 25 controls were studied. After each levosimendan infusion, ventricular function and various clinical and metabolic parameters were improved. After 12 months, left ventricular ejection fraction (LVEF) had improved compared with baseline in the levosimendan group. The 1-year mortality rate was similar in both groups. During the 6 months before enrolment, hospitalizations were fewer in controls compared with the levosimendan group; after 6 and 12 months they increased in controls and decreased in the levosimendan group. Seven patients were super-responders to levosimendan, with LVEF improving more than 20% and hospitalizations being reduced at 12 months compared with the rest of the levosimendan group. Conclusion Intermittent levosimendan improved LVEF and decreased hospitalizations in advanced heart failure and represents a therapeutic option for patients whose disease is worsening.
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Affiliation(s)
- Benedetta Ortis
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Alessandra Villani
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Matteo Oldani
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy.,2 Department of Clinical Medicine, Prevention and Applied Biotechnology, University of Milano-Bicocca, Milan, Italy
| | - Alessia Giglio
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Francesca Ciambellotti
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Mario Facchini
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Gianfranco Parati
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy.,2 Department of Clinical Medicine, Prevention and Applied Biotechnology, University of Milano-Bicocca, Milan, Italy
| | - Gabriella Malfatto
- 1 Division of Cardiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
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Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. Utility of SARC-F for Assessing Physical Function in Elderly Patients With Cardiovascular Disease. J Am Med Dir Assoc 2016; 18:176-181. [PMID: 28043805 DOI: 10.1016/j.jamda.2016.10.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function. DESIGN Cross-sectional study. SETTING Single university hospital. PARTICIPANTS A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD. MEASUREMENTS SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group). RESULTS The sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates. CONCLUSION The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings.
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Affiliation(s)
- Shinya Tanaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Takashi Masuda
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Fruhwald S, Pollesello P, Fruhwald F. Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations. Expert Rev Cardiovasc Ther 2016; 14:1335-1347. [PMID: 27778514 DOI: 10.1080/14779072.2016.1247694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.
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Affiliation(s)
- Sonja Fruhwald
- a Department of Anesthesiology and Intensive Care Medicine, Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine , Medical University of Graz , Graz , Austria
| | - Piero Pollesello
- b Critical Care Proprietary Products , Orion Pharma , Espoo , Finland
| | - Friedrich Fruhwald
- c Department of Internal Medicine, Division of Cardiology , Medical University of Graz , Graz , Austria
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131
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Elliott AM, Lampert BC. Patient Selection for Long-Term Mechanical Circulatory Support: Is It Ever too Early for the NYHA Class III Patient? Curr Heart Fail Rep 2016; 13:13-9. [PMID: 26780915 DOI: 10.1007/s11897-016-0279-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heart failure is a common condition with significant morbidity and mortality. Pharmacologic and device therapies have resulted in substantial improvements in heart failure outcomes. Despite optimal therapy, 10 % of patients progress to advanced HF, characterized by progressive symptoms, poor quality of life, and poor prognosis. The "gold-standard" treatment of advanced heart failure remains cardiac transplantation. However, the number of patients with advanced heart failure far exceeds available donor organs. Left ventricular assist devices (LVADs) were initially developed to bridge patients with hemodynamic collapse to transplantation. Their use resulted in marked improvements in survival and quality of life in select patients giving rise to increased and expanded overall implantation. Despite these improvements, patient selection and timing for LVAD therapy is still evolving. In this article, we will review a brief history of LVADs, examine patient selection, and explore the currently debated expansion of LVADs to "less sick" patients.
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Affiliation(s)
- Andrea M Elliott
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Heart Failure & Transplantation, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA.
