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Shah SJ, Sharma K, Borlaug BA, Butler J, Davies M, Kitzman DW, Petrie MC, Verma S, Patel S, Chinnakondepalli KM, Einfeldt MN, Jensen TJ, Rasmussen S, Asleh R, Ben-Gal T, Kosiborod MN. Semaglutide and diuretic use in obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF-DM trials. Eur Heart J 2024; 45:3254-3269. [PMID: 38739118 PMCID: PMC11400859 DOI: 10.1093/eurheartj/ehae322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/27/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND AND AIMS In the STEP-HFpEF trial programme, treatment with semaglutide resulted in multiple beneficial effects in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Efficacy may vary according to baseline diuretic use, and semaglutide treatment could modify diuretic dose. METHODS In this pre-specified analysis of pooled data from the STEP-HFpEF and STEP-HFpEF-DM trials (n = 1145), which randomized participants with HFpEF and body mass index ≥ 30 kg/m2 to once weekly semaglutide 2.4 mg or placebo for 52 weeks, we examined whether efficacy and safety endpoints differed by baseline diuretic use, as well as the effect of semaglutide on loop diuretic use and dose changes over the 52-week treatment period. RESULTS At baseline, across no diuretic (n = 220), non-loop diuretic only (n = 223), and loop diuretic [<40 (n = 219), 40 (n = 309), and >40 (n = 174) mg/day furosemide equivalents] groups, there was progressively higher prevalence of hypertension and atrial fibrillation; and greater severity of obesity and heart failure. Over 52 weeks of treatment, semaglutide had a consistent beneficial effect on change in body weight across diuretic use categories (adjusted mean difference vs. placebo ranged from -8.8% [95% confidence interval (CI) -10.3, -6.3] to -6.9% [95% CI -9.1, -4.7] from no diuretics to the highest loop diuretic dose category; interaction P = .39). Kansas City Cardiomyopathy Questionnaire clinical summary score improvement was greater in patients on loop diuretics compared to those not on loop diuretics (adjusted mean difference vs. placebo: +9.3 [6.5; 12.1] vs. +4.7 points [1.3, 8.2]; P = .042). Semaglutide had consistent beneficial effects on all secondary efficacy endpoints (including 6 min walk distance) across diuretic subgroups (interaction P = .24-.92). Safety also favoured semaglutide vs. placebo across the diuretic subgroups. From baseline to 52 weeks, loop diuretic dose decreased by 17% in the semaglutide group vs. a 2.4% increase in the placebo group (P < .0001). Semaglutide (vs. placebo) was more likely to result in loop diuretic dose reduction (odds ratio [OR] 2.67 [95% CI 1.70, 4.18]) and less likely dose increase (OR 0.35 [95% CI 0.23, 0.53]; P < .001 for both) from baseline to 52 weeks. CONCLUSIONS In patients with obesity-related HFpEF, semaglutide improved heart failure-related symptoms and physical limitations across diuretic use subgroups, with more pronounced benefits among patients receiving loop diuretics at baseline. Reductions in weight and improvements in exercise function with semaglutide vs. placebo were consistent in all diuretic use categories. Semaglutide also led to a reduction in loop diuretic use and dose between baseline and 52 weeks. CLINICAL TRIAL REGISTRATION NCT04788511 and NCT04916470.
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Affiliation(s)
- Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kavita Sharma
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics/Gerontology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Shachi Patel
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Khaja M Chinnakondepalli
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | | | | | - Rabea Asleh
- Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tuvia Ben-Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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2
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Visco V, Robustelli A, Loria F, Rispoli A, Palmieri F, Bramanti A, Carrizzo A, Vecchione C, Palmieri F, Ciccarelli M, D'Angelo G. An explainable model for predicting Worsening Heart Failure based on genetic programming. Comput Biol Med 2024; 182:109110. [PMID: 39243517 DOI: 10.1016/j.compbiomed.2024.109110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
Heart Failure (HF) poses a challenge for our health systems, and early detection of Worsening HF (WHF), defined as a deterioration in symptoms and clinical and instrumental signs of HF, is vital to improving prognosis. Predicting WHF in a phase that is currently undiagnosable by physicians would enable prompt treatment of such events in patients at a higher risk of WHF. Although the role of Artificial Intelligence in cardiovascular diseases is becoming part of clinical practice, especially for diagnostic and prognostic purposes, its usage is often considered not completely reliable due to the incapacity of these models to provide a valid explanation about their output results. Physicians are often reluctant to make decisions based on unjustified results and see these models as black boxes. This study aims to develop a novel diagnostic model capable of predicting WHF while also providing an easy interpretation of the outcomes. We propose a threshold-based binary classifier built on a mathematical model derived from the Genetic Programming approach. This model clearly indicates that WHF is closely linked to creatinine, sPAP, and CAD, even though the relationship of these variables and WHF is almost complex. However, the proposed mathematical model allows for providing a 3D graphical representation, which medical staff can use to better understand the clinical situation of patients. Experiments conducted using retrospectively collected data from 519 patients treated at the HF Clinic of the University Hospital of Salerno have demonstrated the effectiveness of our model, surpassing the most commonly used machine learning algorithms. Indeed, the proposed GP-based classifier achieved a 96% average score for all considered evaluation metrics and fully supported the controls of medical staff. Our solution has the potential to impact clinical practice for HF by identifying patients at high risk of WHF and facilitating more rapid diagnosis, targeted treatment, and a reduction in hospitalizations.
