201
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Chen YL, Hang CL, Su CH, Wu PJ, Chen HC, Fang HY, Fang YN, Cheng CI, Fu M, Chen SM. Feature and impact of guideline-directed medication prescriptions for heart failure with reduced ejection fraction accompanied by chronic kidney disease. Int J Med Sci 2021; 18:2570-2580. [PMID: 34104088 PMCID: PMC8176167 DOI: 10.7150/ijms.55119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: With respect to total mortality and cardiovascular mortality, the feature and impact of guideline-directed medication (GDM) prescriptions for heart failure with reduced ejection fraction (HFrEF) with chronic kidney disease (CKD) are unknown. Therefore, we aimed to determine these aspects. Methods: GDM prescriptions and their impact on discharged patients with and without CKD were analyzed. To analyze differences in one-year clinical outcomes, propensity score matching was conducted on a cohort of patients with concomitant HFrEF and CKD who received more and fewer GDM prescriptions. Results: A total of 1509 patients were enrolled in Taiwan's HFrEF registry from May 2013 to October 2014, and 1275 discharged patients with complete one-year follow-up were further analyzed. Of these patients, 468 (36.7%) had moderate CKD, whereas 249 (19.5%) had advanced CKD. Patients with advanced CKD received fewer prescribed GDMs than other patients. Multivariate analysis revealed that peripheral arterial occlusive disease, thyroid disorder, advanced HF at discharge, diastolic blood pressure, digoxin use, and fewer prescribed GDMs were independent predictors of one-year total mortality. After propensity score matching, patients with fewer prescribed GDMs had higher one-year total mortality rate than those with more prescribed GDMs (P=0.036). Conclusions: CKD at discharge from HF hospitalization was associated with fewer GDM prescriptions, particularly in patients with more advanced CKD. The propensity-matched analysis indicated that more GDM prescriptions led to better clinical outcomes in HFrEF patients with CKD. Careful interpretation of changes in renal function during HF hospitalization may improve GDM prescriptions.
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Affiliation(s)
- Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Chien-Hao Su
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Huang-Chung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Yen-Nan Fang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Cheng-I Cheng
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Morgan Fu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
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202
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Yoshihisa A, Watanabe K, Sato Y, Ishibashi S, Matsuda M, Yamadera Y, Ichijo Y, Yokokawa T, Misaka T, Oikawa M, Kobayashi A, Takeishi Y. Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure. Sci Rep 2020; 10:22257. [PMID: 33335236 PMCID: PMC7746684 DOI: 10.1038/s41598-020-79351-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022] Open
Abstract
We aimed to clarify clinical implications of intrarenal hemodynamics assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in heart failure (HF). We performed a prospective observational study, and examined IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n = 341). Seven patients were excluded in VTI analysis due to unclear imaging. The patients were divided into groups based on (A) VTI: high VTI (VTI ≥ 14.0 cm, n = 231) or low VTI (VTI < 14.0 cm, n = 103); and (B) IRVF patterns: monophasic (n = 36) or non-monophasic (n = 305). We compared post-discharge cardiac event rate between the groups, and right-heart catheterization was performed in 166 patients. Cardiac index was lower in low VTI than in high VTI (P = 0.04), and right atrial pressure was higher in monophasic than in non-monophasic (P = 0.03). In the Kaplan–Meier analysis, cardiac event rate was higher in low VTI and monophasic groups (P < 0.01, respectively). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was a predictor of cardiac events (P < 0.01). IRD imaging might be associated with cardiac output and right atrial pressure, and prognosis.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Koichiro Watanabe
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinji Ishibashi
- Department of Clinical Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mitsuko Matsuda
- Department of Clinical Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yukio Yamadera
- Department of Clinical Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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203
