151
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Starling RC. Augmenting outcomes in advanced heart failure: a lot to learn. Eur J Heart Fail 2016; 18:326-7. [DOI: 10.1002/ejhf.488] [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: 12/21/2015] [Revised: 12/26/2015] [Accepted: 12/27/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Randall C. Starling
- Kaufman Center for Heart Failure; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; 9500 Euclid Avenue Cleveland OH 44195 USA
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152
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In-hospital management of acute heart failure: Practical recommendations and future perspectives. Int J Cardiol 2015; 201:231-6. [DOI: 10.1016/j.ijcard.2015.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/26/2015] [Accepted: 08/01/2015] [Indexed: 01/15/2023]
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153
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Abstract
Heart failure (HF) is a growing global health concern that affects more than 20 million people worldwide. With an ever-growing segment of the population over the age of 65, the prevalence of HF and its associated costs are expected to increase exponentially over the next decade. Advances in the understanding of the pathophysiology and treatment of HF have resulted in the ability to enhance both the quantity and the quality of life of patients with HF. This article reviews the current understanding of the pathophysiology, cause, classification, and treatment of HF and describes areas of uncertainty that demand future study.
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Affiliation(s)
- Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Mariell Jessup
- Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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154
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Bagnato S, Minà C, Sant’Angelo A, Boccagni C, Prestandrea C, Caronia A, Clemenza F, Galardi G. Occurrence of neuropathies in patients with severe heart failure before and after heart transplantation. Neurol Sci 2015; 37:393-401. [DOI: 10.1007/s10072-015-2413-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
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155
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Ujeyl A, Krüger M. [Rise of the machines? Left ventricular assist devices for treatment of severe heart failure]. Herz 2015; 40:972-9. [PMID: 26530283 DOI: 10.1007/s00059-015-4365-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of left ventricular assist devices (LVAD) as a treatment for severe heart failure has gained momentum in recent years. Even at this stage the number of worldwide LVAD implantations far exceeds the volume of heart transplantations in view of the chronic shortage of donor organs. Third generation continuous flow assist devices have helped to improve survival, quality of life and symptom burden of heart failure patients in comparison to a regimen of optimal medication management. Alongside bridging to transplantation, destination therapy has become an established strategy of LVAD implantation. A careful patient selection process is crucial for a good clinical outcome after device implantation and risk assessment for postoperative right ventricular failure is of particular importance in this context. The rate of hospitalization during LVAD support is still high, despite the step-wise attempts to widen the indications to less severely ill heart failure patients. An effective perioperative and postoperative management will help to lower the incidence of complications (e.g. bleeding, infections, thromboembolic events and right ventricular failure) and to improve the encouraging results of mechanical circulatory support.
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Affiliation(s)
- A Ujeyl
- Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland.
| | - M Krüger
- Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland
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156
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Background and design of the profiling biobehavioral responses to mechanical support in advanced heart failure study. J Cardiovasc Nurs 2015; 29:405-15. [PMID: 23839571 DOI: 10.1097/jcn.0b013e318299fa09] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Unexplained heterogeneity in response to ventricular assist device (VAD) implantation for the management of advanced heart failure impedes our ability to predict favorable outcomes, provide adequate patient and family education, and personalize monitoring and symptom management strategies. The purpose of this article was to describe the background and the design of a study entitled "Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure" (PREMISE). STUDY DESIGN AND METHODS PREMISE is a prospective cohort study designed to (1) identify common and distinct trajectories of change in physical and psychological symptom burden; (2) characterize common trajectories of change in serum biomarkers of myocardial stress, systemic inflammation, and endothelial dysfunction; and (3) quantify associations between symptoms and biomarkers of pathogenesis in adults undergoing VAD implantation. Latent growth mixture modeling, including parallel process and cross-classification modeling, will be used to address the study aims and will entail identifying trajectories, quantifying associations between trajectories and both clinical and quality-of-life outcomes, and identifying predictors of favorable symptom and biomarker responses to VAD implantation. CONCLUSIONS Research findings from the PREMISE study will be used to enhance shared patient and provider decision making and to shape a much-needed new breed of interventions and clinical management strategies that are tailored to differential symptom and pathogenic responses to VAD implantation.
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157
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Hu D, Liu Y, Tao H, Gao J. Clinical value of plasma B-type natriuretic peptide assay in pediatric pneumonia accompanied by heart failure. Exp Ther Med 2015; 10:2175-2179. [PMID: 26668612 DOI: 10.3892/etm.2015.2781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 06/30/2015] [Indexed: 12/31/2022] Open
Abstract
Previous studies have shown that B-type natriuretic peptide (BNP) is useful in differentiating cardiac from pulmonary causes of dyspnea in adults. To date, international guidelines have recommended measurements of circulating BNP as a biomarker for diagnostic and prognostic purposes, as well as therapeutic monitoring, in adults with cardiac diseases, particularly those suffering from acute and chronic heart failure (HF). The aim of the present study was to investigate the differential diagnostic and therapeutic analysis of BNP levels assayed in pediatric pneumonia accompanied by HF. The clinical data of 80 patients with pneumonia, aged 1-3 years, were analyzed. The patients were divided into two groups: Simple pneumonia (46 cases) and pneumonia accompanied by HF (34 cases). All patients underwent two plasma BNP assays: The first one upon admission to the hospital and the second one prior to discharge. The plasma BNP levels of 20 healthy children were used as the negative control. Plasma BNP levels were measured using the Triage® BNP automated immunoassay systems and reagents. Statistical analysis showed that the plasma BNP levels of the patients upon admission were higher in the pneumonia accompanied by HF group compared with those in the simple pneumonia group (750±120 vs. 135±50 pg/ml; P<0.05). In addition, in the pneumonia accompanied by HF group, the plasma BNP levels of the patients were higher upon admission to the hospital than they were prior to discharge (750±120 vs. 115±45 pg/ml; P<0.05); therefore, plasma BNP may comprise a sensitive diagnostic and therapeutic evaluative marker for pediatric patients with pneumonia accompanied by HF. This finding could prove invaluable in the clinical diagnosis and treatment of the disease.