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Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), 84081, Italy
| | - Antonio Robustelli
- Department of Computer Science, University of Salerno, Via Giovanni Paolo II, 132, Fisciano (SA), 84084, Italy
| | - Francesco Loria
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), 84081, Italy
| | - Antonella Rispoli
- University Hospital San Giovanni di Dio e Ruggi d'Aragona, Largo Città Ippocrate, Salerno, 84131, Italy
| | - Francesca Palmieri
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), 84081, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), 84081, Italy; University Hospital San Giovanni di Dio e Ruggi d'Aragona, Largo Città Ippocrate, Salerno, 84131, Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), 84081, Italy; Vascular Physiopathology Unit, IRCCS Neuromed Mediterranean Neurological Institute, Via Atinense, 18, Pozzilli (IS), 86077, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), 84081, Italy; University Hospital San Giovanni di Dio e Ruggi d'Aragona, Largo Città Ippocrate, Salerno, 84131, Italy; Vascular Physiopathology Unit, IRCCS Neuromed Mediterranean Neurological Institute, Via Atinense, 18, Pozzilli (IS), 86077, Italy
| | - Francesco Palmieri
- Department of Computer Science, University of Salerno, Via Giovanni Paolo II, 132, Fisciano (SA), 84084, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), 84081, Italy; University Hospital San Giovanni di Dio e Ruggi d'Aragona, Largo Città Ippocrate, Salerno, 84131, Italy
| | - Gianni D'Angelo
- Department of Computer Science, University of Salerno, Via Giovanni Paolo II, 132, Fisciano (SA), 84084, Italy.
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3
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Silva G, Moura B, Moreira E, Camila Dias C, Sousa Pinto B, Campelo M, Amorim S, Martins E, Pinto R, Maia Araújo P, Resende CX, Mena B, Grácio T, Teixeira A, Silva Cardoso J. Loop diuretic discontinuation in chronic heart failure patients: A retrospective study. Rev Port Cardiol 2024; 43:513-522. [PMID: 38906521 DOI: 10.1016/j.repc.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/03/2023] [Accepted: 02/07/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The use of loop diuretics is central in managing congestion in heart failure (HF), but their impact on prognosis remains unclear. In euvolemic patients, dose reduction is recommended, but there is no recommendation on their discontinuation. This study aims to assess the impact of loop diuretic discontinuation on the prognosis of outpatients with HF with reduced ejection fraction. METHODS This retrospective cohort study collected data from medical records of patients followed in an outpatient HF clinic at a university hospital center. Patients were included if they had been on loop diuretics and these were discontinued. Demographic, clinical and laboratory data were collected, and number and type of congestive events during the one-year period after discontinuation were recorded. RESULTS Among 265 patients on loop diuretics, almost half (129) discontinued them at some point. Patients had optimized medical therapy, low median age, low New York Heart Association class, low B-type natriuretic peptide values, normal blood pressure, controlled heart rate and kidney function within normal limits. Among 122 patients with one year of follow-up, 18 (14.8%) had a congestive event. Fifteen events (83.3%) were low-dose diuretic reinitiation at a scheduled visit. There were only three worsening heart failure events (2.5%) during the one-year period. A significant improvement in kidney function from discontinuation to the one-year follow-up appointment was also observed. CONCLUSIONS In our cohort, loop diuretic discontinuation was possible and safe in a large proportion of patients. The results should be interpreted with caution and cannot be extrapolated to a broader population of HF patients.