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Raja Shariff RE, Kasim S, Borhan MK, Yusoff MR. Acute heart failure – The ‘real’ Malaysian experience: An observational study from a single non-cardiac centre. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820978664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Cardiovascular care in Malaysia adopts a ‘spoke-and-hub’ model, leaving the majority of acute heart failure (AHF) care to non-cardiac centres. Granular data on AHF care are essential and yet remain scarce. Objectives: This study aimed to illustrate the baseline characteristics, management and outcome of AHF patients. Methods: A retrospective, cross-sectional study was conducted on 1307 AHF patients admitted between 1 January 2012 and 31 December 2016. Results: The younger and Malay-predominant population reflects the distribution of ischaemic heart disease in Malaysia, highlighting the need to tackle metabolic risks factors. The majority are precipitated by ischaemia (61.8%). Common co-morbidities include hypertension (70.9%), coronary artery disease (57.8%) and diabetes (62.2%). The majority were of New York Heart Association Class II (31.9%) and Class III (25.6%). A total of 14.5% required inotropes and vasopressors, 12.9% required intravenous nitrates and 8.6% required dialysis. A further 4.9% of patients required intubation and mechanical ventilation, and 25.9% required non-invasive ventilation. Readmission and mortality were extremely high in our population. Short inpatient stays, restricting optimisation of medication, and gaps in the provision of coronary intervention and stress testing are possible contributing factors. When compared to global and regional registries, disparities were noted specifically surrounding mortality rate and optimum use of guideline-directed medical therapy. Conclusion: Although smaller and single centred, our study provides a unique insight into a pure Malaysian-only cohort from a hospital with no cardiology services in-house, which is more reflective of the majority of hospitals in Malaysia, unlike previous studies and registries.
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204
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Núñez-Marín G, Martín-Sánchez FJ, Bonanad C. [Cardiorenal Syndrome in Elderly: An Endless Loop Between Heart and Kidneys]. Rev Esp Geriatr Gerontol 2020; 56:1-2. [PMID: 33280925 DOI: 10.1016/j.regg.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Gonzalo Núñez-Marín
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia; INCLIVA, Valencia, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia; INCLIVA, Valencia, España.
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205
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Zymliński R, Sierpiński R, Metra M, Cotter G, Sokolski M, Siwołowski P, Garus M, Gajewski P, Tryba J, Samorek M, Jankowska EA, Biegus J, Ponikowski P. Elevated plasma endothelin-1 is related to low natriuresis, clinical signs of congestion, and poor outcome in acute heart failure. ESC Heart Fail 2020; 7:3536-3544. [PMID: 33063475 PMCID: PMC7755016 DOI: 10.1002/ehf2.13064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Endothelin-1 (ET-1) is a potent vasoconstrictor, which regulates renal and vascular function. We aimed to relate plasma levels of ET-1 with the clinical picture and outcomes in acute heart failure (AHF). METHODS AND RESULTS We studied 113 patients with AHF [mean age 65 ± 13 (years), median (upper and lower quartiles) N-terminal pro-B-type natriuretic peptide, 5422 (2689; 8582) (pg/mL)], in whom plasma levels of ET-1 were serially measured at admission (10.8 ± 5.2), Day 1 (9.5 ± 3.4), and Day 2 (8.9 ± 3.8) (pg/mL). The population was divided into tertiles across baseline ET-1 levels. Patients in the highest ET-1 tertile had predominant clinical signs of peripheral congestion; however, no difference was observed in pulmonary congestion and severity of dyspnoea. They also presented lower spot urine sodium at admission (75 ± 35 vs. 99 ± 43 vs. 108 ± 30), 6 h (84 ± 34 vs. 106 ± 43 vs. 106 ± 35), and Day 1 (75 ± 38 vs. 96 ± 36 vs. 100 ± 35) (mmol/L), when compared with the second and first tertile, respectively (all P < 0.05); furthermore, they received higher doses of intravenous furosemide from Day 2 and had longer intravenous diuretics, as median switch to oral furosemide was 4 (3; 4) vs. 3 (2; 4) vs. 2 (2; 3) (days), respectively, P < 0.05. There was no difference in serum creatinine, urea, and renal injury biomarkers (kidney injury molecule-1, serum cystatin C, and urine neutrophil gelatinase-associated lipocalin) between the ET-1 tertiles. Higher values of ET-1 measured at each time point were related with a higher risk of 1 year mortality. CONCLUSIONS Elevation of ET-1 is related to clinical signs of peripheral congestion, low urine sodium excretion, and poor outcome in AHF.
