101
|
Chaudhary AG, Arshad SJ, Dahdouleh FW, Heaphy EL, Koulouridis IE. The Characteristics and Outcomes of Nonhospitalized Patients With Heart Failure in Saudi Arabia: A Contemporary Single-Center Study. Cureus 2024; 16:e51756. [PMID: 38192527 PMCID: PMC10773691 DOI: 10.7759/cureus.51756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 01/10/2024] Open
Abstract
Background Contemporary data on patients with heart failure (HF) in Saudi Arabia is limited. Methods This was a retrospective study of patients who were followed in the HF Clinic at our center after January 1, 2022. The study end date was August 31, 2023. Patients who were alive and followed for <6 months were excluded. We reported the clinical characteristics, utilization of established therapies for HF, proportion of potential candidates for ancillary HF treatments, and rates of HF events and mortality. Results A total of 202 patients met the study criteria. The mean age was 56.0 ± 15.2 years. The median follow-up from the initial visit to the study end date was 47 months (interquartile range {IQR}: 29-58 months). Coronary artery disease (CAD) was the cause of HF in 85 (42%) patients. At their latest visit, 103 (51%) patients had diabetes, 82 (41%) were obese, and 134 (66%) received quadruple therapy. Iron deficiency was present in 143 (71%) patients during follow-up. At their latest visit, moderate-to-severe or severe functional mitral regurgitation (MR) and hyperkalemia were present in 15 (7%) and 20 (10%) patients, respectively. The combined annual rate of HF hospitalization and emergency visits for HF was 20%. At least one hospitalization for HF within a year before the study end date occurred in 19 (9%) patients. The annual all-cause mortality was 1.8%. Conclusion This contemporary cohort of outpatients with HF was relatively young and had a high prevalence of diabetes, obesity, and iron deficiency. An estimate of potential candidates for iron replacement, transcatheter repair of the mitral valve, novel potassium binders, and the implantation of the pulmonary artery pressure monitor was among the first reported regionally. All-cause mortality was low, yet the burden of HF-related events was significant.
Collapse
Affiliation(s)
- Ammar G Chaudhary
- Cardiovascular Diseases Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Shifa J Arshad
- Academic and Training Affairs Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Farida W Dahdouleh
- Nursing and Clinical Affairs Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Emily L Heaphy
- Research Center, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Ioannis E Koulouridis
- Cardiovascular Diseases Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| |
Collapse
|
102
|
Wright LK, Rossano JW. Reducing Pediatric Heart Failure Readmissions: The Time Is Now. JACC. HEART FAILURE 2024; 12:97-99. [PMID: 37999663 DOI: 10.1016/j.jchf.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Lydia K Wright
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.
| | - Joseph W Rossano
- The Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
103
|
Samson R, Ennezat PV, Jemtel THL. Patient-Centered Heart Failure Therapy. Am J Med 2024; 137:23-29. [PMID: 37838238 DOI: 10.1016/j.amjmed.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/16/2023]
Abstract
Simultaneous initiation of quadruple therapy with angiotensin receptor-neprilysin inhibitor, beta-adrenergic receptor blocker, mineralocorticoid receptor antagonist, and sodium glucose cotransporter 2 inhibitor aims at prompt improvement and prevention of readmission in patients hospitalized for heart failure with reduced ejection fraction. However, titration of quadruple therapy is time consuming. Lengthy up-titration of quadruple therapy may negate the benefit of early initiation. Quadruple therapy should start with a sodium glucose cotransporter 2 inhibition and a mineralocorticoid antagonist, as both enable safe decongestion and require minimal or no titration. Depending on the level of decongestion and clinical characteristics, patients receive an angiotensin receptor-neprilysin inhibitor or a beta-adrenergic receptor blocker to be titrated after hospital discharge. Outpatient addition of an angiotensin receptor-neprilysin inhibitor to a beta-adrenergic receptor blocker or vice versa completes the quadruple therapy scheme. By focusing on decongestion and matching intervention to patients' profile, the present therapeutic sequence allows rapid implementation of quadruple therapy at fully recommended doses.
Collapse
Affiliation(s)
- Rohan Samson
- Advanced Heart Failure Therapies Program, University of Louisville Health-Jewish Hospital, Ky
| | - Pierre V Ennezat
- Department of Cardiology, AP-HP Hopitaux Universitaires Henri Mondor, Créteil, France
| | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, La.
| |
Collapse
|
104
|
Xia J, Brownell NK, Fonarow GC, Ziaeian B. New models for heart failure care delivery. Prog Cardiovasc Dis 2024; 82:70-89. [PMID: 38311306 DOI: 10.1016/j.pcad.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 02/10/2024]
Abstract
Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT. Only a minority of HF patients are prescribed on all four classes of GDMT. To bridge the gap between the vulnerable population of HF patients and lifesaving GDMT, HF implementation is of increasing importance. HF implementation involves strategies and techniques to improve GDMT optimization along with other modalities to improve HF management. HF implementation meets patients where they are, including at the time of acute decompensation in the inpatient setting, at the vulnerable discharge stage, and at the chronic management stage in the outpatient setting. Inpatient HF implementation strategies include protocolized rapid titration of GDMT, site-level audit-and-feedback, virtual GDMT optimization teams, and electronic health record notifications and alerts. Discharge HF implementation strategies include education at patient and provider levels, discharge summaries, and HF transitional programs. Outpatient HF implementation strategies include digital innovations such as electronic health record utilization and mobile applications, population level strategies such as registries and clinical dashboards), changes in HF team structure and member roles, remote monitoring with implanted devices and telemonitoring, and hospital at home care model. With a growing population of HF patients, there is an increasing need for novel and creative HF implementation and monitoring methods.
Collapse
Affiliation(s)
- Jeffrey Xia
- Department of Medicine David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Nicholas K Brownell
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| |
Collapse
|
105
|
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024; 26:5-17. [PMID: 38169072 DOI: 10.1002/ejhf.3024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Document Reviewers: Rudolf A. de Boer (CPG Review Co-ordinator) (Netherlands), P. Christian Schulze (CPG Review Co-ordinator) (Germany), Elena Arbelo (Spain), Jozef Bartunek (Belgium), Johann Bauersachs (Germany), Michael A. Borger (Germany), Sergio Buccheri (Sweden), Elisabetta Cerbai (Italy), Erwan Donal (France), Frank Edelmann (Germany), Gloria Färber (Germany), Bettina Heidecker (Germany), Borja Ibanez (Spain), Stefan James (Sweden), Lars Køber (Denmark), Konstantinos C. Koskinas (Switzerland), Josep Masip (Spain), John William McEvoy (Ireland), Robert Mentz (United States of America), Borislava Mihaylova (United Kingdom), Jacob Eifer Møller (Denmark), Wilfried Mullens (Belgium), Lis Neubeck (United Kingdom), Jens Cosedis Nielsen (Denmark), Agnes A. Pasquet (Belgium), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Bianca Rocca (Italy), Xavier Rossello (Spain), Leyla Elif Sade (United States of America/Türkiye), Hannah Schaubroeck (Belgium), Elena Tessitore (Switzerland), Mariya Tokmakova (Bulgaria), Peter van der Meer (Netherlands), Isabelle C. Van Gelder (Netherlands), Mattias Van Heetvelde (Belgium), Christiaan Vrints (Belgium), Matthias Wilhelm (Switzerland), Adam Witkowski (Poland), and Katja Zeppenfeld (Netherlands) All experts involved in the development of this Focused Update have submitted declarations of interest. These have been compiled in a report and simultaneously published in a supplementary document to the Focused Update. The report is also available on the ESC website www.escardio.org/guidelines See the European Heart Journal online for supplementary documents that include evidence tables.
Collapse
|
106
|
Kanai M, Minamisawa M, Motoki H, Seko Y, Kimura K, Okano T, Ueki Y, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Ozasa N, Kato T, Kuwahara K. Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure - Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry. Circ J 2023; 88:33-42. [PMID: 37544741 DOI: 10.1253/circj.cj-22-0712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Hyperpolypharmacy is associated with adverse outcomes in older adults, but because literature on its association with cardiovascular (CV) outcomes after acute decompensated heart failure (ADHF) is sparse, we investigated the relationships among hyperpolypharmacy, medication class, and death in patients with HF.Methods and Results: We evaluated the total number of medications prescribed to 884 patients at discharge following ADHF. Patients were categorized into nonpolypharmacy (<5 medications), polypharmacy (5-9 medications), and hyperpolypharmacy (≥10 medications) groups. We examined the relationship of polypharmacy status with the 2-year mortality rate. The proportion of patients taking ≥5 medications was 91.3% (polypharmacy, 55.3%; hyperpolypharmacy, 36.0%). Patients in the hyperpolypharmacy group showed worse outcomes than patients in the other 2 groups (P=0.002). After multivariable adjustment, the total number of medications was significantly associated with an increased risk of death (hazard ratio [HR] per additional increase in the number of medications, 1.05; 95% confidence interval [CI], 1.01-1.10; P=0.027). Although the number of non-CV medications was significantly associated with death (HR, 1.07; 95% CI, 1.02-1.13; P=0.01), the number of CV medications was not (HR, 1.01; 95% CI, 0.92-1.10; P=0.95). CONCLUSIONS Hyperpolypharmacy due to non-CV medications was associated with an elevated risk of death in patients after ADHF, suggesting the importance of a regular review of the prescribed drugs including non-CV medications.