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Affiliation(s)
- Dan Hu
- Department of Pediatrics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Yang Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Huixian Tao
- Department of Pediatrics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Jinping Gao
- Department of Pediatrics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu 215600, P.R. China
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158
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Triantafyllis AS, Kortlandt F, Bakker ALM, Swaans MJ, Eefting FD, van der Heyden JAS, Post MC, Rensing BWJM. Long-term survival and preprocedural predictors of mortality in high surgical risk patients undergoing percutaneous mitral valve repair. Catheter Cardiovasc Interv 2015; 87:467-75. [PMID: 26268819 DOI: 10.1002/ccd.26137] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 04/29/2015] [Accepted: 07/11/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate long-term survival in high surgical risk patients undergoing percutaneous mitral valve repair (MVR) using the MitraClip(®) system and to identify preprocedural predictors of long-term mortality. BACKGROUND Data for long-term survival and preprocedural predictors of mortality after percutaneous MVR in high surgical risk patients are sporadic. METHODS From January 2009 to April 2013, 136 consecutive high surgical risk patients, with symptomatic moderate-to-severe or severe mitral regurgitation (MR), underwent percutaneous MVR using the MitraClip system. Cardiac and overall survival was determined at one and 2 years postprocedure. Univariate and multivariate analysis was performed to identify preprocedural predictors of long-term mortality. RESULTS One year postprocedure, cardiac and overall survival was 86.7% and 84.6%, respectively and at 2 years cardiac and overall survival was 77.7% and 74.8%, respectively. In univariate analysis advanced age, lower body mass index, impaired renal function, elevated levels of log-N-terminal-pro-brain-natriuretic-peptide (log-NTproBNP), poor performance in functional tests (New York Heart Association (NYHA) class) and high logistic Euroscore (LES) and Society of Thoracic Surgeons (STS) score were identified as preprocedural predictors of long-term cardiac mortality. In multivariate analysis preoperative NYHA class III and IV, elevated levels of log-NTproBNP and advanced age predicted long-term cardiac mortality. CONCLUSIONS Percutaneous MVR using the MitraClip system has favorable long-term survival rates in high surgical risk patients. Preprocedural NYHA functional class III and IV, elevated log-NTproBNP levels and advanced age predict higher long-term cardiac mortality and should be considered during patient selection.
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Affiliation(s)
| | - Friso Kortlandt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Annelies L M Bakker
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Frank D Eefting
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Martijn C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Benno W J M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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159
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Lee SA, Cha MJ, Cho Y, Oh IY, Choi EK, Oh S. Paced QRS duration and myocardial scar amount: predictors of long-term outcome of right ventricular apical pacing. Heart Vessels 2015; 31:1131-9. [PMID: 26142378 DOI: 10.1007/s00380-015-0707-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 06/19/2015] [Indexed: 11/28/2022]
Abstract
Long-term right ventricular apical pacing (RVAP) is reportedly associated with heart failure (HF) development. However, the predictors of pacing-induced HF (PHF) remained unclear. We retrospectively enrolled 234 patients without structural heart disease who underwent a permanent pacemaker implantation with RVAP between 1982 and 2004. RVAP-induced HF was defined as left ventricular ejection fraction decrease >5 % with HF symptom without other HF development etiology. The QRS duration of a paced beat (pQRSd) and myocardial scar score were analyzed from each patient's 12-lead ECG. During a mean 15.6 years (range 3.3-30.0 years), 48 patients (20.5 %) patients developed RVAP-induced HF. The PHF group patients had a longer pQRSd (192.4 ± 13.5 vs. 175.7 ± 14.7 ms in non-PHF patients, p < 0.001) and a higher myocardial scar score (5.2 ± 1.9 vs. 2.7 ± 1.9, respectively p < 0.001). In multivariate Cox regression analysis, old age at implantation [Hazard ratio (HR) 1.62, 95 % confidential interval (CI) 1.22-2.16, p = 0.001], a longer pQRSd (HR 1.54, 95 % CI 1.15-2.05, p = 0.003), a higher myocardial scar score (HR 1.23, 95 % CI 1.03-1.49, p = 0.037), and a higher percentage of ventricular pacing (HR 1.31, 95 % CI 1.01-1.49, p = 0.010) were independent predictors of PHF. Based on the results of the receiver-operating characteristic (ROC) curve, the pQRSd cutoff was 185 ms (AUC 0.79, sensitivity 66.7 %, specificity 76.3 %) and myocardial scar score cutoff value was 4 (AUC 0.81, sensitivity 81.3 %, specificity 66.1 %). The pQRSd was positively correlated with scar score (r = 0.70, p < 0.001). pQRSd ≥185 ms and/or myocardial scar score ≥4 might be independent long-term prognostic markers of PHF.