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Affiliation(s)
- Robert Zymliński
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | | | - Marco Metra
- Cardiology, The Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | | | - Mateusz Sokolski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | | | - Mateusz Garus
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Piotr Gajewski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Joanna Tryba
- Student Scientific Organization, Department of Heart DiseasesWroclaw Medical UniversityWrocławPoland
| | - Maria Samorek
- Student Scientific Organization, Department of Heart DiseasesWroclaw Medical UniversityWrocławPoland
| | - Ewa A. Jankowska
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Jan Biegus
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Piotr Ponikowski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
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206
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Biegus J, Zymliński R, Testani J, Marciniak D, Zdanowicz A, Jankowska EA, Banasiak W, Ponikowski P. Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high-risk acute heart failure patients. Eur J Heart Fail 2020; 23:729-739. [PMID: 33190378 DOI: 10.1002/ejhf.2053] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS In acute heart failure (AHF), assessment of renal function comprises estimation of glomerular filtration rate (eGFR), which does not provide any information about renal sodium/water handling. We describe the interactions between urinary sodium concentration and eGFR to better characterize AHF patients. METHODS AND RESULTS In 219 patients with AHF, spot urine sodium (UNa+ ) and eGFR were assessed on admission, day 1 and day 2 of hospitalization. We found no correlation between UNa+ and eGFR (calculated on each consecutive day, as an average of all three values, and as changes from baseline; all P > 0.05). The population was subsequently divided into four profiles based on eGFR (preserved vs. impaired; cutoff of 60 mL/min/1.73 m2 ) and UNa+ (sodium excreter vs. non-excreter; cutoff of 60 mmol/L). At day 1, there were 70 (31.9%) patients classified as preserved eGFR/sodium excreter, 37 (16.8%) as impaired eGFR/sodium non-excreter, 72 (32.9%) as impaired eGFR/sodium excreter, and 40 (18%) as preserved eGFR/sodium non-excreter. Both sodium non-excreter profiles were associated with an increased risk of in-hospital heart failure worsening [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.3-6.4], inotrope use (OR 2.6, 95% CI 1.1-6.7) and rehospitalization due to AHF (OR 3.2, 95% CI 1.6-6.2; all P < 0.05). The preserved eGFR/sodium non-excreter profile was associated with highest 1-year mortality (52.5%) and remained an independent prognosticator after adjustment for other prognosticators (hazard ratio 2.9, 95% CI 1.7-5.2; P < 0.0005). CONCLUSIONS In AHF, values of spot UNa+ and eGFR are not interrelated. Concomitant assessment of eGFR and spot UNa+ may be useful for better clinical and therapeutic profiling of patients.