Collapse
Affiliation(s)
- Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| |
Collapse
|
107
|
Onoue K. Optimizing Guideline-Directed Medical Therapy for Heart Failure - Challenges and Strategies. Circ J 2023; 88:31-32. [PMID: 38030299 DOI: 10.1253/circj.cj-23-0828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| |
Collapse
|
108
|
Cardelli LS, Cherbi M, Huet F, Schurtz G, Bonnefoy-Cudraz E, Gerbaud E, Bonello L, Leurent G, Puymirat E, Casella G, Delmas C, Roubille F. Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry. Pharmaceuticals (Basel) 2023; 16:1740. [PMID: 38139866 PMCID: PMC10747751 DOI: 10.3390/ph16121740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Beta blockers (BBs) are a cornerstone for patients with heart failure (HF) and ventricular dysfunction. However, their use in patients recovering from a cardiogenic shock (CS) remains a bone of contention, especially regarding whether and when to reintroduce this class of drugs. METHODS FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. Our aim was to compare outcomes (1-month and 1-year all-cause mortality) between CS patients taking and those not taking BBs in three scenarios: (1) at 24 h after CS; (2) patients who did or did not discontinue BBs within 24 h; and (3) patients who did or did not undergo the early introduction of BBs. RESULTS Among the 693 CS included, at 24 h after the CS event, 95 patients (13.7%) were taking BB, while 598 (86.3%) were not. Between the groups, there were no differences in terms of major comorbidities or initial CS triggers. Patients receiving BBs at 24 h presented a trend toward reduced all-cause mortality both at 1 month (aHR = 0.61, 95% CI 0.34 to 1.1, p = 0.10) and 1 year, which was, in both cases, not significant. Compared with patients who discontinued BBs at 24 h, patients who did not discontinue BBs showed lower 1-month mortality (aHR = 0.43, 95% CI 0.2 to 0.92, p = 0.03) and a trend to lower 1-year mortality. No reduction in outcomes was observed in patients who underwent an early introduction of BB therapy. CONCLUSIONS BBs are drugs of first choice in patients with HF and should also be considered early in patients with CS. In contrast, the discontinuation of BB therapy resulted in increased 1-month all-cause mortality and a trend toward increased 1-year all-cause mortality.
Collapse
Affiliation(s)
| | - Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France (C.D.)
| | - Fabien Huet
- Department of Cardiology, Centre Hospitalier Bretagne Atlantique, 56000 Vannes, France
| | - Guillaume Schurtz
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | | | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604 Pessac, France;
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI—UMR 1099, Univ Rennes 1, 35000 Rennes, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, 40131 Bologna, Italy
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France (C.D.)
- REICATRA, Institut Saint Jacques, 31059 Toulouse, France
| | - François Roubille
- PhyMedExp, INSERM, CNRS, Cardiology Department, INI-CRT, Université de Montpellier, 34295 Montpellier, France
| |
Collapse
|
109
|
Zhang H, Zhou Y, Cheng F, Zhu Y, Li N, Peng X, Wu M, Huang H, Zhang L, Liao M, Xiao S, Chen Y, Chen S, Liu Z, Yi L, Fan J, Zeng J. Prognostic impact of lung ultrasound detected B-lines on hospitalised ischaemic heart failure with mildly reduced ejection fraction patients. Open Heart 2023; 10:e002480. [PMID: 38065587 PMCID: PMC10711819 DOI: 10.1136/openhrt-2023-002480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Prognostic impact of lung ultrasound-derived B-lines (LUS-BL) in heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) patients remains elusive. We evaluated the correlation between LUS-BL and prognosis in HFmrEF patients. METHODS This is a subgroup analysis based on our previously published retrospective study with 1691 HFmrEF patients. This subgroup analysis involved 574 patients with LUS-BL results at admission. After discharge, patients underwent clinical follow-up for a minimum of 1 year through telephone, clinical visits or community visits. The primary endpoint was defined as cardiovascular (CV) event, including CV-related mortality or HF hospitalisation at 90 days and 1 year after discharge. RESULTS CV event at 90 days was significantly increased with higher LUS-BL number (0, 1-2, 3-9 and ≥10: 20%, 14%, 18% and 33%, p=0.008), while CV event rate at 1 year was similar among groups (45% vs 45% vs 42% vs 50%, p=0.573). Older age, hypertension (HR=2.06, 95% CI 1.31 to 3.25), higher right ventricular diameter (>23 mm, HR=2.008, 95% CI 1.37 to 2.94), increased ratio of early transmitral flow velocity to early mitral annular velocity (>24, HR=1.79, 95% CI 1.11 to 2.26) and higher LUS-BL number (>11, HR=1.510, 95% CI 1.01 to 2.26) were identified as independent determinants associated with increased risk of CV event at 90 days after discharge. The Harrell's C-Statistic analysis, based on the Cox regression models, demonstrated a significant improvement in the predictive ability of the model that incorporated both clinical and echocardiographic risk factors along with LUS-BL (areas under the curve (AUC)=0.72) compared with the model comprising only clinical risk factors and LUS-BL (AUC=0.69, p=0.036), or to the model with echocardiographic risk factors and LUS-BL (AUC=0.68, p=0.025). CONCLUSION In HFmrEF patients with ischaemic heart disease, admission LUS-BL>11 is independently associated with an increased risk of CV event at 90 days following discharge.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Yuying Zhou
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | | | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Na Li
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Xin Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Mingxin Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Lingling Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Min Liao
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Sha Xiao
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Yongliang Chen
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Sihao Chen
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Zhican Liu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Liqing Yi
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Jie Fan
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | | |
Collapse
|
110
|
Voors AA. Novel Recommendations for the Treatment of Patients With Heart Failure: 2023 Focused Update of the 2021 ESC Heart Failure Guidelines. J Card Fail 2023; 29:1667-1671. [PMID: 37666294 DOI: 10.1016/j.cardfail.2023.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Adriaan A Voors
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
| |
Collapse
|
111
|
Kerwagen F, Riemer U, Wachter R, von Haehling S, Abdin A, Böhm M, Schulz M, Störk S. Impact of the COVID-19 pandemic on implementation of novel guideline-directed medical therapies for heart failure in Germany: a nationwide retrospective analysis. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100778. [PMID: 38023333 PMCID: PMC10652117 DOI: 10.1016/j.lanepe.2023.100778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
Background Guideline-directed medical therapy (GDMT) is the cornerstone in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) and novel substances such as sacubitril/valsartan (S/V) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated marked clinical benefits. We investigated their implementation into real-world HF care in Germany before, during, and after the COVID-19 pandemic period. Methods The IQVIA LRx data set is based on ∼80% of 73 million people covered by the German statutory health insurance. Prescriptions of S/V were used as a proxy for HFrEF. Time trends were analysed between Q1/2016 and Q2/2023 for prescriptions for S/V alone and in combination therapy with SGLT2i. Findings The number of patients treated with S/V increased from 5260 in Q1/2016 to 351,262 in Q2/2023. The share of patients with combination therapy grew from 0.6% (29 of 5260) to 14.2% (31,128 of 219,762) in Q2/2021, and then showed a steep surge up to 54.8% (192,429 of 351,262) in Q2/2023, coinciding with the release of the European Society of Cardiology (ESC) guidelines for HF in Q3/2021. Women and patients aged >80 years were treated less often with combined therapy than men and younger patients. With the start of the COVID-19 pandemic, the number of patients with new S/V prescriptions dropped by 17.5% within one quarter, i.e., from 26,855 in Q1/2020 to 22,145 in Q2/2020, and returned to pre-pandemic levels only in Q1/2021. Interpretation The COVID-19 pandemic was associated with a 12-month deceleration of S/V uptake in Germany. Following the release of the ESC HF guidelines, the combined prescription of S/V and SGLT2i was readily adopted. Further efforts are needed to fully implement GDMT and strengthen the resilience of healthcare systems during public health crises. Funding Supported by Novartis Pharma GmbH, Nuremberg, Germany.
Collapse
Affiliation(s)
- Fabian Kerwagen
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Uwe Riemer
- Medical Department, Novartis Pharma GmbH, Nuremberg, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Amr Abdin
- Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany
| | - Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- German Institute for Drug Use Evaluation (DAPI), Berlin, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| |
Collapse
|
112
|
Kittleson MM. Management of Heart Failure in Hospitalized Patients. Ann Intern Med 2023; 176:ITC177-ITC192. [PMID: 38079639 DOI: 10.7326/aitc202312190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Heart failure affects more than 6 million people in the United States, and hospitalizations for decompensated heart failure confer a heavy toll in morbidity, mortality, and health care costs. Clinical trials have demonstrated effective interventions; however, hospitalization and mortality rates remain high. Key components of effective hospital care include appropriate diagnostic evaluation, triage and risk stratification, early implementation of guideline-directed medical therapy, adequate diuresis, and appropriate discharge planning.