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Affiliation(s)
- Gonçalo Silva
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiology, Hospital das Forças Armadas, Polo do Porto, Porto, Portugal; Hospital Lusíadas Porto, Porto, Portugal
| | - Emília Moreira
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Hospital Lusíadas Porto, Porto, Portugal; Escola Superior de Educação de Coimbra, Coimbra, Portugal
| | - Cláudia Camila Dias
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Bernardo Sousa Pinto
- Faculty of Medicine, University of Porto, Portugal; Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Campelo
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Amorim
- Faculty of Medicine, University of Porto, Portugal; Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elisabete Martins
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal; European Reference Network GUARD-Heart
| | - Roberto Pinto
- Faculty of Medicine, University of Porto, Portugal; Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Maia Araújo
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carlos Xavier Resende
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Beatriz Mena
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Tiago Grácio
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | | | - José Silva Cardoso
- Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Escola Superior de Educação de Coimbra, Coimbra, Portugal; Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
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4
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Konstam MA, Massaro J, Dhingra R, Walsh M, Ordway L, Pursley MS, McLean DS, Saha S, Close N, Konstam JM, Luepke KH, Mohr JF, Udelson JE. Avoiding Treatment in Hospital With Subcutaneous Furosemide for Worsening Heart Failure: A Pilot Study (AT HOME-HF). JACC. HEART FAILURE 2024:S2213-1779(24)00575-4. [PMID: 39269392 DOI: 10.1016/j.jchf.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Therapies are needed to address worsening congestion, without hospitalization, in patients with chronic heart failure (HF). OBJECTIVES This pilot study assessed outcomes of a novel subcutaneous (SC) furosemide formulation compared to usual care in outpatients with worsening congestion. METHODS Participants with chronic HF and worsening congestion were randomized open-label 2:1 to SC furosemide compared to usual care (UC). Decongestion was estimated by tracking body weight. The primary endpoint was a win ratio of a 30-day hierarchical composite of cardiovascular death, HF events, and change in N-terminal pro-B-type natriuretic peptide. Secondary endpoints included dyspnea severity, functional capacity, and quality of life. RESULTS Thirty-four participants were randomized to SC furosemide and 17 to UC. SC furosemide caused greater reduction in body weight: between-group difference in least square mean change was -2.02 kg at day 3 (95% CI: -3.9 to -0.14; P = 0.035). SC furosemide-to-UC win ratio was 1.11 (95% CI: 0.48-2.50; P = 0.806). Significant between-group least square mean differences favoring SC furosemide occurred in 7-point dyspnea score (P = 0.017) and 6-minute walk test (P = 0.032), with trend in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 Overall Summary Score of 9.15 (95% CI: 1.95-20.3; P = 0.106). The most common related adverse event with SC furosemide was mild infusion site pain (11.8%). CONCLUSIONS SC furosemide augmented weight loss in patients with HF and worsening congestion. The composite primary endpoint was not statistically significant in this pilot investigation. However, findings of improved dyspnea scores and functional capacity, with favorable trend in KCCQ-12 score, warrant additional investigation to further document the clinical value of SC furosemide as an alternative to hospitalization (AT HOME-HF [Avoiding Treatment in the Hospital With Furoscix for the Management of Congestion in Heart Failure-A Pilot Study]; NCT04593823).
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Affiliation(s)
- Marvin A Konstam
- Tufts Medical Center, and Tufts University School of Medicine, Boston, Massachusetts, USA.
| | - Joseph Massaro
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ravi Dhingra
- University of Wisconsin, Madison, Wisconsin, USA
| | - Mary Walsh
- Ascension St Vincent Heart Center, Indianapolis, Indiana, USA
| | - Linda Ordway
- Tufts Medical Center, and Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Sandeep Saha
- Cardiovascular Clinical Science Foundation, Boston, Massachusetts, USA
| | - Nicole Close
- Cardiovascular Clinical Science Foundation, Boston, Massachusetts, USA
| | | | | | - John F Mohr
- scPharmaceuticals, Inc, Burlington, Massachusetts, USA
| | - James E Udelson
- Tufts Medical Center, and Tufts University School of Medicine, Boston, Massachusetts, USA
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5
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Cirelli C, Limonta R, Carioli G, D'Elia E, Ameri P, Inciardi RM, Ghirardi A, Fazzini L, Perra F, Rizzola G, Chiesa E, Tomasoni L, Montisci R, Gavazzi A, Senni M, Gori M. Prognostic role of gait speed in worsening heart failure. Eur J Intern Med 2024:S0953-6205(24)00311-X. [PMID: 39117554 DOI: 10.1016/j.ejim.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/03/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Worsening Heart Failure (WHF) is associated with adverse prognosis. Identifying novel prognostic markers in WHF is crucial. Gait speed (GS), a validated frailty index, is an easily obtainable parameter that may aid in reclassifying the risk of HF patients. We assessed the independent prognostic role of GS in WHF patients. METHODS We studied 171 patients with chronic HF with worsening congestion symptoms and inadequate response to standard therapies, requiring intravenous diuretic treatment. The primary outcome was a composite of all-cause mortality or HF hospitalization. We assessed the association and the incremental value of GS, as compared to other clinical confounders, with the primary outcome. RESULTS The mean age was 76±11 years, 66 % were male, median BNP was 481 pg/ml, and median ejection fraction was 40 %. Over a median follow-up of 11.3 months, 71 events occurred. Lower GS was significantly associated with a higher risk of events (HR of 4.03, 95 % CI 2.25-7.21), along with neutrophil to lymphocyte ratio, BNP, QRS duration, natremia, and previous myocardial infarction. When added to the MAGGIC risk score and the other significant confounders identified, GS significantly enhanced the model risk prediction (Harrell's C-index 0.75 vs 0.71, p < 0.001). At Classification And Regression Tree analysis, GS≤0.8 m/s was the first parameter to be considered to risk stratify the population. CONCLUSIONS GS, an easily obtainable marker of frailty, may contribute to improve the risk stratification of patients with WHF.