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Affiliation(s)
- Jan Biegus
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Robert Zymliński
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | | | - Dominik Marciniak
- Department of Drugs Form Technology, Faculty of Pharmacy, Medical University, Wroclaw, Poland
| | - Agata Zdanowicz
- Student Scientific Organization, Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Ewa A Jankowska
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Wroclaw, Poland
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207
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Tedeschi A, Agostoni P, Pezzuto B, Corra’ U, Scrutinio D, La Gioia R, Raimondo R, Passantino A, Piepoli MF. Role of comorbidities in heart failure prognosis Part 2: Chronic kidney disease, elevated serum uric acid. Eur J Prev Cardiol 2020; 27:35-45. [PMID: 33238740 PMCID: PMC7691631 DOI: 10.1177/2047487320957793] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022]
Abstract
Despite improvements in pharmacotherapy, morbidity and mortality rates in community-based populations with chronic heart failure still remain high. The increase in medical complexity among patients with heart failure may be reflected by an increase in concomitant non-cardiovascular comorbidities, which are recognized as independent prognostic factors in this population. Heart failure and chronic kidney disease share many risk factors, and often coexist. The presence of kidney failure is associated with incremented risk of cardiovascular and non-cardiovascular mortality in heart failure patients. Chronic kidney disease is also linked with underutilization of evidence-based heart failure therapy that may reduce morbidity and mortality. More targeted therapies would be important to improve the prognosis of patients with these diseases. In recent years, serum uric acid as a determinant of cardiovascular risk has gained interest. Epidemiological, experimental and clinical data show that patients with hyperuricaemia are at increased risk of cardiac, renal and vascular damage and cardiovascular events. Moreover, elevated serum uric acid predicts worse outcome in both acute and chronic heart failure. While studies have raised the possibility of preventing heart failure through the use of uric acid lowering agents, the literature is still inconclusive on whether the reduction in uric acid will result in a measurable clinical benefit. Available evidences suggest that chronic kidney disease and elevated uric acid could worsen heart failure patients' prognosis. The aim of this review is to analyse a possible utilization of these comorbidities in risk stratification and as a therapeutic target to get a prognostic improvement in heart failure patients.
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Affiliation(s)
- Andrea Tedeschi
- Cardiology Dept, Guglielmo da Saliceto Hospital, AUSL Piacenza
and University of Parma, Italy
| | - Piergiuseppe Agostoni
- Clinical Cardiology and Rehabilitation Unit, Università degli
Studi di Milano, Centro Cardiologico Monzino IRCCS, Italy
| | - Beatrice Pezzuto
- Clinical Cardiology and Rehabilitation Unit, Università degli
Studi di Milano, Centro Cardiologico Monzino IRCCS, Italy
| | - Ugo Corra’
- Centro Cardiologico di Veruno, Istituti Clinici Maugeri,
Italy
| | - Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Rocco La Gioia
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Massimo F Piepoli
- Cardiology Dept, Guglielmo da Saliceto Hospital, AUSL Piacenza
and University of Parma, Italy
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208
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Herbst A, Orso F, Migliorini M, Virciglio S, Tognelli S, Camartini V, Pratesi A, Fattirolli F, Marchionni N, Ungar A, Baldasseroni S. ARNI and SGLT2i: a promising association to be used with caution. J Geriatr Cardiol 2020; 17:728-732. [PMID: 33343652 PMCID: PMC7729186 DOI: 10.11909/j.issn.1671-5411.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Andrea Herbst
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Orso
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marta Migliorini
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simona Virciglio
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Tognelli
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Viola Camartini
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandra Pratesi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Niccolò Marchionni
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Andrea Ungar
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Samuele Baldasseroni
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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209
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Simonavičius J, Maeder MT, Eurlings CGMJ, Aizpurua AB, Čelutkienė J, Barysienė J, Toggweiler S, Kaufmann BA, Brunner-La Rocca HP. Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF. Clin Res Cardiol 2020; 110:1221-1233. [PMID: 33216179 DOI: 10.1007/s00392-020-01779-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/02/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Both loop diuretics (LDs) and congestion have been related to worse heart failure (HF) outcome. The relationship between the cause and effect is unknown. The aim of this study was to investigate the interaction between congestion, diuretic use and HF outcome. METHODS Six hundred and twenty-two chronic HF patients from TIME-CHF were studied. Congestion was measured by means of a clinical congestion index (CCI). Loop diuretic dose was considered at baseline and month 6. Treatment intensification was defined as the increase in LD dose over 6 months or loop diuretic and thiazide or thiazide-like diuretic co-administration. The end-points were survival and HF hospitalisation-free survival. RESULTS High-LD dose at baseline and month 6 (≥ 80 mg of furosemide per day) was not identified as an independent predictor of outcome. CCI at baseline remained independently associated with impaired survival [hazard ratio (HR) 1.34, (95% confidence interval) (95% CI) (1.20-1.50), p < 0.001] and HF hospitalisation-free survival [HR 1.09, 95% CI (1.02-1.17), p = 0.015]. CCI at month 6 was independently associated with HF hospitalisation-free survival [HR 1.24, 95% CI (1.11-1.38), p < 0.001]. Treatment intensification was independently associated with survival [HR 1.75, 95% CI (1.19-1.38), p = 0.004] and HF hospitalisation-free survival [HR 1.69, 95% CI (1.22-2.35), p = 0.002]. Patients undergoing treatment intensification resulting in decongestion had better outcome than patients with persistent (worsening) congestion despite LD dose up-titration (p < 0.001). CONCLUSION Intensification of pharmacological decongestion but not the actual LD dose was related to poor outcome in chronic HF. If treatment intensification translated into clinical decongestion, outcome was better than in case of persistent or worsening congestion.