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Chernomordik F, Freimark D, Arad M, Shechter M, Matetzky S, Savir Y, Shlomo N, Peled A, Goldenberg I, Peled Y. Quality of life and long-term mortality in patients with advanced chronic heart failure treated with intermittent low-dose intravenous inotropes in an outpatient setting. ESC Heart Fail 2016; 4:122-129. [PMID: 28451448 PMCID: PMC5396040 DOI: 10.1002/ehf2.12114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/17/2016] [Accepted: 08/08/2016] [Indexed: 11/07/2022] Open
Abstract
AIMS There are limited data on the effect of low-dose, intermittent inotropic therapy in an outpatient setting on the quality of life (QOL) in patients with advanced refractory heart failure (HF) symptoms. We aimed to analyse the effect of this treatment modality on QOL and subsequent survival. METHODS AND RESULTS The study population comprised 287 consecutive patients with advanced refractory HF symptoms who were treated with low-dose, intravenous intermittent inotropic therapy in the HF Day Care Service at Sheba Medical Centre between September 2000 and September 2012. All patients completed a baseline Minnesota Living with Heart Failure Questionnaire (MLWHFQ), and 137 (48%) completed a 1 year follow-up questionnaire. MLWHFQ scores' means ranged from 0 (better QOL) to 5 (worse QOL). Mean age was 68 ± 12, 86% were men, 77% had ischaemic cardiomyopathy, and the mean left ventricle ejection fraction (LVEF) was 26% ± 13. The mean baseline MLWHFQ score was 3.1 (±1), while the mean at 1 year of treatment was of 2.7 (±1.1), indicating an overall improvement in QOL associated with intermittent low-dose inotrope therapy (p < 0.01). Multivariate analysis showed that younger age, non-ischaemic cardiomyopathy, and worse renal function were independently associated with improvement in QOL at 1 year. Improvement in QOL was not associated with a significant survival benefit during subsequent follow-up. CONCLUSIONS In patients with advanced refractory HF symptoms, treatment with low-dose, intermittent intravenous inotropes in an outpatient setting is associated with significant improvement in QOL. However, improvement in QOL in this population does not appear to affect subsequent long-term survival.
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Affiliation(s)
- Fernando Chernomordik
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Dov Freimark
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Michael Arad
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Michael Shechter
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Shlomi Matetzky
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yulia Savir
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Nir Shlomo
- The Israeli Association for Cardiovascular TrialsTel HashomerIsrael
| | - Amir Peled
- Clalit Health ServicesCentral RegionIsrael
| | - Ilan Goldenberg
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael.,The Israeli Association for Cardiovascular TrialsTel HashomerIsrael
| | - Yael Peled
- Heart Failure Institute, Heart Centre, Sheba Medical Centre and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
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Braun LT, Grady KL, Kutner JS, Adler E, Berlinger N, Boss R, Butler J, Enguidanos S, Friebert S, Gardner TJ, Higgins P, Holloway R, Konig M, Meier D, Morrissey MB, Quest TE, Wiegand DL, Coombs-Lee B, Fitchett G, Gupta C, Roach WH. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association. Circulation 2016; 134:e198-225. [DOI: 10.1161/cir.0000000000000438] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients’ values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient’s family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payer-provider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.
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134
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Gupta S, Larsen E, Garg A, John F, Bansal M, Eckman PM, Sembrano R. Functional Effectiveness of Inpatient Rehabilitation After Heart Transplantation. PM R 2016; 8:855-9. [DOI: 10.1016/j.pmrj.2016.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Saurabh Gupta
- Division of General Internal Medicine, University of Minnesota Medical Center, M Health, 2450 Riverside Ave, Minneapolis, MN 55415
| | - Elizabeth Larsen
- Rehabilitation Services, University of Minnesota Medical Center, M Health, Minneapolis, MN
| | - Ankur Garg
- Indiana University School of Medicine, Indianapolis, IN
| | - Florence John
- University of Minnesota Medical School, Minneapolis, MN
| | - Mukesh Bansal
- Department of systems biology, Columbia University, New York, NY
| | - Peter M. Eckman
- Division of Cardiology, University of Minnesota Medical Center, M Health, Minneapolis, MN
| | - Roderick Sembrano
- Division of PM&R, University of Minnesota Medical Center, M Health, Minneapolis, MN
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135
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Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper. Int J Cardiol 2016; 222:303-312. [PMID: 27498374 DOI: 10.1016/j.ijcard.2016.07.202] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/28/2016] [Indexed: 02/04/2023]
Abstract
Levosimendan is a positive inotrope with vasodilating properties (inodilator) indicated for decompensated heart failure (HF) patients with low cardiac output. Accumulated evidence supports several pleiotropic effects of levosimendan beyond inotropy, the heart and decompensated HF. Those effects are not readily explained by cardiac function enhancement and seem to be related to additional properties of the drug such as anti-inflammatory, anti-oxidative and anti-apoptotic ones. Mechanistic and proof-of-concept studies are still required to clarify the underlying mechanisms involved, while properly designed clinical trials are warranted to translate preclinical or early-phase clinical data into more robust clinical evidence. The present position paper, derived by a panel of 35 experts in the field of cardiology, cardiac anesthesiology, intensive care medicine, cardiac physiology, and cardiovascular pharmacology from 22 European countries, compiles the existing evidence on the pleiotropic effects of levosimendan, identifies potential novel areas of clinical application and defines the corresponding gaps in evidence and the required research efforts to address those gaps.