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Affiliation(s)
- Camilla Cirelli
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Raul Limonta
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Greta Carioli
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Emilia D'Elia
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy; Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Viale Benedetto XV 6, 16132, Genova, Italy
| | - Riccardo Maria Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Luca Fazzini
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale 8, 09042, Monserrato, Cagliari, Italy
| | - Ferdinando Perra
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale 8, 09042, Monserrato, Cagliari, Italy
| | - Ginevra Rizzola
- Department of Internal Medicine, University of Genova, Viale Benedetto XV 6, 16132, Genova, Italy; Cardiology Unit, Medical Sciences Department, ASST Bergamo Est, Via Paderno 21, 24068, Seriate, Italy
| | - Erika Chiesa
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Laura Tomasoni
- In charge of Surgical, Cardiovascular & Neuroscience Nursing Department, Department of Health and Social Professions, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Roberta Montisci
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale 8, 09042, Monserrato, Cagliari, Italy
| | - Antonello Gavazzi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Michele Senni
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy; Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Mauro Gori
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy; Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
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6
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Inciardi RM, Vaduganathan M, Lombardi CM, Gussago C, Agostoni P, Ameri P, Aspromonte N, Calò L, Cameli M, Carluccio E, Carugo S, Cipriani M, De Caterina R, De Ferrari GM, Emdin M, Fornaro A, Guazzi M, Iacoviello M, Imazio M, La Rovere MT, Leonardi S, Maccallini M, Masarone D, Moschini L, Palazzuoli A, Patti G, Pedretti RFE, Perrone Filardi P, Piepoli MF, Potena L, Salzano A, Sciacqua A, Senni M, Sinagra G, Specchia C, Taddei S, Vizza D, Savarese G, Rosano G, Volterrani M, Metra M. OPTImal PHARMacological therapy for patients with heart failure: Rationale and design of the OPTIPHARM-HF registry. Eur J Heart Fail 2024; 26:1707-1714. [PMID: 38923140 DOI: 10.1002/ejhf.3260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS Patients with heart failure (HF) remain often undertreated for multiple reasons, including treatment inertia, contraindications, and intolerance. The OPTIimal PHARMacological therapy for patients with Heart Failure (OPTIPHARM-HF) registry is designed to evaluate the prevalence of evidence-based medical treatment prescription and titration, as well as the causes of its underuse, in a broad real-world population of consecutive patients with HF across the whole ejection fraction spectrum and among different clinical phenotypes. METHODS The OPTIPHARM-HF registry (NCT06192524) is a prospective, multicenter, observational, national study of adult patients with symptomatic HF, as defined by current international guidelines, regardless of ejection fraction. Both outpatients and inpatients with chronic and acute decompensated HF will be recruited. The study will enroll up to 2500 patients with chronic HF at approximately 35 Italian HF centres. Patients will be followed for a maximum duration of 24 months. The primary objective of the OPTIPHARM-HF registry is to assess prescription and adherence to evidence-based guideline-directed medical therapy (GDMT) in patients with HF. The primary outcome is to describe the prevalence of GDMT use according to target guideline recommendation. Secondary objectives include implementation of comorbidity treatment, evaluation of sequence of treatment introduction and up-titration, description of GDMT implementation in the specific HF population, main causes of GDMT underuse, and assessment of cumulative rate of cardiovascular events. CONCLUSION The OPTIPHARM-HF registry will provide important implications for improving patient care and adoption of recommended medical therapy into clinical practice among HF patients.
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Affiliation(s)
- Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cristina Gussago
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Ameri
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular ad Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Manlio Cipriani
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT, Palermo, Italy
| | - Raffaele De Caterina
- Cardiology Division, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
- Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa, Pisa, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Marco Guazzi
- Cardiology Division, San Paolo Hospital, Milan, Italy
- Department of Biological Sciences, University of Milan School of Medicine, Milan, Italy
| | - Massimo Iacoviello
- Cardiology Unit, University Hospital Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Imazio
- Department of Medicine (DMED), University of Udine, and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, ASUFC, Udine, Italy
| | | | - Sergio Leonardi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Marta Maccallini
- Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Luigi Moschini
- Division of Cardiology, Ospedale Oglio Po, ASST Cremona, Cremona, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardiothoracic and Vascular Department, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Giuseppe Patti
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Roberto F E Pedretti
- Unit of Cardiology, Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- University of Milano - Bicocca, School of Medicine and Surgery, Milan, Italy
| | | | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinicco San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | - Angela Sciacqua
- Geriatrics Division. AOU R.Dulbecco, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Michele Senni
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dario Vizza
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Rosano
- Chair of Pharmacology, University San Raffaele, Rome, Italy
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
- Cardiovascular CAG, St George's University Hospital, London, UK
| | - Maurizio Volterrani
- Department of Exercise Science and Medicine, San Raffaele Open University of Rome, Italy
- Cardiopulmonary Department, IRCCS San Raffaele Roma, Rome, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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7