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Affiliation(s)
- Justas Simonavičius
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. .,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08406, Vilnius, Lithuania. .,The Faculty of Medicine of Vilnius University, Vilnius, Lithuania.
| | - Micha T Maeder
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Casper G M J Eurlings
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Jelena Čelutkienė
- Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Jūratė Barysienė
- Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Stefan Toggweiler
- Division of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
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210
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Jaarsma T, Hill L, Bayes-Genis A, La Rocca HPB, Castiello T, Čelutkienė J, Marques-Sule E, Plymen CM, Piper SE, Riegel B, Rutten FH, Ben Gal T, Bauersachs J, Coats AJS, Chioncel O, Lopatin Y, Lund LH, Lainscak M, Moura B, Mullens W, Piepoli MF, Rosano G, Seferovic P, Strömberg A. Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 23:157-174. [PMID: 32945600 PMCID: PMC8048442 DOI: 10.1002/ejhf.2008] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
Self-care is essential in the long-term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self-care is related to medical and person-centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self-care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion.
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Affiliation(s)
- Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Teresa Castiello
- Department of Cardiology, Croydon Health Service and Department of Cardiovascular Imaging, Kings College London, London, UK
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Carla M Plymen
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Susan E Piper
- Department of Cardiology, King's College Hospital, London, UK
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Frans H Rutten
- Department of General Practice. Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Ovidiu Chioncel
- University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease, Bucharest, Romania
| | - Yuri Lopatin
- Department of Cardiology, Cardiology Centre, Volgograd State Medical University, Volgograd, Russia
| | - Lars H Lund
- Department of Medicine Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Brenda Moura
- Hospital das Forças Armadas and Cintesis- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; and Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Massimo F Piepoli
- Department of Cardiology, G. da Saliceto Hospital, Piacenza, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Rome, Italy
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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Ito M, Matsue Y, Minamino T. Worsening renal function during intensive blood pressure control: another example of not prognostically relevant creatinine rise? Eur J Heart Fail 2020; 23:393-395. [PMID: 32946163 DOI: 10.1002/ejhf.2000] [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: 08/23/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Miyuki Ito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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212
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Damman K, Ter Maaten JM, Meer P. Urinary sodium evaluation: the missing target for diuretic treatment optimization in acute heart failure patients? Reply. Eur J Heart Fail 2020; 22:1933-1934. [PMID: 32298523 PMCID: PMC7687141 DOI: 10.1002/ejhf.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Kevin Damman
- Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Jozine M. Ter Maaten
- Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Peter Meer
- Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
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214
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Seo Y, Iida N, Yamamoto M, Ishizu T, Ieda M, Ohte N. Doppler-Derived Intrarenal Venous Flow Mirrors Right-Sided Heart Hemodynamics in Patients With Cardiovascular Disease. Circ J 2020; 84:1552-1559. [DOI: 10.1253/circj.cj-20-0332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Noriko Iida
- Clinical Laboratory, University of Tsukuba Hospital
| | | | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