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Affiliation(s)
- Seung-Ah Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
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160
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161
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Frea S, Bovolo V, Pidello S, Canavosio FG, Botta M, Bergerone S, Gaita F. Clinical and prognostic role of ammonia in advanced decompensated heart failure. The cardio-abdominal syndrome? Int J Cardiol 2015; 195:53-60. [PMID: 26022800 DOI: 10.1016/j.ijcard.2015.05.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/29/2015] [Accepted: 05/08/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Advanced heart failure is associated with end-organ damage. Recent literature suggested an intriguing crosstalk between failing heart, abdomen and kidneys. Venous ammonia, as a by-product of the gut, could be a marker of abdominal injury in heart failure patients. The aim of the study was to investigate the clinical and prognostic role of ammonia in patients with advanced decompensated heart failure (ADHF). METHODS & RESULTS 90 patients admitted with ADHF were prospectively studied. The prognostic role of ammonia at admission was evaluated. Primary end-points were: a composite of cardiac death, urgent heart transplantation and mechanical circulatory support at 3 months and need for renal replacement therapies (RRT). In the study cohort (age 59.0 ± 12.0 years, FE 21.6 ± 9.0%, INTERMACS profile 3.7 ± 0.9, creatinine 1.71 ± 0.95 mg/dl) 27 patients (30%) underwent the cardiac composite endpoint, while 9 patients (10%) needed RRT. At ROC curve analysis ammonia ≥ 130 μg/dl (abdominal damage) showed the best diagnostic accuracy. At multivariate analysis abdominal damage predicted the cardiac composite endpoint. Abdominal damage further increased risk among patient with cold profile at admission (HR 2.7, 95% CI 1.1-7.0, p = 0.046). At multivariate analysis abdominal damage also predicted need for RRT (OR 10.8, 95% CI 1.5-75.8, p = 0.017). The combined use of estimated right atrial pressure and ammonia showed the highest diagnostic accuracy and a very high specificity in prediction of need for RRT. CONCLUSION In a selected population admitted for ADHF ammonia, as a marker of abdominal derangement, predicted adverse cardiac events and need for RRT.
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Affiliation(s)
- Simone Frea
- Cardiovascular and Thoracic Department, Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy
| | - Virginia Bovolo
- Cardiovascular and Thoracic Department, Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy
| | - Stefano Pidello
- Cardiovascular and Thoracic Department, Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
| | - Federico G Canavosio
- Cardiovascular and Thoracic Department, Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy
| | - Michela Botta
- Cardiovascular and Thoracic Department, Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy
| | - Serena Bergerone
- Cardiovascular and Thoracic Department, Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy
| | - Fiorenzo Gaita
- Cardiovascular and Thoracic Department, Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy
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162
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Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee. J Card Fail 2015; 21:519-34. [PMID: 25953697 DOI: 10.1016/j.cardfail.2015.04.013] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 12/26/2022]
Abstract
We propose that stage D advanced heart failure be defined as the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy. Importantly, the progressive decline should be primarily driven by the heart failure syndrome. Formally defining advanced heart failure and specifying when medical and device therapies have failed is challenging, but signs and symptoms, hemodynamics, exercise testing, biomarkers, and risk prediction models are useful in this process. Identification of patients in stage D is a clinically important task because treatments are inherently limited, morbidity is typically progressive, and survival is often short. Age, frailty, and psychosocial issues affect both outcomes and selection of therapy for stage D patients. Heart transplant and mechanical circulatory support devices are potential treatment options in select patients. In addition to considering indications, contraindications, clinical status, and comorbidities, treatment selection for stage D patients involves incorporating the patient's wishes for survival versus quality of life, and palliative and hospice care should be integrated into care plans. More research is needed to determine optimal strategies for patient selection and medical decision making, with the ultimate goal of improving clinical and patient centered outcomes in patients with stage D heart failure.
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163
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Y Birati E, Jessup M. Left Ventricular Assist Devices in the Management of Heart Failure. Card Fail Rev 2015; 1:25-30. [PMID: 28785427 PMCID: PMC5491024 DOI: 10.15420/cfr.2015.01.01.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/04/2015] [Indexed: 11/04/2022] Open
Abstract
Mechanical circulatory support has emerged as an important therapy for advanced heart failure, with more than 18,000 continuous flow devices implanted worldwide to date. These devices significantly improve survival and quality of life and should be considered in every patient with end-stage heart failure with reduced ejection fraction who has no other life-limiting diseases. All candidates for device implantation should undergo a thorough evaluation in order to identify those who could benefit from device implantation. Long-term management of ventricular assist device patients is challenging and requires knowledge of the characteristic complications with their unique clinical presentations.
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Affiliation(s)
- Edo Y Birati
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mariell Jessup
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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164
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Gavazzi A, De Maria R, Manzoli L, Bocconcelli P, Di Leonardo A, Frigerio M, Gasparini S, Humar F, Perna G, Pozzi R, Svanoni F, Ugolini M, Deales A. Palliative needs for heart failure or chronic obstructive pulmonary disease: Results of a multicenter observational registry. Int J Cardiol 2015; 184:552-558. [DOI: 10.1016/j.ijcard.2015.03.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/26/2015] [Accepted: 03/03/2015] [Indexed: 01/07/2023]
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165
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Campbell RT, Jackson CE, Wright A, Gardner RS, Ford I, Davidson PM, Denvir MA, Hogg KJ, Johnson MJ, Petrie MC, McMurray JJV. Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design. ESC Heart Fail 2015; 2:25-36. [PMID: 27347426 PMCID: PMC4864752 DOI: 10.1002/ehf2.12027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 01/29/2023] Open
Abstract
Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near‐consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2‐year period. All potential participants will be screened using B‐type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease‐specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF.