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136
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Kane PM, Murtagh FEM, Ryan K, Mahon NG, McAdam B, McQuillan R, Ellis-Smith C, Tracey C, Howley C, Raleigh C, O'Gara G, Higginson IJ, Daveson BA. The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure. Heart Fail Rev 2016; 20:673-87. [PMID: 26435042 PMCID: PMC4608978 DOI: 10.1007/s10741-015-9508-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II–IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included ‘patient-centred care’, ‘quality of life’ and ‘shared decision making’. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.
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Affiliation(s)
- P M Kane
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - K Ryan
- St. Francis Hospice, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - N G Mahon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B McAdam
- Beaumont Hospital, Dublin, Ireland
| | - R McQuillan
- St. Francis Hospice, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - C Ellis-Smith
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - C Tracey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Howley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - G O'Gara
- Beaumont Hospital, Dublin, Ireland
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - B A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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138
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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139
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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140
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8971] [Impact Index Per Article: 1121.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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141
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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142
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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143
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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144
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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145
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Chair SY, Yu DSF, Ng MT, Wang Q, Cheng HY, Wong EML, Sit JWH. Evolvement of left ventricular assist device: the implications on heart failure management. J Geriatr Cardiol 2016; 13:425-30. [PMID: 27594870 PMCID: PMC4984573 DOI: 10.11909/j.issn.1671-5411.2016.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 11/21/2022] Open
Abstract
Heart failure (HF) is a potentially fatal disease that affects increasing number of people worldwide. Although heart transplant is the "gold standard" therapy for HF, due to the limited availability of organs, many patients died when waiting for the transplant. Left ventricular assist device (LVAD), as a mechanical circulatory support, has become a new light for patients with HF. With the technical advancements, LVADs work not only as a bridge to transplant, but also assist heart recovery and even as a destination therapy in long-term treatment. This observation paper reviewed the development of LVAD and its clinical roles. The challenges and possible solutions in nursing care for patients with LVAD at different stage of implantation were discussed. The healthcare professionals could obtain a better understanding about the LVAD treatment for HF patients.
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Affiliation(s)
- Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Doris SF Yu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Timothy Ng
- Department of Psychology, Faculty of Social Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Qun Wang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza ML Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Janet WH Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Sajgalik P, Grupper A, Edwards BS, Kushwaha SS, Stulak JM, Joyce DL, Joyce LD, Daly RC, Kara T, Schirger JA. Current Status of Left Ventricular Assist Device Therapy. Mayo Clin Proc 2016; 91:927-40. [PMID: 27378038 DOI: 10.1016/j.mayocp.2016.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/22/2016] [Accepted: 05/03/2016] [Indexed: 02/05/2023]
Abstract
Congestive heart failure (HF) remains a serious burden in the Western World. Despite advances in pharmacotherapy and resynchronization, many patients have progression to end-stage HF. These patients may be candidates for heart transplant or left ventricular assist device (LVAD) therapy. Heart transplants are limited by organ shortages and in some cases by patient comorbidities; therefore, LVAD therapy is emerging as a strategy of bridge to transplant or as a destination therapy in patients ineligible for transplant. Patients initially ineligible for a transplant may, in certain cases, become eligible for transplant after physiologic improvement with LVAD therapy, and a small number of patients with an LVAD may have sufficient recovery of myocardial function to allow device explantation. This clinically oriented review will describe (1) the most frequently used pump types and aspects of the continuous-flow physiology and (2) the clinical indications for and the shift toward the use of LVADs in less sick patients with HF. Additionally, we review complications of LVAD therapy and project future directions in this field. We referred to the Interagency Registry for Mechanically Assisted Circulatory Support, landmark trials, and results from recently published studies as major sources in obtaining recent outcomes, and we searched for related published literature via PubMed. This review focuses primarily on clinical practice for primary care physicians and non-HF cardiologists in the United States.