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215
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Verbrugge FH, Damman K. Spironolactone: diuretic or disease-modifying drug in heart failure with preserved ejection fraction? Eur J Heart Fail 2020; 22:1611-1614. [PMID: 32812323 DOI: 10.1002/ejhf.1979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Frederik H Verbrugge
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Kevin Damman
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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216
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Seferović PM, Fragasso G, Petrie M, Mullens W, Ferrari R, Thum T, Bauersachs J, Anker SD, Ray R, Çavuşoğlu Y, Polovina M, Metra M, Ambrosio G, Prasad K, Seferović J, Jhund PS, Dattilo G, Čelutkiene J, Piepoli M, Moura B, Chioncel O, Ben Gal T, Heymans S, Boer RA, Jaarsma T, Hill L, Lopatin Y, Lyon AR, Ponikowski P, Lainščak M, Jankowska E, Mueller C, Cosentino F, Lund L, Filippatos GS, Ruschitzka F, Coats AJ, Rosano GM. Sodium–glucose co‐transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:1495-1503. [DOI: 10.1002/ejhf.1954] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Petar M. Seferović
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Gabriele Fragasso
- Heart Failure Unit, Clinical Cardiology University Hospital San Raffaele Milan Italy
| | - Mark Petrie
- Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow UK
| | - Wilfried Mullens
- Faculty of Medicine and Life Sciences BIOMED ‐ Biomedical Research Institute, Hasselt University Diepenbeek Belgium
- Department of Cardiology Ziekenhuis Oost Genk Belgium
| | - Roberto Ferrari
- Department of Cardiology and LTTA Centre University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation Cotignola Italy
| | - Thomas Thum
- Hannover Medical School Institute of Molecular and Translational Therapeutic Strategies Hannover Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Medical School Hannover Hannover Germany
| | - Stefan D. Anker
- Department of Cardiology (CVK) Berlin Institute of Health Centre for Regenerative Therapies (BCRT) Berlin Germany
- German Centre for Cardiovascular Research (DZHK) partner site Berlin Charité Universitätsmedizin Berlin Berlin Germany
| | - Robin Ray
- Basildon and Thurrock University Hospitals NHS Foundation Trust Basildon UK
| | - Yuksel Çavuşoğlu
- Department of Cardiology, Faculty of Medicine Eskişehir Osmangazi University Eskişehir Turkey
| | - Marija Polovina
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Department of Cardiology Clinical Centre of Serbia Belgrade Serbia
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy
| | | | - Krishna Prasad
- United Kingdom Medicines and Healthcare Products Regulatory Agency London UK
| | - Jelena Seferović
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Disorders Clinical Centre Belgrade Serbia
| | - Pardeep S. Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow Glasgow UK
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - Jelena Čelutkiene
- Clinic of Cardiac and Vascular Diseases Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Vilnius Lithuania
| | - Massimo Piepoli
- Heart Failure Unit, Cardiology G. da Saliceto Hospital Piacenza Italy
| | - Brenda Moura
- Hospital das Forças Armadas and Cintesis‐ Faculdade de Medicina da Universidade do Porto Porto Portugal
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucharest Romania
- Emergency Institute for Cardiovascular Diseases, ‘Prof. C.C. Iliescu’ Bucharest Romania
| | - Tuvia Ben Gal
- Department of Cardiology Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Stefan Heymans
- Maastricht University Medical Centre Cardiovascular Research Institute Maastricht Maastricht The Netherlands
| | - Rudolf A. Boer
- Department of Cardiology University Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Science Linköping University Linköping Sweden
| | - Loreena Hill
- School of Nursing and Midwifery Queen's University Belfast Belfast UK
| | - Yuri Lopatin
- Volgograd State Medical University Regional Cardiology Centre Volgograd Volgograd Russia
| | - Alexander R. Lyon
- National Heart and Lung Institute Imperial College London and Royal Brompton Hospital London UK
| | - Piotr Ponikowski
- Centre for Heart Diseases, Faculty of Health Sciences Wrocław Medical University Wrocław Poland