Collapse
Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California (M.M.K.)
| |
Collapse
|
113
|
Mwita JC, Joubert A, Saidu H, Sani MU, Damasceno A, Mocumbi AO, Sinxadi P, Viljoen CA, Hoevelmann J, Gebreyesus MS, Denti P, Wasmann R, Maartens G, Wiesner L, Stewart S, Davison B, Cotter G, Sliwa K. Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200213. [PMID: 37811486 PMCID: PMC10556761 DOI: 10.1016/j.ijcrp.2023.200213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
Background Poor medication adherence leads to poor health outcomes and increased healthcare costs among patients with heart failure (HF). This study aimed to objectively assess medication adherence by measuring carvedilol and enalaprilat plasma concentrations among patients with HF. Methods The present sub-study of the Safety, Tolerability, and Efficacy of Rapid Optimization, helped by NT-proBNP testing, of Heart Failure therapies (STRONG-HF) study involved adult patients with acute HF admitted in two Mozambican and two Nigerian hospitals who were not optimally treated with oral enalapril and carvedilol. Patients in the high-intensity arm of the STRONG-HF study, and those not meeting the biomarker criteria for persistent congestion, were included in the "frequent visit" (FV) arm. In the FV arm, blood for bioanalysis of plasma enalaprilat or/and carvedilol was drawn at the 2,6,12th week post-discharge. Patients in the usual care arm of STRONG-HF were included in the "standard visit" (SV) arm, which followed the usual local practice with blood sampling in week 12. Results The study involved 113 (79 FV and 34 SV) participants with a mean age of 48.6 years and a mean left ventricular (LV) ejection fraction of 33.1%. Theenalaprilat below the lower level of quantification (LLOQ) was documented in 7.7%, 11.9%, and 15.6% of participants in FV during the 2,6 and 12th weeks. Carvedilol concentration below LLOQ was documented in 37%, 30%, and 44.4% of participants in the FV arm during the 2,6 and 12th weeks, respectively. For the SV arm, enalaprilat and carvedilol concentrations below LLOQ in the twelfth week were documented in 37.3% and 42.9% of patients, respectively. Conclusion Up to a third of patients using enalapril and carvedilol did not take any medication during the 12 weeks of follow-up. Non adherence was more common in patients who had less follow up, emphasizing the importance of close follow up to adherence. No adherence was also more common in medications know to have more side effects such as carvedilol.
Collapse
Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Andre Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Hadiza Saidu
- Department of Medicine Bayero University Kano & Murtala Muhammed Specialist Hospital, Kano, Nigeria
| | - Mahmoud Umar Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Instituto Nacional de Saúde, Vila de Marracuene, Mozambique
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC/UCT Platform for Pharmacogenomics Research and Translation, South African Medical Research Council, Cape Town, South Africa
| | - Charle Andre Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Manna Semere Gebreyesus
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Roeland Wasmann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Beth Davison
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Gad Cotter
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
114
|
Dixit NM, Parikh NU, Ziaeian B, Fonarow GC. Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients. Circ Heart Fail 2023; 16:e011218. [PMID: 37929591 PMCID: PMC10872946 DOI: 10.1161/circheartfailure.123.011218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown. METHODS Using a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction. Two population models were created to simulate this intervention, a clinical trial model, based on the participants in the STRONG-HF trial, and a real-world model, based on the Get With The Guidelines-HF registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both population models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a US health care sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled. RESULTS An intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios <$10 000 per quality-adjusted life-year in both models. Optimal quadruple GDMT implementation resulted in the most gains in life-years with incremental cost-effectiveness ratios of $60 000 and $54 000 in the clinical trial and real-world models, respectively. CONCLUSIONS An intensive GDMT optimization program for patients hospitalized with HF with reduced ejection fraction would be cost-effective and result in substantial gains in clinical outcomes, especially with the use of optimal quadruple GDMT. Clinicians, payers, and policymakers should prioritize the creation of such programs.
Collapse
Affiliation(s)
- Neal M. Dixit
- Division of Cardiovascular Medicine, Department of Medicine, University of California, Davis, Sacramento, California
| | - Neil U. Parikh
- School of Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Boback Ziaeian
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Gregg C. Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
115
|
Deniau B, Costanzo MR, Sliwa K, Asakage A, Mullens W, Mebazaa A. Acute heart failure: current pharmacological treatment and perspectives. Eur Heart J 2023; 44:4634-4649. [PMID: 37850661 DOI: 10.1093/eurheartj/ehad617] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 10/19/2023] Open
Abstract
Acute heart failure (AHF) represents the most frequent cause of unplanned hospital admission in patients older than 65 years. Symptoms and clinical signs of AHF (e.g. dyspnoea, orthopnoea, oedema, jugular vein distension, and variation of body weight) are mostly related to systemic venous congestion secondary to various mechanisms including extracellular fluids, increased ventricular filling pressures, and/or auto-transfusion of blood from the splanchnic into the pulmonary circulation. Thus, the initial management of AHF patients should be mostly based on decongestive therapies on admission followed, before discharge, by rapid implementation of guideline-directed oral medical therapies for heart failure. The therapeutic management of AHF requires the identification and rapid diagnosis of the disease, the diagnosis of the cause (or triggering factor), the evaluation of severity, the presence of comorbidities, and, finally, the initiation of a rapid treatment. The most recent guidelines from ESC and ACC/AHA/HFSA have provided updated recommendations on AHF management. Recommended pharmacological treatment for AHF includes diuretic therapy aiming to relieve congestion and achieve optimal fluid status, early and rapid initiation of oral therapies before discharge combined with a close follow-up. Non-pharmacological AHF management requires risk stratification in the emergency department and non-invasive ventilation in case of respiratory failure. Vasodilators should be considered as initial therapy in AHF precipitated by hypertension. On the background of recent large randomized clinical trials and international guidelines, this state-of-the-art review describes current pharmacological treatments and potential directions for future research in AHF.
Collapse
Affiliation(s)
- Benjamin Deniau
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
- UMR-S 942, INSERM, MASCOT, Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, France
| | | | - Karen Sliwa
- Cape Heart Institute, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, South Africa
| | - Ayu Asakage
- UMR-S 942, INSERM, MASCOT, Université de Paris Cité, Paris, France
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium
- Hasselt University, Diepenbeek/Hasselt, Belgium
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
- UMR-S 942, INSERM, MASCOT, Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, France
| |
Collapse
|
116
|
Chaikijurajai T, Rincon-Choles H, Tang WHW. Natriuretic peptide testing strategies in heart failure: A 2023 update. Adv Clin Chem 2023; 118:155-203. [PMID: 38280805 DOI: 10.1016/bs.acc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Natriuretic peptides (NPs), including B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP), have been recommended as standard biomarkers for diagnosing heart failure (HF), and one of the strongest risk predictors for mortality and HF hospitalization regardless of ejection fraction (EF) and etiology of HF. BNP is an active neurohormone opposing renin-angiotensin-aldosterone and sympathetic nervous system overactivated in HF, whereas NT-proBNP is an inactive prohormone released from cardiomyocytes in response to wall stress. Despite substantial advances in the development of guideline-directed medical therapy (GDMT) for HF with reduced EF, studies demonstrating direct benefits of NP-guided chronic HF therapy on mortality, HF hospitalization, and GDMT optimization have yielded conflicting results. However, accumulating evidence shows that achieving prespecified BNP or NT-proBNP target over time is significantly associated with favorable outcomes, suggesting that benefits of serially measured NPs may be limited to particular groups of HF patients, such as those with extreme levels of baseline BNP or NT-proBNP, which could represent severe phenotypes of HF associated with natriuretic peptide resistance or cardiorenal syndrome. Over the past decade, clinical utilization of BNP and NT-proBNP has been expanded, especially using serial NP measurements for guiding HF therapy, optimizing GDMT and identifying at-risk patients with HF phenotypes who may be minimally symptomatic or asymptomatic.
Collapse
Affiliation(s)
- Thanat Chaikijurajai
- Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hernan Rincon-Choles
- Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - W H Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
117
|
Garofalo M, Corso R, Tomasoni D, Adamo M, Lombardi CM, Inciardi RM, Gussago C, Di Mario C, Metra M, Pagnesi M. Inflammation in acute heart failure. Front Cardiovasc Med 2023; 10:1235178. [PMID: 38045909 PMCID: PMC10690826 DOI: 10.3389/fcvm.2023.1235178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Acute heart failure (AHF) represents a common clinical scenario that requires prompt evaluation and therapy and that is characterized by a high risk of mortality or subsequent rehospitalizations. The pathophysiology leading to AHF decompensation is still not fully understood. Significant activation of inflammatory pathways has been identified in patients with AHF, particularly in its most severe forms, and it has been hypothesized that systemic inflammation has a role in AHF pathogenesis. Several inflammatory mediators and cytokines, such as high sensitivity C-reactive protein, tumor necrosis factor-α, interleukin-6, interleukin-1, soluble suppression of tumorigenicity 2 and galectin-3, have been shown to play a role in the pathogenesis, development and worsening of this condition with an independent prediction of adverse outcomes. This manuscript reviews the prevalence and prognostic value of systemic inflammation in AHF, as well as the potential role of anti-inflammatory therapies, focusing on available evidence from clinical trials and ongoing studies.