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Affiliation(s)
- Pavol Sajgalik
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Avishay Grupper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Brook S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David L Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Lyle D Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Tomas Kara
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - John A Schirger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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147
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Gong H, Wang X, Shi YJ, Shang WJ, Ling YI, Pan LJ, Shi HM. Correlation between brain natriuretic peptide levels and the prognosis of patients with left ventricular diastolic dysfunction. Exp Ther Med 2016; 11:2583-2589. [PMID: 27313677 DOI: 10.3892/etm.2016.3203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/19/2016] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate the association between brain natriuretic peptide (BNP) levels and the prognosis of patients with left ventricular (LV) diastolic dysfunction. A total of 708 inpatients with cardiovascular disease (mean age, 66 years; 395 males and 313 females) were grouped according to initial BNP and were followed-up for 20-51 months (average, 30.86 months) until endpoint events occurred. Endpoints were defined as mortality or readmission due to cardiovascular disease, or mortality due to any other reason. A total of 67 and 77 events were reported in the BNP ≤80 pg/ml and BNP >80 pg/ml groups, respectively. The occurrence rate of the endpoint was significantly higher in the BNP >80 pg/ml group, as compared with the BNP ≤80 pg/ml group (26.28 vs. 16.14%; relative risk=1.63). Furthermore, the durations of patient survival were significantly shorter in the BNP >80 pg/ml group, as compared with the BNP ≤80 pg/ml group (P=0.0006), and patient survival decreased as BNP levels rose (P=0.0074). Among the 708 patients, 677 underwent echocardiographic detection at the same time. No significant correlation was detected between BNP levels and survival time in 178 patients with normal LV diastolic function [mitral Doppler flow, early diastolic (E)/late diastolic (A)>1] (P=0.2165); whereas a negative correlation was determined in 499 patients with LVD dysfunction (E/A≤1) (Spearman's rho=-0.0899; P=0.0447). The prognoses of patients with elevated BNP levels were correspondingly worse in the present study and these correlations were demonstrated to be significant in patients with LV diastolic dysfunction. Therefore, BNP levels may be used to predict the prognosis of patients with cardiovascular disease.
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Affiliation(s)
- Hui Gong
- Department of Internal Medicine, Division of Cardiology, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
| | - Xin Wang
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Yi-Jun Shi
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Wen-Jing Shang
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Y I Ling
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Li-Jian Pan
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Hai-Ming Shi
- Department of Internal Medicine, Division of Cardiology, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
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148
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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149
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Stokes MB, Bergin P, McGiffin D. Role of long-term mechanical circulatory support in patients with advanced heart failure. Intern Med J 2016; 46:530-40. [DOI: 10.1111/imj.12817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/12/2015] [Indexed: 01/24/2023]
Affiliation(s)
- M. B. Stokes
- Department of Advanced Heart Failure/Transplantation; The Alfred Hospital; Melbourne Victoria Australia
| | - P. Bergin
- Department of Advanced Heart Failure/Transplantation; The Alfred Hospital; Melbourne Victoria Australia
| | - D. McGiffin
- Department of Advanced Heart Failure/Transplantation; The Alfred Hospital; Melbourne Victoria Australia
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150
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Frea S, Pidello S, Bovolo V, Iacovino C, Franco E, Pinneri F, Galluzzo A, Volpe A, Visconti M, Peirone A, Morello M, Bergerone S, Gaita F. Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure. Eur J Heart Fail 2016; 18:564-72. [DOI: 10.1002/ejhf.504] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/17/2015] [Accepted: 12/25/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Simone Frea
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Stefano Pidello
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Virginia Bovolo
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Cristina Iacovino
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Erica Franco
- Division of Cardiology; Ospedale Civico of Chivasso; Torino Italy
| | | | - Alessandro Galluzzo
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Alessandra Volpe
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Massimiliano Visconti
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Andrea Peirone
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Mara Morello
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Serena Bergerone
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Fiorenzo Gaita
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
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