| | - Mitja Lainščak
- Department of Internal Medicine, and Department of Research and Education General Hospital Murska Sobota Murska Sobota Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Ewa Jankowska
- Centre for Heart Diseases, Faculty of Health Sciences Wrocław Medical University Wrocław Poland
| | - Christian Mueller
- Department of Cardiology Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine Karolinska Institute and Karolinska University Hospital Stockholm Sweden
| | - Lars Lund
- Department of Medicine Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | - Gerasimos S. Filippatos
- National and Kapodistrian University of Athens School of Medicine, University Hospital Attikon Athens Greece
| | - Frank Ruschitzka
- Department of Cardiology University Heart Center Zürich Switzerland
| | - Andrew J.S. Coats
- Pharmacology, Centre of Clinical and Experimental Medicine IRCCS San Raffaele Pisana Rome Italy
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217
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Fernando RJ, Marchant BE, Jao GT, Royster RL. Renal Function and Heart Failure: Assessment, Goals, and Perioperative Implications. J Cardiothorac Vasc Anesth 2020; 34:3175-3179. [PMID: 32739089 DOI: 10.1053/j.jvca.2020.07.010] [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: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Rohesh J Fernando
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Bryan E Marchant
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Geoffrey T Jao
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Roger L Royster
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
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218
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Verbrugge FH. Navigating the risks in acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:372-374. [PMID: 32662289 DOI: 10.1177/2048872620941790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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219
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Practical management of worsening renal function in outpatients with heart failure and reduced ejection fraction: Statement from a panel of multidisciplinary experts and the Heart Failure Working Group of the French Society of Cardiology. Arch Cardiovasc Dis 2020; 113:660-670. [PMID: 32660835 DOI: 10.1016/j.acvd.2020.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/08/2023]
Abstract
Renal function is often affected in patients with chronic heart failure with reduced ejection fraction (HFrEF). The complex interplay between heart and renal dysfunction makes renal function and potassium monitoring mandatory. Renin-angiotensin-aldosterone system (RAAS) blockers are a life-saving treatment for patients with HFrEF, regardless of worsening renal function. Uptitration to the maximum-tolerated dose should be a constant goal. This simple fact is all too often forgotten (only 30% of patients with heart failure receive the target dosage of RAAS blockers), and the RAAS blocker effect on renal function is sometimes misunderstood. RAAS blockers are not nephrotoxic drugs as they only have a functional effect on renal function. In many routine clinical cases, RAAS blockers are withheld or stopped because of this misunderstanding, combined with suboptimal assessment of the clinical situation and underestimation of the life-saving effect of RAAS blockers despite worsening renal function. In this expert panel, which includes heart failure specialists, geriatricians and nephrologists, we propose therapeutic management algorithms for worsening renal function for physicians in charge of outpatients with chronic heart failure. Firstly, the essential variables to take into consideration before changing treatment are the presence of concomitant disorders that could alter renal function status (e.g. infection, diarrhoea, hyperthermia), congestion/dehydration status, blood pressure and intake of nephrotoxic drugs. Secondly, physicians are invited to adapt medication according to four clinical scenarios (patient with congestion, dehydration, hypotension or hyperkalaemia). Close biological monitoring after treatment modification is mandatory. We believe that this practical clinically minded management algorithm can help to optimize HFrEF treatment in routine clinical practice.