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Affiliation(s)
- Ross T Campbell
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ann Wright
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics University of Glasgow UK
| | | | | | | | | | - Mark C Petrie
- Robertson Centre for Biostatistics University of Glasgow UK
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
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166
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Dor V. Remodelado ventricular postinfarto de miocardio. Interés de la resonancia magnética cardíaca para destacar su fisiopatología y la eficacia de la reconstrucción ventricular. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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167
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168
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Physical and psychological symptom profiling and event-free survival in adults with moderate to advanced heart failure. J Cardiovasc Nurs 2015; 29:315-23. [PMID: 23416942 DOI: 10.1097/jcn.0b013e318285968a] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
UNLABELLED : Heart failure (HF) is a heterogeneous symptomatic disorder. The goal of this study was to identify and link common profiles of physical and psychological symptoms to 1-year event-free survival in adults with moderate to advanced HF. METHODS Multiple valid, reliable, and domain-specific measures were used to assess physical and psychological symptoms. Latent class mixture modeling was used to identify distinct symptom profiles. Associations between observed symptom profiles and 1-year event-free survival were quantified using Cox proportional hazards modeling. RESULTS The mean age of the participants (n = 202) was 57 ± 13 years, 50% were men, and 60% had class III/IV HF. Three distinct profiles, mild (41.7%), moderate (30.2%), and severe (28.1%), that captured a gradient of both physical and psychological symptom burden were identified (P < .001 for all comparisons). Controlling for the Seattle HF Score, adults with the moderate symptom profile were 82% more likely (hazard ratio, 1.82; 95% confidence interval, 1.07-3.11; P = .028) and adults with the severe symptom profile were more than twice as likely (hazard ratio, 2.06; 95% confidence interval, 1.21-3.52; P = .001) to have a clinical event within 1 year than patients with the mild symptom profile. CONCLUSIONS Profiling patterns among physical and psychological symptoms identifies HF patient subgroups with significantly worse 1-year event-free survival independent of prognostication based on objective clinical HF data.
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169
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Frea S, Pidello S, Canavosio FG, Bovolo V, Botta M, Bergerone S, Gaita F. Clinical Assessment of Hypoperfusion in Acute Heart Failure. Circ J 2015; 79:398-405. [DOI: 10.1253/circj.cj-14-1052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Simone Frea
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino
| | - Stefano Pidello
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino
| | - Federico G. Canavosio
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino
| | - Virginia Bovolo
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino
| | - Michela Botta
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino
| | - Serena Bergerone
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino
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170
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Malfatto G, Della Rosa F, Rella V, Villani A, Branzi G, Blengino S, Giglio A, Facchini M, Parati G. Prognostic value of noninvasive hemodynamic evaluation of the acute effect of levosimendan in advanced heart failure. J Cardiovasc Med (Hagerstown) 2014; 15:322-30. [PMID: 24699010 DOI: 10.2459/01.jcm.0000435614.40439.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Optimization of inotropic treatment in worsening heart failure sometimes requires invasive hemodynamic assessment in selected patients. Impedance cardiography (ICG) may be useful for a noninvasive hemodynamic evaluation. METHODS ICG was performed in 40 patients (69 ± 8 years; left ventricular ejection fraction 27.5 ± 5.6%; New York Heart Association 3.18 ± 0.34; Interagency Registry for Mechanically Assisted Circulatory Support 5.48 ± 0.96, before and after infusion of Levosimendan (0.1–0.2 µg/kg per min for up to 24 h). Echocardiogram, ICG [measuring cardiac index (CI), total peripheral resistances (TPRs) and thoracic fluid content (TFC)] and plasma levels of brain natriuretic peptide (BNP) were obtained; in nine patients, right heart catheterization was also carried out. RESULTS When right catheterization and ICG were performed simultaneously, a significant relationship was observed between values of CI and TPR, and between TFC and pulmonary wedge pressure. ICG detected the Levosimendan-induced recovery of the hemodynamic status, associated with improved systolic and diastolic function and reduction in BNP levels. One-year mortality was 4.4%. At multivariate analysis, independent predictors of mortality were: no improvement in the severity of mitral regurgitation, a persistent restrictive filling pattern (E/E’ > 15), a reduction of BNP levels below 30% and a change below 10% in CI, TPR and TFC. When combined, absence of hemodynamic improvement at ICG could predict 1-year mortality with better sensitivity (86%) and specificity (85%) than the combination of echocardiographic and BNP criteria only (sensitivity 80% and specificity 36%). CONCLUSION Noninvasive hemodynamic evaluation of heart failure patients during infusion of inodilator drugs is reliable and may help in their prognostic stratification.
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171
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Halbreiner MS, Soltesz E, Starling R, Moazami N. Current Practice in Patient Selecting for Long-Term Mechanical Circulatory Support. Curr Heart Fail Rep 2014; 12:120-9. [DOI: 10.1007/s11897-014-0243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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172
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Joyce E, Nohria A. Therapeutic Adjustments in Stage D Heart Failure: Challenges and Strategies. Curr Heart Fail Rep 2014; 12:15-23. [DOI: 10.1007/s11897-014-0240-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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173
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Mahr C, Gundry RL. Hold or fold--proteins in advanced heart failure and myocardial recovery. Proteomics Clin Appl 2014; 9:121-33. [PMID: 25331159 DOI: 10.1002/prca.201400100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/17/2014] [Accepted: 10/14/2014] [Indexed: 12/14/2022]
Abstract
Advanced heart failure (AHF) describes the subset of heart failure patients refractory to conventional medical therapy. For some AHF patients, the use of mechanical circulatory support (MCS) provides an intermediary "bridge" step for transplant-eligible patients or an alternative therapy for transplant-ineligible patients. Over the past 20 years, clinical observations have revealed that approximately 1% of patients with MCS undergo significant reverse remodeling to the point where the device can be explanted. Unfortunately, it is unclear why some patients experience durable, sustained myocardial remission, while others redevelop heart failure (i.e. which hearts "hold" and which hearts "fold"). In this review, we outline unmet clinical needs related to treating patients with MCS, provide an overview of protein dynamics in the reverse-remodeling process, and propose specific areas where we expect MS and proteomic analyses will have significant impact on our understanding of disease progression, molecular mechanisms of recovery, and provide new markers with prognostic value that can positively impact patient care. Complimentary perspectives are provided with the goal of making this important topic accessible and relevant to both a clinical and basic science audience, as the intersection of these disciplines is required to advance the field.