Collapse
Affiliation(s)
- Manuel Garofalo
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Rossana Corso
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M. Lombardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M. Inciardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Cristina Gussago
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Di Mario
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
118
|
Jarjour M, Ducharme A. Optimization of GDMT for patients with heart failure and reduced ejection fraction: can physiological and biological barriers explain the gaps in adherence to heart failure guidelines? Drugs Context 2023; 12:2023-5-6. [PMID: 38021409 PMCID: PMC10664772 DOI: 10.7573/dic.2023-5-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Heart failure is a growing epidemic with high mortality rates and recurrent hospital admissions that creates a burden on affected individuals, their caregivers and the whole healthcare system. Throughout the years, many randomized trials have established the effectiveness of several pharmacological therapies and electrophysiological devices to reduce hospitalizations and improve quality of life and survival, mostly for patients with heart failure with reduced ejection fraction (HFrEF). These studies led to the publication of national societies' recommendations to guide clinicians in the management of HFrEF. Yet, many reports have shown significant care gaps in adherence to these recommendations in clinical practice, highlighting suboptimal use and/or dosing of evidence-based therapies. Adherence to guidelines has been shown to be associated with the best prognosis in HFrEF, with patients presenting with intolerances or contraindications having the highest risk of events; however, it remains unclear whether this association is causal or merely a marker of more advanced disease. Furthermore, individual characteristics may limit the possibility of reaching the targeted dosage of specific agents. Herein, we provide a comprehensive overview of clinicians' adherence to heart failure guidelines in a specialized real-life setting, particularly regarding use and optimization of guideline-derived medical therapies, as well as the implementation of more recent agents such as sacubitril/valsartan and SGLT2 inhibitors. We seek potential explanations for suboptimal treatment and its impact on patient outcomes.
Collapse
Affiliation(s)
- Marilyne Jarjour
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Canada
| |
Collapse
|
119
|
Schurtz G, Mewton N, Lemesle G, Delmas C, Levy B, Puymirat E, Aissaoui N, Bauer F, Gerbaud E, Henry P, Bonello L, Bochaton T, Bonnefoy E, Roubille F, Lamblin N. Beta-blocker management in patients admitted for acute heart failure and reduced ejection fraction: a review and expert consensus opinion. Front Cardiovasc Med 2023; 10:1263482. [PMID: 38050613 PMCID: PMC10693984 DOI: 10.3389/fcvm.2023.1263482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
The role of the beta-adrenergic signaling pathway in heart failure (HF) is pivotal. Early blockade of this pathway with beta-blocker (BB) therapy is recommended as the first-line medication for patients with HF and reduced ejection fraction (HFrEF). Conversely, in patients with severe acute HF (AHF), including those with resolved cardiogenic shock (CS), BB initiation can be hazardous. There are very few data on the management of BB in these situations. The present expert consensus aims to review all published data on the use of BB in patients with severe decompensated AHF, with or without hemodynamic compromise, and proposes an expert-recommended practical algorithm for the prescription and monitoring of BB therapy in critical settings.
Collapse
Affiliation(s)
- Guillaume Schurtz
- USICet Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Nathan Mewton
- Hôpital Cardio-Vasculaire Louis Pradel. Filière Insuffisance Cardiaque, Centre D'Investigation Clinique, INSERM 1407. Unité CarMeN, INSERM 1060, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Gilles Lemesle
- USICet Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
- Institut Pasteur de Lille, Unité INSERM UMR1011, Lille, France
- Faculté de Médecine de l’Université de Lille, Lille, France
- FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, Université de Lorraine, Nancy, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Nadia Aissaoui
- Médecine Intensive Réanimation, Cochin, AfterROSC, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Fabrice Bauer
- Heart Failure Network, Advanced Heart Failure Clinic and Pulmonary Hypertension Department, Cardiac Surgery Department, INSERM U1096, Rouen University Teaching Hospital, Rouen, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, INSERM U1045, Bordeaux University, Bordeaux, France
| | - Patrick Henry
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, INSERM U942, University of Paris, Paris, France
| | - Laurent Bonello
- Cardiology Department, APHM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, Aix-Marseille Univ, Marseille, France
| | - Thomas Bochaton
- Intensive Cardiological Care Division, Hospices Civils de Lyon-Hôpital Cardiovasculaire et Pulmonaire, Lyon, France
| | - Eric Bonnefoy
- Intensive Cardiological Care Division, Hospices Civils de Lyon-Hôpital Cardiovasculaire et Pulmonaire, Lyon, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, INSERM, CNRS, Université de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Cardiology Department, Heart and Lung Institute, University Hospital of Lille, Lille, France
- INSERM U1167, Institut Pasteur of Lille, Lille, France
| |
Collapse
|
120
|
Ismail TF. Predicting 30-Day Readmission in Patients With Heart Failure-Primary Versus Secondary Diagnosis: Does It Matter? Am J Cardiol 2023; 207:503-504. [PMID: 37739908 DOI: 10.1016/j.amjcard.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Tevfik F Ismail
- Department of Cardiology, Guy's and St Thomas' Hospital, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| |
Collapse
|
121
|
Barbieri A, Mantovani F. The Paradox of Choice in Transcatheter Edge-to-Edge Mitral Valve Repair for Functional Mitral Regurgitation: What Meta-Analyses Can and Can Not Tell Us. Am J Cardiol 2023; 207:515-517. [PMID: 37778909 DOI: 10.1016/j.amjcard.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, Modena, Italy.
| | | |
Collapse
|
122
|
Lavalle C, Di Lullo L, Jabbour JP, Palombi M, Trivigno S, Mariani MV, Summaria F, Severino P, Badagliacca R, Miraldi F, Bellasi A, Vizza CD. New Challenges in Heart Failure with Reduced Ejection Fraction: Managing Worsening Events. J Clin Med 2023; 12:6956. [PMID: 38002571 PMCID: PMC10672118 DOI: 10.3390/jcm12226956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with an established diagnosis of heart failure (HF) with reduced ejection fraction (HFrEF) are prone to experience episodes of worsening symptoms and signs despite continued therapy, termed "worsening heart failure" (WHF). Despite guideline-directed medical therapy, worsening of chronic heart failure accounts for almost 50% of all hospital admissions for HF, and patients experiencing WHF carry a substantially higher risk of death and hospitalization than patients with "stable" HF. New drugs are emerging as arrows in the quiver for clinicians to address the residual risk of HF hospitalization and cardiovascular deaths in patients with WHF. This question-and-answer-based review will discuss the emerging definition of WHF in light of the recent clinical consensus released by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC), the new therapeutic approaches to treat WHF and then move on to their timing and safety concerns (i.e., renal profile).
Collapse
Affiliation(s)
- Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi—Delfino Hospital, 00034 Rome, Italy;
| | - Jean Pierre Jabbour
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Marta Palombi
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Sara Trivigno
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | | | - Paolo Severino
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Fabio Miraldi
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Antonio Bellasi
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| |
Collapse
|
123
|
Cotter G, Davison BA, Lam CSP, Metra M, Ponikowski P, Teerlink JR, Mebazaa A. Acute Heart Failure Is a Malignant Process: But We Can Induce Remission. J Am Heart Assoc 2023; 12:e031745. [PMID: 37889197 PMCID: PMC10727371 DOI: 10.1161/jaha.123.031745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Acute heart failure is a common and increasingly prevalent condition, affecting >10 million people annually. For those patients who survive to discharge, early readmissions and death rates are >30% everywhere on the planet, making it a malignant condition. Beyond these adverse outcomes, it represents one of the largest drivers of health care costs globally. Studies in the past 2 years have demonstrated that we can induce remissions in this malignant process if therapy is instituted rapidly, at the first acute heart failure episode, using full doses of all available effective medications. Multiple studies have demonstrated that this goal can be achieved safely and effectively. Now the urgent call is for all stakeholders, patients, physicians, payers, politicians, and the public at large to come together to address the gaps in implementation and enable health care providers to induce durable remissions in patients with acute heart failure.
Collapse
Affiliation(s)
- Gad Cotter
- Heart InitiativeDurhamNC
- Momentum Research, IncDurhamNC
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
| | - Beth A. Davison
- Heart InitiativeDurhamNC
- Momentum Research, IncDurhamNC
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
| | - Carolyn S. P. Lam
- National Heart Centre SingaporeSingapore
- Duke–National University of SingaporeSingapore
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical UniversityWrocławPoland
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of MedicineUniversity of California San FranciscoSan FranciscoCA
| | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
- Department of Anesthesiology and Critical Care and Burn UnitSaint‐Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP NordParisFrance
| |
Collapse
|
124
|
Mastoris I, Gupta K, Sauer AJ. The War Against Heart Failure Hospitalizations: Remote Monitoring and the Case for Expanding Criteria. Cardiol Clin 2023; 41:557-573. [PMID: 37743078 DOI: 10.1016/j.ccl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Successful remote patient monitoring depends on bidirectional interaction between patients and multidisciplinary clinical teams. Invasive pulmonary artery pressure monitoring has been shown to reduce heart failure (HF) hospitalizations, facilitate guideline-directed medical therapy optimization, and improve quality of life. Cardiac implantable electronic device-based multiparameter monitoring has shown encouraging results in predicting future HF-related events. Potential expanded indications for remote monitoring include guideline-directed medical therapy optimization, application to specific populations, and subclinical detection of HF. Voice analysis, inferior vena cava diameter monitoring, and artificial intelligence-based remote electrocardiogram show potential to gain some merit in remote patient monitoring in HF.