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Leung CJ, Bhatt AS, Go AS, Parikh RV, Garcia EA, LE KC, Low D, Allen AR, Fitzpatrick JK, Adatya S, Sax DR, Goyal P, Varshney AS, Sandhu AT, Gustafson SE, Ambrosy AP. Sex-Based Differences in the Epidemiology, Clinical Characteristics, and Outcomes Associated with Worsening Heart Failure Events in a Learning Health System. J Card Fail 2024; 30:981-990. [PMID: 38697466 DOI: 10.1016/j.cardfail.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Differences in demographics, risk factors, and clinical characteristics may contribute to variations in men and women in terms of the prevalence, clinical setting, and outcomes associated with worsening heart failure (WHF) events. We sought to describe sex-based differences in the epidemiology, clinical characteristics, and outcomes associated with WHF events across clinical settings. METHODS AND RESULTS We examined adults diagnosed with HF from 2010 to 2019 within a large, integrated health care delivery system. Electronic health record data were accessed for hospitalizations, emergency department (ED) visits and observation stays, and outpatient encounters. WHF was identified using validated natural language processing algorithms and defined as ≥1 symptom, ≥2 objective findings (including ≥1 sign), and ≥1 change in HF-related therapy. Incidence rates and associated outcomes for WHF were compared across care setting by sex. We identified 1,122,368 unique clinical encounters with a diagnosis code for HF, with 124,479 meeting WHF criteria. These WHF encounters existed among 102,116 patients, of whom 48,543 (47.5%) were women and 53,573 (52.5%) were men. Women experiencing WHF were older and more likely to have HF with preserved ejection fraction compared with men. The clinical settings of WHF were similar among women and men: hospitalizations (36.8% vs 37.7%), ED visits or observation stays (11.8% vs 13.4%), and outpatient encounters (4.4% vs 4.9%). Women had lower odds of 30-day mortality after an index hospitalization (adjusted odds ratio 0.88, 95% confidence interval 0.83-0.93) or ED visit or observation stay (adjusted odds ratio 0.86, 95% confidence interval 0.75-0.98) for WHF. CONCLUSIONS Women and men contribute similarly to WHF events across diverse clinical settings despite marked differences in age and left ventricular ejection fraction.
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Affiliation(s)
- Chloe J Leung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Ankeet S Bhatt
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Epidemiology and Population Health, Stanford University, Palo Alto, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, California; Department of Medicine, Stanford University, Palo Alto, California
| | - Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Elisha A Garcia
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Kathy C LE
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Deborah Low
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Amanda R Allen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jesse K Fitzpatrick
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Sirtaz Adatya
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Dana R Sax
- Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Anubodh S Varshney
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California; Medical Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Shanshan E Gustafson
- Department of Medicine, Kaiser Permanente Mid-Atlantic Medical Group, Gaithersburg, Maryland
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
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8
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Abbo AR, Gruber A, Volis I, Aronson D, Girerd N, Lund Kristensen S, Zukermann R, Alberkant N, Sitnitsky E, Kruger A, Khasis P, Bravo E, Elad B, Helmer Levin L, Caspi O. Diuresis Efficacy in Ambulatory Congested Heart Failure Patients: Intrapatient Comparison of 3 Diuretic Regimens (DEA-HF). JACC. HEART FAILURE 2024; 12:1396-1405. [PMID: 38739124 DOI: 10.1016/j.jchf.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Limited evidence exists regarding efficacy and safety of diuretic regimens in ambulatory, congestion-refractory, chronic heart failure (CHF) patients. OBJECTIVES The authors sought to compare the potency and safety of commonly used diuretic regimens in CHF patients. METHODS A prospective, randomized, open-label, crossover study conducted in NYHA functional class II to IV CHF patients, treated in an ambulatory day-care unit. Each patient received 3 different diuretic regimens: intravenous (IV) furosemide 250 mg; IV furosemide 250 mg plus oral metolazone 5 mg; and IV furosemide 250 mg plus IV acetazolamide 500 mg. Treatments were administered once a week, in 1 of 6 randomized sequences. The primary endpoint was total sodium excretion, and the secondary was total urinary volume excreted, both measured for 6 hours post-treatment initiation. RESULTS A total of 42 patients were recruited. Administration of furosemide plus metolazone resulted in the highest weight of sodium excreted, 4,691 mg (95% CI: 4,153-5,229 mg) compared with furosemide alone, 3,835 mg (95% CI: 3,279-4,392 mg; P = 0.015) and to furosemide plus acetazolamide 3,584 mg (95% CI: 3,020-4,148 mg; P = 0.001). Furosemide plus metolazone resulted in 1.84 L of urine (95% CI: 1.63-2.05 L), compared with 1.58 L (95% CI: 1.37-1.8); P = 0.039 collected following administration of furosemide plus acetazolamide and 1.71 L (95% CI: 1.49-1.93 L) following furosemide alone. The incidence of worsening renal function was significantly higher when adding metolazone (39%) to furosemide compared with furosemide alone (16%) and to furosemide plus acetazolamide (2.6%) (P < 0.001). CONCLUSIONS In ambulatory CHF patients, furosemide plus metolazone resulted in a significantly higher natriuresis compared with IV furosemide alone or furosemide plus acetazolamide.
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Affiliation(s)
- Aharon Ronnie Abbo
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Amit Gruber
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ina Volis
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Doron Aronson
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, CHRU Nancy, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Søren Lund Kristensen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Robert Zukermann
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Natalia Alberkant
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Elena Sitnitsky
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Anton Kruger
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Polina Khasis
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Evgeny Bravo
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Boaz Elad
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Ludmila Helmer Levin
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel
| | - Oren Caspi
- Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Clinical Research Institute at Rambam (CRIR), Haifa, Israel.