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Affiliation(s)
- Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, WA, USA
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174
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Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, Jaarsma T, Krum H, Rastogi V, Rohde LE, Samal UC, Shimokawa H, Budi Siswanto B, Sliwa K, Filippatos G. Heart failure: preventing disease and death worldwide. ESC Heart Fail 2014; 1:4-25. [DOI: 10.1002/ehf2.12005] [Citation(s) in RCA: 712] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | | | - Khalid F. AlHabib
- King Fahad Cardiac Centre; King Saud University; Riyadh Saudi Arabia
| | - Martin R. Cowie
- National Heart and Lung Institute; Imperial College London (Royal Brompton Hospital); London UK
| | - Thomas L. Force
- Center for Translational Medicine and Cardiology Division; Temple University School of Medicine; Philadelphia PA USA
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Tiny Jaarsma
- Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Vishal Rastogi
- Medical Advanced Heart Failure Program; Fortis Escorts Heart Institute; New Delhi India
| | - Luis E. Rohde
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Medical School of the Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Umesh C. Samal
- Heart Failure Subspecialty; Cardiological Society of India; Kolkata India
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine; University of Indonesia, National Cardiovascular Center Harapan Kita; Jakarta Indonesia
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences; University of Cape Town, Cape Town, and Soweto Cardiovascular Research Unit, University of the Witwatersrand; Johannesburg South Africa
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital; University of Athens; Athens Greece
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175
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Alraies MC, Eckman P. Adult heart transplant: indications and outcomes. J Thorac Dis 2014; 6:1120-8. [PMID: 25132979 DOI: 10.3978/j.issn.2072-1439.2014.06.44] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/03/2014] [Indexed: 12/14/2022]
Abstract
Cardiac transplantation is the treatment of choice for many patients with end-stage heart failure (HF) who remain symptomatic despite optimal medical therapy. For carefully selected patients, heart transplantation offers markedly improved survival and quality of life. Risk stratification of the large group of patients with end-stage HF is essential for identifying patients who are most likely to benefit, particularly as the number of suitable donors is insufficient to meet demand. The indications for heart transplant and review components of the pre-transplant evaluation, including the role for exercise testing and risk scores such as the Heart Failure Survival Score (HFSS) and Seattle Heart Failure Model (SHFM) are summarized. Common contraindications are also discussed. Outcomes, including survival and common complications such as coronary allograft vasculopathy are reviewed.
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Affiliation(s)
- M Chadi Alraies
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Peter Eckman
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
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176
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Don-Wauchope AC, Santaguida PL, McKelvie R, Brown JA, Oremus M, Ali U, Bustamam A, Sohel N, Hill SA, Booth RA, Balion C, Raina P. Prediction of clinical outcomes using B-type natriuretic peptides in the general population: a systematic review. Heart Fail Rev 2014; 19:541-51. [PMID: 25052419 DOI: 10.1007/s10741-014-9446-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The use of B-type natriuretic peptides to predict outcomes in general populations has been investigated in a number of primary studies. A previous systematic review considering natriuretic peptides in cardiovascular disease included a subgroup of general population studies, which suggested an association with a number of clinical outcomes. We electronically searched Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and mid-2012. We utilized trained reviewers and standardized forms to screen articles for inclusion and extract data from included articles. All included studies (n = 7) were summarized in narrative and tabular form. A general population was defined as one that was randomly selected from a community setting where no specific inclusion or exclusion criteria were specified. The seven included studies all used FDA approved assays for NT-proBNP. The range of clinical outcomes and heterogeneity did not allow for meta-analysis. The hazard ratios for predicting outcomes in the included studies ranged from 1.0 to 4.1 (all p values <0.05). The discrimination statistics reported in four studies all demonstrated statistically significant improvements in predicting outcomes. NT-proBNP is associated with heart failure, all-cause and cardiovascular mortality, and other combined cardiovascular events in a general unselected population. The discrimination statistics suggest modest improvements in risk stratification. No prospective studies exist to demonstrate the clinical utility of using B-type natriuretic peptides to predict clinical outcomes in a general population.