Collapse
Affiliation(s)
- Ioannis Mastoris
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Kashvi Gupta
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA.
| |
Collapse
|
125
|
Dacunka M, Sanchez S, Raoul F, Chapoutot L, Maillier B, Marchais A. [Republication of: Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. Ann Cardiol Angeiol (Paris) 2023; 72:101680. [PMID: 37839136 DOI: 10.1016/j.ancard.2023.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.
Collapse
Affiliation(s)
- Marianne Dacunka
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Stéphane Sanchez
- Pôle territoriale Santé Publique et Performance, Centre Hospitalier de Troyes, Troyes France; Vieillissement fragilité, Université de Reims Champagne-Ardenne, Reims, EA3797 France.
| | - Florian Raoul
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Laurent Chapoutot
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Bruno Maillier
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Aurélie Marchais
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| |
Collapse
|
126
|
Khan MS, Singh S, Segar MW, Usman MS, Keshvani N, Ambrosy AP, Fiuzat M, Van Spall HGC, Fonarow GC, Zannad F, Felker GM, Januzzi JL, O'Connor C, Butler J, Pandey A. Polypharmacy and Optimization of Guideline-Directed Medical Therapy in Heart Failure: The GUIDE-IT Trial. JACC. HEART FAILURE 2023; 11:1507-1517. [PMID: 37115133 DOI: 10.1016/j.jchf.2023.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Polypharmacy is common among patients with heart failure with reduced ejection fraction (HFrEF). However, its impact on the use of optimal guideline-directed medical therapy (GDMT) is not well established. OBJECTIVES This study sought to evaluate the association between polypharmacy and odds of receiving optimal GDMT over time among patients with HFrEF. METHODS The authors conducted a post hoc analysis of the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment) trial. Polypharmacy was defined as receiving ≥5 medications (excluding HFrEF GDMT) at baseline. The outcome of interest was optimal triple therapy GDMT (concurrent administration of a renin-angiotensin-aldosterone blocker and beta-blocker at 50% of the target dose and a mineralocorticoid receptor antagonist at any dose) achieved over the 12-month follow-up. Multivariable adjusted mixed-effect logistic regression models with multiplicative interaction terms (time × polypharmacy) were constructed to evaluate how polypharmacy at baseline modified the odds of achieving optimal GDMT on follow-up. RESULTS The study included 891 participants with HFrEF. The median number of non-GDMT medications at baseline was 4 (IQR: 3-6), with 414 (46.5%) prescribed ≥5 and identified as being on polypharmacy. The proportion of participants who achieved optimal GDMT at the end of the 12-month follow-up was lower with vs without polypharmacy at baseline (15% vs 19%, respectively). In adjusted mixed models, the odds of achieving optimal GDMT over time were modified by baseline polypharmacy status (P for interaction < 0.001). Patients without polypharmacy at baseline had increased odds of achieving GDMT (OR: 1.16 [95% CI: 1.12-1.21] per 1-month increase; P < 0.001) but not patients with polypharmacy (OR: 1.01 [95% CI: 0.96-1.06)] per 1-month increase). CONCLUSIONS Patients with HFrEF who are on non-GDMT polypharmacy have lower odds of achieving optimal GDMT on follow-up.
Collapse
Affiliation(s)
- Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sumitabh Singh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Muhammad Shariq Usman
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Neil Keshvani
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Mona Fiuzat
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Harriette G C Van Spall
- Department of Medicine, Population Health Research Institute, Research Institute of St. Joseph's, McMaster University, Hamilton, Ontario, Canada
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Faiez Zannad
- Université de Lorraine, Inserm Centre d'Investigation, Centre Hospitalier Régional Universitaire, Université de Lorraine, Nancy, France
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
127
|
Contreras J, Tinuoye EO, Folch A, Aguilar J, Free K, Ilonze O, Mazimba S, Rao R, Breathett K. Heart Failure with Reduced Ejection Fraction and COVID-19, when the Sick Get Sicker: Unmasking Racial and Ethnic Inequities During a Pandemic. Cardiol Clin 2023; 41:491-499. [PMID: 37743072 PMCID: PMC10267502 DOI: 10.1016/j.ccl.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Minoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias, and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID-19 pandemic and its interconnection between heart failure and SDOH. The pandemic presents a window of opportunity for achieving greater equity in the health care of all vulnerable populations.
Collapse
Affiliation(s)
- Johanna Contreras
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Elizabeth O Tinuoye
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Alejandro Folch
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Jose Aguilar
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Kendall Free
- Department of Biofunction Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Onyedika Ilonze
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908-0158, USA
| | - Roopa Rao
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA.
| |
Collapse
|
128
|
Hu JR, Schwann AN, Tan JW, Nuqali A, Riello RJ, Beasley MH. Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter? Cardiol Clin 2023; 41:511-524. [PMID: 37743074 DOI: 10.1016/j.ccl.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
The conventional sequence of guideline-directed medical therapy (GDMT) initiation in heart failure with reduced ejection fraction (HFrEF) assumes that the effectiveness and tolerability of GDMT agents mirror their order of discovery, which is not true. In this review, the authors discuss flexible GDMT sequencing that should be permitted in special populations, such as patients with bradycardia, chronic kidney disease, or atrial fibrillation. Moreover, the initiation of certain GDMT medications may enable tolerance of other GDMT medications. Most importantly, the achievement of partial doses of all four pillars of GDMT is better than achievement of target dosing of only a couple.
Collapse
Affiliation(s)
- Jiun-Ruey Hu
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT 06520, USA. https://twitter.com/ruey_hu
| | - Alexandra N Schwann
- Department of Internal Medicine, Yale New Haven Hospital, P.O. Box 208030, New Haven, CT, 06520-8030, USA. https://twitter.com/aschwann212
| | - Jia Wei Tan
- Division of Nephrology, Stanford University School of Medicine, 780 Welch Road, Palo Alto, CA 94304, USA. https://twitter.com/jiiiiawei
| | - Abdulelah Nuqali
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT 06520, USA. https://twitter.com/AbdulelahNuqali
| | - Ralph J Riello
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT 06520, USA. https://twitter.com/ralphadelta
| | - Michael H Beasley
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT 06520, USA.
| |
Collapse
|
129
|
Charbonnel C, Jagu A, Vannier C, De Cordoue M, Aroulanda MJ, Lozinguez O, Komajda M, Garcon P, Antakly-Hanon Y, Moeuf Y, Lesage JB, Mantes L, Midey C, Izabel M, Boukefoussa W, Manne J, Standish B, Duc P, Iliou MC, Cador R. [Introduction of treatments for heart failure and reduced ejection fraction under 50 % : In-hospital optimization using an algorithmic approach]. Ann Cardiol Angeiol (Paris) 2023; 72:101640. [PMID: 37677914 DOI: 10.1016/j.ancard.2023.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Recent international guidelines recommend rapid initiation and titration of basic treatments of heart failure but do not explain how to achieve this goal. Despite these recommendations, implementation of treatment in daily practice is poor. This may be partly explained by the profile of the patients (frailty, comorbidities), safety considerations and tolerability issues related to kydney function, low blood pressure or heart rate and hyperkalaemia. In this special article, we intended to help the physician, through an algorithmic approach, to quickly and safely introduce guideline-directed medical therapy in the field of heart failure with ejection fraction under 50%.