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9
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Zheng J, Abudayyeh I, Rakovski C, Ehwerhemuepha L, Mianroodi AR, Patel JN, Ihab A, Ani C. Trends in heart failure costs for commercially insured patients in the United States (2006-2021). BMC Health Serv Res 2024; 24:780. [PMID: 38977998 PMCID: PMC11232302 DOI: 10.1186/s12913-024-11240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Although prior research has estimated the overarching cost burden of heart failure (HF), a thorough analysis examining medical expense differences and trends, specifically among commercially insured patients with heart failure, is still lacking. Thus, the study aims to examine historical trends and differences in medical costs for commercially insured heart failure patients in the United States from 2006 to 2021. METHODS A population-based, cross-sectional analysis of medical and pharmacy claims data (IQVIA PharMetrics® Plus for Academic) from 2006 to 2021 was conducted. The cohort included adult patients (age > = 18) who were enrolled in commercial insurance plans and had healthcare encounters with a primary diagnosis of HF. The primary outcome measures were the average total annual payment per patient and per cost categories encompassing hospitalization, surgery, emergency department (ED) visits, outpatient care, post-discharge care, and medications. The sub-group measures included systolic, diastolic, and systolic combined with diastolic, age, gender, comorbidity, regions, states, insurance payment, and self-payment. RESULTS The study included 422,289 commercially insured heart failure (HF) patients in the U.S. evaluated from 2006 to 2021. The average total annual cost per patient decreased overall from $9,636.99 to $8,201.89, with an average annual percentage change (AAPC) of -1.11% (95% CI: -2% to -0.26%). Hospitalization and medication costs decreased with an AAPC of -1.99% (95% CI: -3.25% to -0.8%) and - 3.1% (95% CI: -6.86-0.69%). On the other hand, post-discharge, outpatient, ED visit, and surgery costs increased by an AAPC of 0.84% (95% CI: 0.12-1.49%), 4.31% (95% CI: 1.03-7.63%), 7.21% (95% CI: 6.44-8.12%), and 9.36% (95% CI: 8.61-10.19%). CONCLUSIONS The study's findings reveal a rising trend in average total annual payments per patient from 2006 to 2015, followed by a subsequent decrease from 2016 to 2021. This decrease was attributed to the decline in average patient costs within the Medicare Cost insurance category after 2016, coinciding with the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Additionally, expenses related to surgical procedures, emergency department (ED) visits, and outpatient care have shown substantial growth over time. Moreover, significant differences across various variables have been identified.
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Affiliation(s)
- Jianwei Zheng
- Department of Preventive and Social Medicine Internal Medicine Department, Charles R Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, USA.
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA.
| | - Islam Abudayyeh
- Loma Linda Veteran Administration Healthcare, Loma Linda, CA, USA
- Internal Medicine Department, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Cyril Rakovski
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | | | | | - Jay N Patel
- Loma Linda Veteran Administration Healthcare, Loma Linda, CA, USA
| | - Alomari Ihab
- School of Medicine, University of California, Irvine, CA, USA
| | - Chizobam Ani
- Internal Medicine Department, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Internal Medicine Department, UCLA, Los Angeles, CA, USA
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10
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Moreyra C, Moreyra E, Rozich JD. Heart Failure With Preserved Ejection Fraction: Will Cardiac Magnetic Imaging Impact on Diagnosis, Treatment, and Outcomes?: Explaining the Need for Advanced Imaging to Clinical Stakeholders. Cardiol Rev 2024; 32:371-377. [PMID: 36576375 DOI: 10.1097/crd.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinicians frequently equate symptoms of volume overload to heart failure (HF) but such generalization may preclude diagnostic or etiologic precision essential to optimizing outcomes. HF itself must be specified as the disparate types of cardiac pathology have been traditionally surmised by examination of left ventricular (LV) ejection fraction (EF) as either HF with preserved LVEF (HFpEF-LVEF >50%) or reduced LVEF of (HFrEF-LVEF <40%). More recent data support a third, potentially transitional HF subtype, but therapy, assessment, and prognosis have been historically dictated within the corresponding LV metrics determined by echocardiography. The present effort asks whether this historically dominant role of echocardiography is now shifting slightly, becoming instead a shared if not complimentary test. Will there be a gradual increasing profile for cardiac magnetic resonance as the attempt to further refine our understanding, diagnostic accuracy, and outcomes for HFpEF is attempted?