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Affiliation(s)
- Andrew C Don-Wauchope
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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177
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Dorent R, Cantrelle C, Jasseron C, Legeai C. La greffe cardiaque en France : bilan actuel. Presse Med 2014; 43:813-22. [DOI: 10.1016/j.lpm.2014.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/18/2014] [Indexed: 12/01/2022] Open
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178
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García-González MJ, de Mora-Martín M, López-Fernández S, López-Díaz J, Martínez-Sellés M, Romero-García J, Cordero M, Lara-Padrón A, Marrero-Rodríguez F, del Mar García-Saiz M, Aldea-Perona A. Rationale and design of a randomized, double-blind, placebo controlled multicenter trial to study efficacy, security, and long term effects of intermittent repeated levosimendan administration in patients with advanced heart failure: LAICA study. Cardiovasc Drugs Ther 2014; 27:573-9. [PMID: 23887741 PMCID: PMC3830203 DOI: 10.1007/s10557-013-6476-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Advanced heart failure (HF) is associated with high morbidity and mortality; it represents a major burden for the health system. Episodes of acute decompensation requiring frequent and prolonged hospitalizations account for most HF-related expenditure. Inotropic drugs are frequently used during hospitalization, but rarely in out-patients. The LAICA clinical trial aims to evaluate the effectiveness and safety of monthly levosimendan infusion in patients with advanced HF to reduce the incidence of hospital admissions for acute HF decompensation. METHODS The LAICA study is a multicenter, prospective, randomized, double-blind, placebo-controlled, parallel group trial. It aims to recruit 213 out-patients, randomized to receive either a 24-h infusion of levosimendan at 0.1 μg/kg/min dose, without a loading dose, every 30 days, or placebo. RESULTS The main objective is to assess the incidence of admission for acute HF worsening during 12 months. Secondarily, the trial will assess the effect of intermittent levosimendan on other variables, including the time in days from randomization to first admission for acute HF worsening, mortality and serious adverse events. CONCLUSIONS The LAICA trial results could allow confirmation of the usefulness of intermittent levosimendan infusion in reducing the rate of hospitalization for HF worsening in advanced HF outpatients.
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Affiliation(s)
- Martín J García-González
- Department of Cardiology, Hospital Universitario de Canarias, Ctra. La Cuesta - Taco, Ofra s/n, 38320, San Cristóbal de La Laguna, Sta. Cruz de Tenerife, Spain,
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A systematic review of BNP and NT-proBNP in the management of heart failure: overview and methods. Heart Fail Rev 2014; 19:413-9. [DOI: 10.1007/s10741-014-9440-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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180
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Advanced Heart Failure Unit. Notf Rett Med 2014. [DOI: 10.1007/s10049-013-1783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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181
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Nieminen M, Altenberger J, Ben-Gal T, Böhmer A, Comin-Colet J, Dickstein K, Édes I, Fedele F, Fonseca C, García-González M, Giannakoulas G, Iakobishvili Z, Jääskeläinen P, Karavidas A, Kettner J, Kivikko M, Lund L, Matskeplishvili S, Metra M, Morandi F, Oliva F, Parkhomenko A, Parissis J, Pollesello P, Pölzl G, Schwinger R, Segovia J, Seidel M, Vrtovec B, Wikström G. Repetitive use of levosimendan for treatment of chronic advanced heart failure: Clinical evidence, practical considerations, and perspectives: An expert panel consensus. Int J Cardiol 2014; 174:360-7. [DOI: 10.1016/j.ijcard.2014.04.111] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/14/2014] [Accepted: 04/09/2014] [Indexed: 01/19/2023]
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182
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Ammirati E, Oliva F, Cannata A, Contri R, Colombo T, Martinelli L, Frigerio M. Current indications for heart transplantation and left ventricular assist device: a practical point of view. Eur J Intern Med 2014; 25:422-9. [PMID: 24641806 DOI: 10.1016/j.ejim.2014.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 01/21/2023]
Abstract
Heart transplantation (HTx) is considered the "gold standard" therapy of refractory heart failure (HF), but it is accessible only to few patients because of the paucity of suitable heart donors. On the other hand, left ventricular assist devices (LVADs) have proven to be effective in improving survival and quality of life in patients with refractory HF. The challenge encountered by multidisciplinary teams in dealing with advanced HF lies in identifying patients who could benefit more from HTx as compared to LVAD implantation and the appropriate timing. The decision-making is based on clinical parameters, imaging-based data and risk scores. Current outcome of HF patients supported by LVAD (2-year survival around 70%) is rapidly improving and leads the way to a new therapeutic strategy. Patients who have a low likelihood to gain access to the heart graft pool could benefit more from LVAD implantation (defined as bridge to transplantation indication) than from remaining on HTx waiting list with the likely risk of clinical deterioration or removal from the list because patients are no longer suitable for transplantation. LVAD has also demonstrated to be effective in patients who are not considered eligible candidates for HTx with a destination therapy indication. HTx should be reserved to those patients for whom the maximum clinical benefit can be expected, such as young patients with no comorbidities. Here we discuss the current listing criteria for HTx and indications to implant of LVAD for patients with refractory acute and chronic HF based on the guidelines and the practical experience of our center.
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Affiliation(s)
- Enrico Ammirati
- Cardio-thoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy; San Raffaele Hospital and Vita-Salute University, Milan, Italy.
| | - Fabrizio Oliva
- Cardio-thoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Aldo Cannata
- Cardio-thoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Rachele Contri
- San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Tiziano Colombo
- Cardio-thoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Luigi Martinelli
- Cardio-thoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Maria Frigerio
- Cardio-thoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
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183
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Buonocore D, Wallace E. Comprehensive Guideline for Care of Patients With Heart Failure. AACN Adv Crit Care 2014. [DOI: 10.4037/nci.0000000000000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. More than 5.1 million people are living with HF in the United States today. This number will continue to rise with the increase in the aging population. With so many people living with HF, nurses need to be well versed on how best to care for them. The 2013 American College of Cardiology Foundation/American Heart Association guideline for the management of HF is a comprehensive guide for all clinicians caring for patients with HF. The updated guideline was developed to assist providers in decision making in the diagnosis and treatment of HF. The goals of the writing committee were to improve quality of care for patients with HF, optimize their outcomes, and improve the efficient use of various resources in the treatment of patients with HF.