Collapse
Affiliation(s)
- Clément Charbonnel
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Annabelle Jagu
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Claire Vannier
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Maylis De Cordoue
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Olivier Lozinguez
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Michel Komajda
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Garcon
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yara Antakly-Hanon
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yoann Moeuf
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Lucie Mantes
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Charlotte Midey
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Mathilde Izabel
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Wahiba Boukefoussa
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Julien Manne
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Brigitte Standish
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Duc
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Romain Cador
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| |
Collapse
|
130
|
Kosaraju RS, Fonarow GC, Ong MK, Heidenreich PA, Washington DL, Wang X, Ziaeian B. Geographic Variation in the Quality of Heart Failure Care Among U.S. Veterans. JACC. HEART FAILURE 2023; 11:1534-1545. [PMID: 37542510 PMCID: PMC10792103 DOI: 10.1016/j.jchf.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/09/2023] [Accepted: 06/05/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The burden of heart failure is growing. Guideline-directed medical therapies (GDMT) reduce adverse outcomes in heart failure with reduced ejection fraction (HFrEF). Whether there is geographic variation in HFrEF quality of care is not well described. OBJECTIVES This study evaluated variation nationally for prescription of GDMT within the Veterans Health Administration. METHODS A cohort of Veterans with HFrEF had their address linked to hospital referral regions (HRRs). GDMT prescription was defined using pharmacy data between July 1, 2020, and July 1, 2021. Within HRRs, we calculated the percentage of Veterans prescribed GDMT and a composite GDMT z-score. National choropleth maps were created to evaluate prescription variation. Associations between GDMT performance and demographic characteristics were evaluated using linear regression. RESULTS Maps demonstrated significant variation in the HRR composite score and GDMT prescriptions. Within HRRs, the prescription of beta-blockers to Veterans was highest with a median of 80% (IQR: 77.3%-82.2%) followed by angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitors (69.3%; IQR: 66.4%-72.1%), sodium-glucose cotransporter-2 inhibitors (10.3%; IQR: 7.7%-12.8%), mineralocorticoid receptor antagonists (29.2%; IQR: 25.8%-33.9%), and angiotensin receptor-neprilysin inhibitors (12.2%; IQR: 8.6%-15.3%). HRR composite GDMT z-scores were inversely associated with the HRR median Gini coefficient (R = -0.13; P = 0.0218) and the percentage of low-income residents (R = -0.117; P = 0.0413). CONCLUSIONS Wide geographic differences exist for HFrEF care. Targeted strategies may be required to increase GDMT prescription for Veterans in lower-performing regions, including those affected by income inequality and poverty.
Collapse
Affiliation(s)
- Revanth S Kosaraju
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. https://twitter.com/revanthsk12
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. https://twitter.com/gcfmd
| | - Michael K Ong
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Veterans Affairs Health Services Research and Development, Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Health Policy and Management, UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA. https://twitter.com/michael_ong
| | - Paul A Heidenreich
- Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA. https://twitter.com/paheidenreich
| | - Donna L Washington
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Veterans Affairs Health Services Research and Development, Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Xiaoyan Wang
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Veterans Affairs Health Services Research and Development, Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
| |
Collapse
|
131
|
Cavallari I, Crispino SP, Segreti A, Ussia GP, Grigioni F. Practical Guidance for the Use of SGLT2 Inhibitors in Heart Failure. Am J Cardiovasc Drugs 2023; 23:609-621. [PMID: 37620653 DOI: 10.1007/s40256-023-00601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
Despite continuous advances in both diagnosis and management, heart failure (HF) still represents a major worldwide health issue. Recently, sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated to reduce cardiovascular death and hospitalization for HF across the entire spectrum of left ventricular ejection fraction. Therefore, dapagliflozin, empagliflozin and sotagliflozin are now recommended as part of the foundational therapy of HF. These agents are characterized by limited contraindications, low cost, non-relevant adverse effects and no need for titration. Although they have a prominent role in the latest recommendations for HF, drug prescriptions are definitely lower than the number of potentially eligible patients. In fact, awareness gaps, therapeutic inertia, concerns about safety and simultaneous initiation of comprehensive medical therapy may represent barriers to their use. This article aims to offer an overview of current knowledge on SGLT2i in HF and provide a comprehensive and updated practical guide on their use in de novo and chronic HF, including potential scenarios that a clinician, cardiologist or others, may face in everyday clinical practice.
Collapse
Affiliation(s)
- Ilaria Cavallari
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Simone Pasquale Crispino
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Andrea Segreti
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome, Foro Italico, Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| |
Collapse
|
132
|
Brownell NK, Fonarow GC. Hospitalization for heart failure requires a PROMPT response. Eur Heart J 2023; 44:4243-4245. [PMID: 37670351 DOI: 10.1093/eurheartj/ehad444] [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: 09/07/2023] Open
Affiliation(s)
| | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, CA, USA
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, 10833 LeConte Ave, Room A2-237 CHS, Los Angeles, CA 90095, USA
| |
Collapse
|
133
|
Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 127] [Impact Index Per Article: 127.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
134
|
Gregson J, Stone GW, Bhatt DL, Packer M, Anker SD, Zeller C, Redfors B, Pocock SJ. Recurrent Events in Cardiovascular Trials: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1445-1463. [PMID: 37758440 DOI: 10.1016/j.jacc.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 10/03/2023]
Abstract
Many randomized trials in cardiovascular disease have repeat nonfatal events (such as hospitalizations) occurring during patient follow-up; yet, it remains common practice to have time-to-first event as the primary outcome. We explore the value of analyses that include repeat events. Do they help us understand the effect of treatment and total disease burden? Do they enhance statistical power? Should they become a trial's primary analysis? It may also be difficult to choose which of the various statistical methods for analyzing repeat events to use, and we provide a nontechnical guide to what each method is doing. We compare several methods for repeat events: Lin Wei Yang Ying, negative binomial, joint frailty, win ratio, and area under the curve. We illustrate their performance in 5 large cardiovascular trials and compare them with time-to-first-event analyses. We review their use in recently published heart failure trials and make recommendations for their use in future trials.
Collapse
Affiliation(s)
- John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Gregg W Stone
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA; Imperial College, London, United Kingdom
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Cardiovascular Research Foundation, New York, New York, USA
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
135
|
Oskouie S, Michael F, Whitelaw S, Bozkurt B, Fonarow GC, Van Spall HGC. A scoping review of heart failure transitional care quality indicators and outcomes for use in clinical care and research. Eur J Heart Fail 2023; 25:1842-1848. [PMID: 37401456 DOI: 10.1002/ejhf.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023] Open
Abstract
AIMS There are no accepted quality indicators for transitional care following hospitalization for heart failure (HF). Current quality measures focus on 30-day readmissions without accounting for competing risks such as death. In this scoping review of clinical trials, we aimed to develop a set of HF transitional care quality indicators for clinical or research applications following hospitalization for HF. METHODS AND RESULTS We performed a scoping review using MEDLINE, Embase, CINAHL, HealthSTAR, reference lists and grey literature from January 1990 to November 2022. We included randomized controlled trials (RCTs) of adults hospitalized for HF who received a healthcare service or strategy intervention that aimed to improve patient-reported or clinical outcomes. We independently extracted data and performed a qualitative synthesis of the results. We generated a list of process, structure, patient-reported, and clinical measures that could be used as quality indicators. We highlighted process indicators that were associated with improved clinical outcomes and patient-reported outcomes that had high adherence to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and United States Food and Drug Administration standards. From 42 RCTs included in the study, we identified a set of process, structure, patient-reported, and clinical indicators that could be used as transitional care measures in clinical or research settings. CONCLUSION In this scoping review, we developed a list of quality indicators that could guide clinical efforts or serve as research endpoints in transitional care in HF. Clinicians, researchers, institutions, and policymakers can use the indicators to guide management, design research, allocate resources, and fund services that improve clinical outcomes.
Collapse
Affiliation(s)
- Suzanne Oskouie
- Division of Cardiology, University of Arizona Sarver Heart Center, Tucson, AZ, USA
| | - Faith Michael
- Northern Ontario School of Medicine, Sudbury, ONT, Canada
| | - Sera Whitelaw
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Biykem Bozkurt
- Department of Medicine-Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Gregg C Fonarow
- Division of Cardiology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ONT, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ONT, Canada
- Population Health Research Institute, Hamilton, ONT, Canada
- Research Institute of St. Joseph's, Hamilton, ONT, Canada
- Baim Institute for Clinical Research, Boston, MA, USA
| |
Collapse
|
136
|
Brandenburg V, Saritas T, Schirmer SH, Rogacev K, Heine GH. [Cardiovascular treatment in chronic kidney disease]. Herz 2023; 48:413-424. [PMID: 37695534 DOI: 10.1007/s00059-023-05205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/12/2023]
Abstract
Patients with combined cardiac and renal diseases are particularly challenging in the routine clinical practice due to the substantial risk profile for increased morbidity and mortality. As cardiorenal patients have often been underrepresented in randomized, controlled interventional trials, guideline recommendations regarding the choice of treatment are often weaker for these individuals than for cardiovascular patients without chronic kidney disease. Furthermore, there are limitations in the approval of certain medications depending on the kidney function. This review addresses some considerations in crucial treatment areas for patients with cardiovascular diseases, whose treatment is significantly influenced by concomitant chronic kidney disease.