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Affiliation(s)
- Camila Moreyra
- From the Cardiology Department, Sanatorium Allende, Córdoba, Argentina
| | - Eduardo Moreyra
- From the Cardiology Department, Sanatorium Allende, Córdoba, Argentina
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11
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Kristensen AMD, Munkhaugen J, Halvorsen S, Olsen MH, Bakken A, Sehested TSG, Ruddox V, Lange T, Fagerland MW, Torp-Pedersen C, Prescott E, Atar D. The Danish-Norwegian randomized trial on beta-blocker therapy after myocardial infarction: Design, rationale, and baseline characteristics. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:175-183. [PMID: 38017624 DOI: 10.1093/ehjcvp/pvad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND AIMS The evidence for beta-blocker therapy after myocardial infarction (MI) is randomized trials conducted more than 30 years ago, and the continued efficacy has been questioned. DESIGN AND METHODS The ongoing Danish (DANBLOCK) and Norwegian (BETAMI) randomized beta-blocker trials are joined to evaluate the effectiveness and risks of long-term beta-blocker therapy after MI. Patients with normal or mildly reduced left ventricular ejection fraction (LVEF ≥ 40%) will be randomized to open-label treatment with beta-blockers or no such therapy. The event-driven trial will randomize ∼5700 patients and continue until 950 primary endpoints have occurred. As of July 2023, 5228 patients have been randomized. Of the first 4000 patients randomized, median age was 62 years, 79% were men, 48% had a ST-segment elevation myocardial infarction (STEMI), and 84% had a normal LVEF. The primary endpoint is a composite of adjudicated recurrent MI, incident heart failure (HF), coronary revascularization, ischaemic stroke, all-cause mortality, malignant ventricular arrhythmia, or resuscitated cardiac arrest. The primary safety endpoint includes a composite of recurrent MI, HF, all-cause mortality, malignant ventricular arrhythmia, or resuscitated cardiac arrest 30 days after randomization. Secondary endpoints include each of the components of the primary endpoint, patient-reported outcomes, and other clinical outcomes linked to beta-blocker therapy. The primary analysis will be conducted according to the intention-to-treat principle using a Cox proportional hazards regression model. End of follow-up is expected in December 2024. CONCLUSION The combined BETAMI-DANBLOCK trial will have the potential to affect current clinical practice for beta-blocker therapy in patients with normal or mildly reduced LVEF after MI.
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Affiliation(s)
- Anna Meta Dyrvig Kristensen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Institute of Behavioural Medicine, University of Oslo, 3004 Drammen, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, 0450 Oslo, Norway
| | - Michael Hecht Olsen
- Department of Regional Health Research, University of Southern Denmark, and Department of Internal Medicine 1, Holbæk Hospital, 4300 Holbæk, Denmark
| | - Arnhild Bakken
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, 0450 Oslo, Norway
| | | | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, 3103 Tonsberg, Norway
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, 0317 Oslo, Norway
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, 3400 Hillerød, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, 0450 Oslo, Norway
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12
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de Juan Bagudá J, Cózar León R, Gavira Gómez JJ, Pachón M, Goirigolzarri Artaza J, Martínez Mateo V, Escolar Pérez V, Iniesta Manjavacas ÁM, Rivas Gándara N, Álvarez-García J, Sánchez Ramos JG, Aguilera Agudo C, Rubín López JM, Macías Gallego A, López Fernández S, González Torres L, Martínez JG, Marrero Negrín N, Ramos Maqueda J, Cabrera Ramos M, Medina Gil JM, De Diego Rus C, Bermúdez Jiménez FJ, Madrazo I, Díaz Molina B, Cobo Marcos M, Ruiz Duthil AD, Cordero D, Méndez Fernández AB, Peña Conde L, Arcocha Torres MF, Pérez Castellano N, Arias MÁ, García Bolao I, Díaz Infante E, Campari M, Arribas Ynsaurriaga F, Delgado Jiménez JF, Valsecchi S, Salguero Bodes R. Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00148-8. [PMID: 38697283 DOI: 10.1016/j.rec.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/17/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION AND OBJECTIVES The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts. METHODS The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol. RESULTS We analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001). CONCLUSIONS A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits.
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Affiliation(s)
- Javier de Juan Bagudá
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina, Salud y Deporte, Universidad Europea de Madrid, Madrid, Spain.
| | - Rocío Cózar León
- Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Juan J Gavira Gómez
- Servicio de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marta Pachón
- Unidad de Arritmias, Hospital Universitario de Toledo, Toledo, Spain
| | - Josebe Goirigolzarri Artaza
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | - Jesús Álvarez-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Cristina Aguilera Agudo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José Manuel Rubín López
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Alfonso Macías Gallego
- Servicio de Cardiología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Silvia López Fernández
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Luis González Torres
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Elche Vinalopó, Elche, Alicante, Spain
| | - Juan Gabriel Martínez
- Servicio de Cardiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Natalia Marrero Negrín
- Servicio de Cardiología, Hospital Insular-Materno Infantil Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Javier Ramos Maqueda
- Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - José María Medina Gil
- Servicio de Cardiología, Hospital Insular-Materno Infantil Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carlos De Diego Rus
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Elche Vinalopó, Elche, Alicante, Spain
| | - Francisco José Bermúdez Jiménez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Inés Madrazo
- Servicio de Cardiología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - David Cordero
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Laura Peña Conde
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Nicasio Pérez Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Miguel Á Arias
- Unidad de Arritmias, Hospital Universitario de Toledo, Toledo, Spain
| | - Ignacio García Bolao
- Servicio de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | | | | | - Fernando Arribas Ynsaurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan F Delgado Jiménez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Rafael Salguero Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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13
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Cheikhali R, Kalish C, Maksymiuk V, Nasereldin M, Bahl S, Frishman WH, Aronow WS, Pan S. Subcutaneous Furosemide: A Novel to Euvolemia. Cardiol Rev 2024:00045415-990000000-00236. [PMID: 38520337 DOI: 10.1097/crd.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Furoscix, a subcutaneous pH-neutral formulation of furosemide, obtained US Food and Drug Administration approval in October 2022 for adult patients with New York Heart Association class II and class III chronic heart failure. This approval marks an anticipated potential shift in the traditional management of decongestive therapy in chronic heart failure patients from the confines of the hospital to more accessible outpatient or home-based care. In this review, we will summarize existing evidence regarding the use of subcutaneous furosemide in comparison to both oral and intravenous formulations, highlighting the demonstrable benefits of its application in both outpatient and inpatient settings, and also discuss several factors that may limit its use.