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Affiliation(s)
- Denise Buonocore
- Denise Buonocore is Acute Care Nurse Practitioner for HF Service, St. Vincent’s Multispecialty Group, 2800 Main St, Bridgeport, CT 06606 . Elizabeth Wallace is Nurse Practitioner for Cardiology Service, St. Vincent’s Multispecialty Group, Bridgeport, Connecticut
| | - Elizabeth Wallace
- Denise Buonocore is Acute Care Nurse Practitioner for HF Service, St. Vincent’s Multispecialty Group, 2800 Main St, Bridgeport, CT 06606 . Elizabeth Wallace is Nurse Practitioner for Cardiology Service, St. Vincent’s Multispecialty Group, Bridgeport, Connecticut
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184
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Gong H, Wang X, Ling Y, Shi Y, Shi H. Prognostic value of brain natriuretic peptide in patients with heart failure and reserved left ventricular systolic function. Exp Ther Med 2014; 7:1506-1512. [PMID: 24926333 PMCID: PMC4043600 DOI: 10.3892/etm.2014.1635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/11/2014] [Indexed: 11/05/2022] Open
Abstract
Brain natriuretic peptide (BNP) is used as a prognostic biomarker for patients with heart failure (HF) in clinical practice, however, the correlation between BNP levels and the prognosis of HF in patients with reserved left ventricular systolic function (RLVSF) is not clear. Thus, the aim of the present study was to evaluate the added value of BNP in the prognosis of HF patients with RLVSF. Inpatients with cardiovascular disease (mean age, 65.7 years; male, 790; female, 625) admitted to the Division of Cardiology at Jinshan Hospital of Fudan University (Shanghai, China) between June 2006 and December 2009 underwent follow-up examinations. Plasma BNP levels were analyzed and measurements of the left ventricular ejection fraction (LVEF) were performed by echocardiography. Evaluations of the patients with HF were performed according to the New York Heart Association (NYHA) classification system. The duration of the follow-up period ranged between 21 and 63 months (average duration, 35.8 months) and key events included cardiovascular mortality, readmission due to cardiovascular disease or mortality due to other reasons. Survival times decreased with increasing BNP levels in all the follow-up patients (Spearman's ρ, -0.1877; P<0.0001). Among the 1,415 patients, 1,312 underwent echocardiographic detection. A total of 395 patients with NYHA classes II-IV and a LVEF ≥45% were selected. The incidence of compound endpoint events was significantly higher in the patients that had BNP levels of >100 pg/ml when compared with the patients that had BNP levels of ≤100 pg/ml (37.07 vs. 23.93%; relative risk, 1.55); consequently the survival times were significantly reduced (P=0.0039). A negative correlation was identified between the BNP levels and the survival times in these patients (Spearman's ρ, -0.1738; P=0.0005). These results indicated that the levels of BNP may be used to predict the prognosis of patients with cardiovascular disease. The prognoses of patients with higher BNP levels were worse compared with the patients with lower BNP levels. Furthermore, significant correlations were confirmed in the HF patients with RLVSF.
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Affiliation(s)
- Hui Gong
- Division of Cardiology, Department of Medicine, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
| | - Xin Wang
- Division of Cardiology, Department of Medicine, Jinshan Hospital of Fudan University, Shanghai 201508, P.R. China
| | - Yi Ling
- Division of Cardiology, Department of Medicine, Jinshan Hospital of Fudan University, Shanghai 201508, P.R. China
| | - Yijun Shi
- Division of Cardiology, Department of Medicine, Jinshan Hospital of Fudan University, Shanghai 201508, P.R. China
| | - Haiming Shi
- Division of Cardiology, Department of Medicine, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
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185
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Risk Stratification in Acute Heart Failure. Can J Cardiol 2014; 30:312-9. [DOI: 10.1016/j.cjca.2014.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/02/2014] [Accepted: 01/02/2014] [Indexed: 12/19/2022] Open
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186
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Tasal A, Demir M, Kanadasi M, Bacaksiz A, Vatankulu MA, Sahin DY, Eker RA, Bozkurt A, Acarturk E. Comparison of single-dose and repeated levosimendan infusion in patients with acute exacerbation of advanced heart failure. Med Sci Monit 2014; 20:276-82. [PMID: 24549281 PMCID: PMC3937020 DOI: 10.12659/msm.889767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/08/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Levosimendan (LS) is a novel inodilator that improves cardiac performance, central hemodynamics, and symptoms of patients with decompensated chronic heart failure. The aim of this study was to compare the effects of single and repeated LS infusion on left ventricular performance, biomarkers, and neurohormonal activation in patients with acute heart failure. MATERIAL AND METHODS Twenty-nine consecutive patients with acute exacerbation of advanced heart failure were included in this study. LS was initiated as a bolus of 6 μg/kg followed by a continuous infusion of 0.1 μg/kg/min for 24 hours in both groups who received intravenous single and repeated (baseline and at 1 and 3 months) treatment. Physical examination, echocardiography, and biochemical tests (brain natriuretic peptide, tumour necrosis factor-alpha, interleukin-1beta, 2, and 6) were performed before treatment and on 3 day of the treatment. The last evaluation was performed at 6 month after the baseline treatment. RESULTS Twenty male and 9 female patients with mean age of 60.2 ± 7.4 years were included in this study. A significant improvement in New York Heart Association functional status and myocardial performance index was detected only in the repeated LS treated patients at 6 month compared to the pretreatment status (p=0.03 and p<0.001; respectively). In addition, a significant decrease in brain natriuretic peptide (p<0.01) and plasma interleukin-6 (p=0.05) levels were also achieved only in patients who were given repeated LS. CONCLUSIONS Our study showed that repeated LS treatment is more effective compared to the single dose LS treatment in improving clinical status, hemodynamic and laboratory parameters in patients with acute exacerbation of advanced heart failure.