Collapse
Affiliation(s)
- Vincent Brandenburg
- Klinik für Kardiologie und Nephrologie, Rhein-Maas Klinikum GmbH, 52146, Würselen, Deutschland.
| | - Turgay Saritas
- Klinik für Nieren- und Hochdruckkrankheiten, Uniklinik der RWTH Aachen, Aachen, Deutschland
| | | | - Kyrill Rogacev
- Klinik für Kardiologie, Sana HANSE-Klinikum Wismar, Wismar, Deutschland
| | - Gunnar Henrik Heine
- Medizinische Klinik, AGAPLESION Markus-Krankenhaus, Frankfurt am Main, Deutschland
| |
Collapse
|
137
|
Girerd N, Leclercq C, Hanon O, Bayés-Genís A, Januzzi JL, Damy T, Lequeux B, Meune C, Sabouret P, Roubille F. Optimisation of treatments for heart failure with reduced ejection fraction in routine practice: a position statement from a panel of experts. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:813-820. [PMID: 36914024 DOI: 10.1016/j.rec.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023]
Abstract
Major international practice guidelines recommend the use of a combination of 4 medication classes in the treatment of patients with heart failure with reduced ejection fraction (HFrEF) but do not specify how these treatments should be introduced and up-titrated. Consequently, many patients with HFrEF do not receive an optimized treatment regimen. This review proposes a pragmatic algorithm for treatment optimization designed to be easily applied in routine practice. The first goal is to ensure that all 4 recommended medication classes are initiated as early as possible to establish effective therapy, even at a low dose. This is considered preferable to starting fewer medications at a maximum dose. The second goal is to ensure that the intervals between the introduction of different medications and between different titration steps are as short as possible to ensure patient safety. Specific proposals are made for older patients (> 75 years) who are frail, and for those with cardiac rhythm disorders. Application of this algorithm should allow an optimal treatment protocol to be achieved within 2-months in most patients, which should the treatment goal in HFrEF.
Collapse
Affiliation(s)
- Nicolas Girerd
- Centre d'Investigations Cliniques-Plurithématique (CIC-P) 14-33, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine, Nancy, France; Cardiovascular and Renal Clinical Trialists network (INI-CRCT), French Clinical Research Infrastructure Network (F-CRIN).
| | - Christophe Leclercq
- Service de Cardiologie, Centre Hospitalier Universitaire de Rennes, Université Rennes 1, Rennes, France; Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM) U642, CIC-IT, 804, Rennes, France
| | - Olivier Hanon
- Service de Gériatrie, Hôpitaux Universitaires Paris Centre, Gérontopôle d'Île-de-France, Université de Paris Cité, Paris, France
| | - Antoni Bayés-Genís
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States; Heart Failure and Biomarker Research, Baim Institute for Clinical Research, Boston, Massachusetts, United States
| | - Thibaut Damy
- Service de Cardiologie, Centre Hospitalier Universitaire Henri Mondor AP-HP, Creteil, France
| | - Benoit Lequeux
- Service de Cardiologie, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Christophe Meune
- Service de Cardiologie, Centre Hospitalier Universitaire Avicenne, Université Paris 13, Bobigny, France
| | - Pierre Sabouret
- Service de Cardiologie, Institut de Cardiologie, Centre Hospitalier Universitaire La Pitié Salpetrière, Sorbonne Université, Paris, France
| | - François Roubille
- Service de Cardiologie, PhyMedExp, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM) U1046, Centre National de la Recherche Scientifique (CNRS) UMR 9214, Montpellier, France
| |
Collapse
|
138
|
Dacunka M, Sanchez S, Raoul F, Chapoutot L, Maillier B, Marchais A. [Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. Ann Cardiol Angeiol (Paris) 2023; 72:101646. [PMID: 37689044 DOI: 10.1016/j.ancard.2023.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.
Collapse
Affiliation(s)
- Marianne Dacunka
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Stéphane Sanchez
- Pôle territoriale Santé Publique et Performance, Centre Hospitalier de Troyes, Troyes France; Vieillissement fragilité, Université de Reims Champagne-Ardenne, Reims, EA3797 France.
| | - Florian Raoul
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Laurent Chapoutot
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Bruno Maillier
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Aurélie Marchais
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| |
Collapse
|
139
|
Averbuch T, Greene SJ, Van Spall HGC. Guideline-Recommended Therapy Following Hospitalization for Heart Failure: Understanding the Gaps, Navigating the Barriers. JACC. HEART FAILURE 2023; 11:1333-1336. [PMID: 37793736 DOI: 10.1016/j.jchf.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Tauben Averbuch
- Department of Cardiology, University of Calgary, Calgary, Alberta, Canada
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
| |
Collapse
|
140
|
Martens P, Burkhoff D, Cowger JA, Jorde UP, Kapur NK, Tang WHW. Emerging Individualized Approaches in the Management of Acute Cardiorenal Syndrome With Renal Assist Devices. JACC. HEART FAILURE 2023; 11:1289-1303. [PMID: 37676211 DOI: 10.1016/j.jchf.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 09/08/2023]
Abstract
Growing insights into the pathophysiology of acute cardiorenal syndrome (CRS) in acute decompensated heart failure have indicated that not every rise in creatinine is associated with adverse outcomes. Detection of persistent volume overload and diuretic resistance associated with creatinine rise may identify patients with true acute CRS. More in-depth phenotyping is needed to identify pathologic processes in renal arterial perfusion, venous outflow, and microcirculatory-interstitial-lymphatic axis alterations that can contribute to acute CRS. Recently, various novel device-based interventions designed to target different pathophysiologic components of acute CRS are in early feasibility and proof-of-concept studies. However, appropriate trial endpoints that reflect improvement in cardiorenal trajectories remain elusive and highly debated. In this review the authors describe the variety of physiological derangements leading to acute CRS and the opportunity to individualize the management of acute CRS with novel renal assist devices that can target specific components of these alterations.
Collapse
Affiliation(s)
- Pieter Martens
- Kaufman Center for Heart Failure Treatment and Recovery, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jennifer A Cowger
- Division of Cardiovascular Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ulrich P Jorde
- Department of Medicine, Division of Cardiology, The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Navin K Kapur
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - W H Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
| |
Collapse
|
141
|
Bauersachs J, Soltani S. Sodium-glucose co-transporter 2 inhibitors and mineralocorticoid receptor antagonists synergism in heart failure: it takes two to tango. Eur Heart J 2023; 44:3697-3699. [PMID: 37611060 DOI: 10.1093/eurheartj/ehad540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, D- 30625 Hannover, Germany
| | - Samira Soltani
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, D- 30625 Hannover, Germany
| |
Collapse
|
142
|
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023; 44:3627-3639. [PMID: 37622666 DOI: 10.1093/eurheartj/ehad195] [Citation(s) in RCA: 250] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
143
|
Lam CSP, Docherty KF, Ho JE, McMurray JJV, Myhre PL, Omland T. Recent successes in heart failure treatment. Nat Med 2023; 29:2424-2437. [PMID: 37814060 DOI: 10.1038/s41591-023-02567-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
Remarkable recent advances have revolutionized the field of heart failure. Survival has improved among individuals with heart failure and a reduced ejection fraction and for the first time, new therapies have been shown to improve outcomes across the entire ejection fraction spectrum of heart failure. Great strides have been taken in the treatment of specific cardiomyopathies such as cardiac amyloidosis and hypertrophic cardiomyopathy, whereby conditions once considered incurable can now be effectively managed with novel genetic and molecular approaches. Yet there remain substantial residual unmet needs in heart failure. The translation of successful clinical trials to improved patient outcomes is limited by large gaps in implementation of care, widespread lack of disease awareness and poor understanding of the socioeconomic determinants of outcomes and how to address disparities. Ongoing clinical trials, advances in phenotype segmentation for precision medicine and the rise in technology solutions all offer hope for the future.
Collapse
Affiliation(s)
- Carolyn S P Lam
- Duke-NUS Medical School, Singapore, Singapore.
- National Heart Centre Singapore, Singapore, Singapore.
- University Medical Center Groningen, Groningen, the Netherlands.
| | - Kieran F Docherty
- University of Glasgow, School of Cardiovascular and Metabolic Health, Glasgow, UK
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John J V McMurray
- University of Glasgow, School of Cardiovascular and Metabolic Health, Glasgow, UK
| | - Peder L Myhre
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| |
Collapse
|
144
|
Moghaddam N, Lindsay MP, Hawkins NM, Anderson K, Ducharme A, Lee DS, McKelvie R, Poon S, Desmarais O, Desbiens M, Virani S. Access to Heart Failure Services in Canada: Findings of the Heart and Stroke National Heart Failure Resources and Services Inventory. Can J Cardiol 2023; 39:1469-1479. [PMID: 37422257 DOI: 10.1016/j.cjca.2023.06.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND The rising incidence of heart failure (HF) in Canada necessitates commensurate resources dedicated to its management. Several health system partners launched an HF Action Plan to understand the current state of HF care in Canada and address inequities in access and resources. METHODS A national Heart Failure Resources and Services Inventory (HF-RaSI) was conducted from 2020 to 2021 of all 629 acute care hospitals and 20 urgent care centres in Canada. The HF-RaSI consisted of 44 questions on available resources, service,s and processes across acute care hospitals and related ambulatory settings. RESULTS HF-RaSIs were completed by 501 acute care hospitals and urgent care centres, representing 94.7% of all HF hospitalisations across Canada. Only 12.2% of HF care was provided by hospitals with HF expertise and resources, and 50.9% of HF admissions were in centres with minimal outpatient or inpatient HF capabilities. Across all Canadian hospitals, 28.7% did not have access to B-type natriuretic peptide testing, and only 48.1% had access to on-site echocardiography. Designated HF medical directors were present at 21.6% of sites (108), and 16.2% sites (81) had dedicated inpatient interdisciplinary HF teams. Among all of the sites, 28.1% (141) were HF clinics, and of those, 40.4% (57) had average wait times from referral to first appointment of more than 2 weeks. CONCLUSIONS Significant gaps and geographic variation in delivery and access to HF services exist in Canada. This study highlights the need for provincial and national health systems changes and quality improvement initiatives to ensure equitable access to the appropriate evidence-based HF care.