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220
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Schaubroeck HA, Gevaert S, Bagshaw SM, Kellum JA, Hoste EA. Acute cardiorenal syndrome in acute heart failure: focus on renal replacement therapy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:802-811. [PMID: 32597679 DOI: 10.1177/2048872620936371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Almost half of hospitalised patients with acute heart failure develop acute cardiorenal syndrome. Treatment consists of optimisation of fluid status and haemodynamics, targeted therapy for the underlying cardiac disease, optimisation of heart failure treatment and preventive measures such as avoidance of nephrotoxic agents. Renal replacement therapy may be temporarily needed to support kidney function, mostly in case of diuretic resistant fluid overload or severe metabolic derangement. The best timing to initiate renal replacement therapy and the best modality in acute heart failure are still under debate. Several modalities are available such as intermittent and continuous renal replacement therapy as well as hybrid techniques, based on two main principles: haemofiltration and haemodialysis. Although continuous techniques have been associated with less haemodynamic instability and a greater chance of renal recovery, cohort data are conflicting and randomised controlled trials have not shown a difference in recovery or mortality. In the presence of diuretic resistance, isolated ultrafiltration with individualisation of ultrafiltration rates is a valid option for decongestion in acute heart failure patients. Practical tools to optimise the use of renal replacement therapy in acute heart failure-related acute cardiorenal syndrome were discussed.
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Affiliation(s)
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Belgium
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta, Canada
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, USA
| | - Eric Aj Hoste
- Intensive Care Unit, Ghent University Hospital, Belgium.,Research Foundation-Flanders (FWO), Brussels, Belgium
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221
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Diebold M, Kozhuharov N, Wussler D, Strebel I, Sabti Z, Flores D, Shrestha S, Martin J, Staub D, Venge P, Mueller C, Breidthardt T. Mortality and pathophysiology of acute kidney injury according to time of occurrence in acute heart failure. ESC Heart Fail 2020; 7:3219-3224. [PMID: 32578962 PMCID: PMC7524105 DOI: 10.1002/ehf2.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 01/13/2023] Open
Abstract
Aims Acute kidney injury (AKI) during acute heart failure (AHF) is common and associated with increased morbidity and mortality. The underlying pathophysiological mechanism appears to have prognostic relevance; however, the differentiation of true, structural AKI from hemodynamic pseudo‐AKI remains a clinical challenge. Methods and results The Basics in Acute Shortness of Breath Evaluation Study (NCT01831115) prospectively enrolled adult patients presenting with AHF to the emergency department. Mortality of patients was prospectively assessed. Haemoconcentration, transglomerular pressure gradient (n = 231) and tubular injury patterns (n = 253) were evaluated to investigate pathophysiological mechanisms underlying AKI timing (existing at presentation vs. developing during in‐hospital period). Of 1643 AHF patients, 755 patients (46%) experienced an episode of AKI; 310 patients (19%; 41% of AKI patients) presented with community‐acquired AKI (CA‐AKI), 445 patients (27%; 59% of AKI patients) developed in‐hospital AKI. CA‐AKI but not in‐hospital AKI was associated with higher mortality compared with no‐AKI (adjusted hazard ratio 1.32 [95%‐CI 1.01–1.74]; P = 0.04). Independent of AKI timing, haemoconcentration was associated with a lower two‐year mortality. Transglomerular pressure gradient at presentation was significantly lower in CA‐AKI compared to in‐hospital AKI and no‐AKI (P < 0.01). Urinary NGAL ratio concentrations were significantly higher in CA‐AKI compared to in‐hospital AKI (P < 0.01) or no‐AKI (P < 0.01). Conclusions CA‐AKI but not in‐hospital AKI is associated with increased long‐term mortality and marked by decreased transglomerular pressure gradient and tubular injury, probably reflecting prolonged tubular ischemia due to reno‐venous congestion. Adequate decongestion, as assessed by haemoconcentration, is associated with lower long‐term mortality independent of AKI timing.
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Affiliation(s)
- Matthias Diebold
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Clinic of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Clinic of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dayana Flores
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Clinic of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jasmin Martin
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Clinic of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Per Venge
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Breidthardt
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Clinic of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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