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Affiliation(s)
- Abdurrahman Tasal
- Department of Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mesut Demir
- Department of Cardiology, Cukurova University, Adana, Turkey
| | - Mehmet Kanadasi
- Department of Cardiology, Cukurova University, Adana, Turkey
| | - Ahmet Bacaksiz
- Department of Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Durmus Yıldıray Sahin
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | | | - Abdi Bozkurt
- Department of Cardiology, Cukurova University, Adana, Turkey
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187
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Hjelmfors L, Strömberg A, Friedrichsen M, Mårtensson J, Jaarsma T. Communicating prognosis and end-of-life care to heart failure patients: A survey of heart failure nurses’ perspectives. Eur J Cardiovasc Nurs 2014; 13:152-61. [DOI: 10.1177/1474515114521746] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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188
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Parissis JT, Farmakis D, Fountoulaki K, Rigas A, Nikolaou M, Paraskevaidis IA, Bistola V, Venetsanou K, Ikonomidis I, Anastasiou-Nana M, Kremastinos DT, Filippatos G. Clinical and neurohormonal correlates and prognostic value of serum prolactin levels in patients with chronic heart failure. Eur J Heart Fail 2014; 15:1122-30. [DOI: 10.1093/eurjhf/hft070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- John T. Parissis
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Dimitrios Farmakis
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Katerina Fountoulaki
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Antonios Rigas
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Maria Nikolaou
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Ioannis A. Paraskevaidis
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Vassiliki Bistola
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Koula Venetsanou
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Ignatios Ikonomidis
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Maria Anastasiou-Nana
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Dimitrios T. Kremastinos
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
| | - Gerasimos Filippatos
- Second Department of Cardiology and Heart Failure Unit; University of Athens Medical School, Attiko University Hospital; Athens Greece
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Intermittent levosimendan improves mid-term survival in chronic heart failure patients: meta-analysis of randomised trials. Clin Res Cardiol 2013; 103:505-13. [PMID: 24368740 DOI: 10.1007/s00392-013-0649-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
AIMS Standard inotropic treatment is often necessary in end-stage heart failure but may be harmful. We performed a meta-analysis of randomized controlled trials to investigate the effect of repeated administration of levosimendan on survival in patients with chronic heart failure. METHODS AND RESULTS Four investigators independently searched in CENTRAL, Google Scholar MEDLINE/PubMed, Scopus and the Cochrane Central Register of clinical trials to identify any randomized study ever performed with intermittent levosimendan intravenous administration in adult patients with chronic heart failure with no restrictions on dose or time of administration. Data from a total of 326 patients from six randomized controlled studies using intermittent levosimendan in a cardiological setting were included in the analysis. Levosimendan was associated with a significant reduction in mortality at the longest follow-up available [32 of 168 (19 %) in the levosimendan group 46 of 133 (35 %) in the control arm, RR = 0.55 (95 % CI 0.37-0.84), p for effect = 0 0.005, p for heterogeneity = 0.3, I (2) = 23.4 %, NNT = 6 with 5 studies included]. Brain natriuretic peptide values, ejection fraction and number of patients with New York Heart Association ≥ III status were similar in survivors of both groups. CONCLUSIONS A large randomized trial is necessary to confirm the promising beneficial effects of intermittent levosimendan administration on the mid-term survival of patients with chronic heart failure.
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Risk factors for onset of depression after heart failure hospitalization. J Cardiol 2013; 64:37-42. [PMID: 24331765 DOI: 10.1016/j.jjcc.2013.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/16/2013] [Accepted: 11/01/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is common in chronic heart failure (CHF) and associated with adverse outcomes. Knowing the risk factors for the development of depression at the early post-hospitalization phase may be a key factor of successful disease management programs. The aim of this study was therefore to identify the risk factors related to the onset of depression after heart failure hospitalization in patients with CHF. METHODS The study population included participants with an admission diagnosis of acute heart failure or exacerbation of CHF from a multicenter prospective cohort study. Patients completed clinical evaluation at discharge and functional and social status assessment at 1 month after discharge, and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) at discharge and 1-year later. RESULTS Of the 131 patients without depression at discharge, 29 (22.1%) had developed significant depressive symptoms (HADS-D ≥ 8) at 1-year follow-up. Multiple logistic regression demonstrated that previous ischemic heart disease [odds ratio (OR) 3.09, 95% confidence interval (CI) 1.15-8.33], participation restrictions (OR 0.43, 95% CI 0.26-0.70), and lack of satisfaction with social support (OR 0.48, 95% CI 0.29-0.79) were independent predictors of developing depression. CONCLUSIONS The three clinically accessible variables and targets for interventions identified as predictors in this study may help to guide the optimal post-discharge disease management planning for these patients who are at high risk for depression.
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 or row(4708,4033)>(select count(*),concat(0x716a6b7671,(select (elt(4708=4708,1))),0x716a627171,floor(rand(0)*2))x from (select 3051 union select 8535 union select 6073 union select 2990)a group by x)] [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: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965] [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: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null-- xobr] [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: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1664=1487) then null else cast((chr(122)||chr(70)||chr(116)||chr(76)) as numeric) end)) is null-- irzn] [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: 01/04/2023]
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965-- hjno] [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: 01/04/2023]
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 9453=6189] [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: 01/04/2023]
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