Collapse
Affiliation(s)
- Nima Moghaddam
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Anderson
- Dalhousie, University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Anique Ducharme
- Institut de Cardiologie, de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Robert McKelvie
- St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Stephanie Poon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sean Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
145
|
Bozkurt B, Savarese G, Adamsson Eryd S, Bodegård J, Cleland JGF, Khordoc C, Kishi T, Thuresson M, Vardeny O, Zhang R, Lund LH. Mortality, Outcomes, Costs, and Use of Medicines Following a First Heart Failure Hospitalization: EVOLUTION HF. JACC. HEART FAILURE 2023; 11:1320-1332. [PMID: 37354145 DOI: 10.1016/j.jchf.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND There are few contemporary data on outcomes, costs, and treatment following a hospitalization for heart failure (hHF) in epidemiologically representative cohorts. OBJECTIVES This study sought to describe rehospitalizations, hospitalization costs, use of guideline-directed medical therapy (GDMT) (renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors), and mortality after hHF. METHODS EVOLUTION HF (Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients: A Multinational Observational Study Based on Secondary Data) is an observational, longitudinal cohort study using data from electronic health records or claims data sources in Japan, Sweden, the United Kingdom, and the United States. Adults with a first hHF discharge between 2018 and 2022 were included. The 1-year event rates per 100 patient-years (ERs) for death and rehospitalizations (with a primary diagnosis of heart failure (HF), chronic kidney disease [CKD], myocardial infarction, stroke, or peripheral artery disease) were calculated. Hospital health care costs were cumulatively summarized. Cumulative GDMT use was assessed using Kaplan-Meier estimates. RESULTS Of 263,525 patients, 28% died within the first year post-hHF (ER: 28.4 [95% CI: 27.0-29.9]). Rehospitalizations were mainly driven by HF (ER: 13.6 [95% CI: 9.8-17.4]) and CKD (ER: 4.5 [95% CI: 3.6-5.3]), whereas the ERs for myocardial infarction, stroke, and peripheral artery disease were lower. Health care costs were predominantly driven by HF and CKD. Between 2020 and 2022, use of renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor antagonists changed little, whereas uptake of sodium-glucose cotransporter-2 inhibitors increased 2- to 7-fold. CONCLUSIONS Incident post-hHF rehospitalization risks and costs were high, and GDMT use changed little in the year following discharge, highlighting the need to consider earlier and greater implementation of GDMT to manage risks and reduce costs.
Collapse
Affiliation(s)
- Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Gianluigi Savarese
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Johan Bodegård
- CVRM Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Cindy Khordoc
- Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware, USA
| | - Takuya Kishi
- Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, Okawa, Japan
| | | | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ruiqi Zhang
- Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, London, United Kingdom
| | - Lars H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
146
|
Galati G, Germanova O, Pedretti RFE, Ambrosio G. Hypotension and optimization of heart failure therapy after a recent hospitalization for heart failure: When the going gets tough, the tough get going. Int J Cardiol 2023; 388:131118. [PMID: 37321330 DOI: 10.1016/j.ijcard.2023.131118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Giuseppe Galati
- Unit of Cardiology, Cardiovascular Department, I.R.C.C.S. Multimedica, Milan, Italy; International Centre for Education and Research in Cardiovascular pathology and Cardiovisualization, Samara state medical university, Samara, Russia.
| | - Olga Germanova
- International Centre for Education and Research in Cardiovascular pathology and Cardiovisualization, Samara state medical university, Samara, Russia
| | | | - Giuseppe Ambrosio
- Division of Cardiology, and Center for Clinical and Translational Research (CERICLET), University of Perugia School of Medicine, Perugia, Italy
| |
Collapse
|
147
|
Linde C. Will the results from the AdaptResponse trial boost CRT use? Lancet 2023; 402:1110-1112. [PMID: 37634522 DOI: 10.1016/s0140-6736(23)01313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/22/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Cecilia Linde
- Heart, Vascular and Neurology Theme, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, 171 77 Stockholm, Sweden.
| |
Collapse
|
148
|
Morton G, Moore J. Systems of care for heart failure: bridging the divide between primary care and specialist services. Heart 2023; 109:1564-1570. [PMID: 37147130 DOI: 10.1136/heartjnl-2022-321757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Affiliation(s)
- Geraint Morton
- Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Jim Moore
- Gloucestershire Heart Failure Service, Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| |
Collapse
|
149
|
Chioncel O, Benson L, Crespo-Leiro MG, Anker SD, Coats AJS, Filippatos G, McDonagh T, Margineanu C, Mebazaa A, Metra M, Piepoli MF, Adamo M, Rosano GMC, Ruschitzka F, Savarese G, Seferovic P, Volterrani M, Ferrari R, Maggioni AP, Lund LH. Comprehensive characterization of non-cardiac comorbidities in acute heart failure: an analysis of ESC-HFA EURObservational Research Programme Heart Failure Long-Term Registry. Eur J Prev Cardiol 2023; 30:1346-1358. [PMID: 37172316 DOI: 10.1093/eurjpc/zwad151] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/14/2023]
Abstract
AIMS To evaluate the prevalence and associations of non-cardiac comorbidities (NCCs) with in-hospital and post-discharge outcomes in acute heart failure (AHF) across the ejection fraction (EF) spectrum. METHODS AND RESULTS The 9326 AHF patients from European Society of Cardiology (ESC)-Heart Failure Association (HFA)-EURObservational Research Programme Heart Failure Long-Term Registry had complete information for the following 12 NCCs: anaemia, chronic obstructive pulmonary disease (COPD), diabetes, depression, hepatic dysfunction, renal dysfunction, malignancy, Parkinson's disease, peripheral vascular disease (PVD), rheumatoid arthritis, sleep apnoea, and stroke/transient ischaemic attack (TIA). Patients were classified by number of NCCs (0, 1, 2, 3, and ≥4). Of the AHF patients, 20.5% had no NCC, 28.5% had 1 NCC, 23.1% had 2 NCC, 15.4% had 3 NCC, and 12.5% had ≥4 NCC. In-hospital and post-discharge mortality increased with number of NCCs from 3.0% and 18.5% for 1 NCC to 12.5% and 36% for ≥4 NCCs.Anaemia, COPD, PVD, sleep apnoea, rheumatoid arthritis, stroke/TIA, Parkinson, and depression were more prevalent in HF with preserved EF (HFpEF). The hazard ratio (95% confidence interval) for post-discharge death for each NCC was for anaemia 1.6 (1.4-1.8), diabetes 1.2 (1.1-1.4), kidney dysfunction 1.7 (1.5-1.9), COPD 1.4 (1.2-1.5), PVD 1.2 (1.1-1.4), stroke/TIA 1.3 (1.1-1.5), depression 1.2 (1.0-1.5), hepatic dysfunction 2.1 (1.8-2.5), malignancy 1.5 (1.2-1.8), sleep apnoea 1.2 (0.9-1.7), rheumatoid arthritis 1.5 (1.1-2.1), and Parkinson 1.4 (0.9-2.1). Anaemia, kidney dysfunction, COPD, and diabetes were associated with post-discharge mortality in all EF categories, PVD, stroke/TIA, and depression only in HF with reduced EF, and sleep apnoea and malignancy only in HFpEF. CONCLUSION Multiple NCCs conferred poor in-hospital and post-discharge outcomes. Ejection fraction categories had different prevalence and risk profile associated with individual NCCs.
Collapse
Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Lina Benson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maria G Crespo-Leiro
- Cardiology Department Complexo Hospitalario Universitario A Coruna, (CHUAC), CIBERCV, INIBIC, UDC, La Coruna, Spain
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany
- Charité Universitätsmedizin, Berlin, Germany
| | - Andrew J S Coats
- Heart Research Institute, Sydney, Monash University, Sidney, Australia
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, University of Athens, Athens, Greece
- School of Medicine, University of Cyprus, Nicosia, Cyprus
| | - Theresa McDonagh
- Department of Cardiology, King's College Hospital London, London, UK
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Cornelia Margineanu
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Alexandre Mebazaa
- University of Paris Diderot, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, Paris, France
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Massimo F Piepoli
- Cardiology, IRCCS PoliclinicoSan Donato, San Donato Milanese, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, University of Milan, Milan, Italy
| | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe M C Rosano
- Cardiology Clinical Academy Group, St Georges Hospital NHS Trust, University of London, London, UK
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | | | | | - Lars H Lund
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
150
|
Dörr M. Liver, kidney, blood, and joints: the underestimated impact of non-cardiac comorbidities in acute heart failure. Eur J Prev Cardiol 2023; 30:1343-1345. [PMID: 37219916 DOI: 10.1093/eurjpc/zwad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Greifswald, Greifswald, Germany
| |
Collapse
|