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Affiliation(s)
- Ryan Cheikhali
- From the Department of Medicine at New York Medical College, Valhalla, NY
| | - Chloe Kalish
- Department of Medicine at Westchester Medical Center, Valhalla, NY
| | | | - Mohamed Nasereldin
- From the Department of Medicine at New York Medical College, Valhalla, NY
| | - Sameer Bahl
- Department of Cardiology at Westchester Medical Center, Valhalla, NY
| | - Willi H Frishman
- From the Department of Medicine at New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Department of Cardiology at Westchester Medical Center, Valhalla, NY
| | - Stephen Pan
- Department of Cardiology at Westchester Medical Center, Valhalla, NY
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14
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Puthenpura M, Wilcox J, Tang WHW. Worsening heart failure: a concept in evolution. Curr Opin Cardiol 2024; 39:119-127. [PMID: 38116785 DOI: 10.1097/hco.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Worsening heart failure (WHF) has developed as a unique definition within heart failure (HF) in recent years. It captures the disease as a dynamic process. This review describes what is currently known about WHF, why it should be considered a discrete scientific endpoint, and future directions for research. RECENT FINDINGS There is no single agreed upon definition for WHF. It can be identified as being due to treatment side-effects, related to concomitant comorbidity, or true disease progression. Risk scores based on criteria like those already developed for HF can be created to stratify risk for WHF. CONCLUSIONS WHF is an emerging entity within HF that defines itself as a unique point of interest. Understanding it as a clinical measure of where a patient's HF is evolving allows for identifying patients that require a refreshed approach to their care. Keeping this in mind will help redefine more patient-centric outcome measures in research to come.
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Affiliation(s)
| | - Jennifer Wilcox
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute
| | - W H Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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15
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Manito N, Cepeda‐Rodrigo JM, Farré N, Castillo Orive M, Galve E, Jiménez‐Candil J, García‐Pinilla JM, López Sánchez ES, Rafols C, Gómez Doblas JJ. Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban. Clin Cardiol 2024; 47:e24189. [PMID: 38018889 PMCID: PMC10823448 DOI: 10.1002/clc.24189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and heart failure (HF) have a high risk of thromboembolism and other outcomes and anticoagulation is recommended. HYPOTHESIS This study was aimed to explore the risk factors associated with HF worsening in patients with AF and HF taking rivaroxaban in Spain. METHODS Multicenter, prospective, observational study that included adults with AF and chronic HF, receiving rivaroxaban ≥4 months before entering. HF worsening was defined as first hospitalization or emergency visit because of HF exacerbation. RESULTS A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, mean age was 73.7 ± 10.9 years, 64.9% were male, CHA2 DS2 -VASc was 4.1 ± 1.5, HAS-BLED was 1.6 ± 0.9% and 51.3% had HF with preserved ejection fraction. After 24 months of follow-up, 24.9% of patients developed HF worsening, 11.6% died, 2.9% had a thromboembolic event, 3.1% a major bleeding, 0.5% an intracranial bleeding and no patient had a fatal hemorrhage. Older age, the history of chronic obstructive pulmonary disease, the previous use of vitamin K antagonists, and restrictive or infiltrative cardiomyopathies, were independently associated with HF worsening. Only 6.9% of patients permanently discontinued rivaroxaban treatment. CONCLUSIONS Approximately one out of four patients with HF and AF treated with rivaroxaban developed a HF worsening episode after 2 years of follow-up. The identification of those factors that increase the risk of HF worsening could be helpful in the comprehensive management of this population.
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Affiliation(s)
- Nicolás Manito
- Cardiology DepartmentHospital Universitario de BellvitgeBarcelonaSpain
| | | | - Nuria Farré
- Cardiology DepartmentHospital del MarBarcelonaSpain
| | | | | | - Javier Jiménez‐Candil
- Cardiology DepartmentIBSAL‐Hospital Universitario de Salamanca, Universidad de Salamanca, CIBER‐CVSalamancaSpain
| | - José M. García‐Pinilla
- Cardiology DepartmentHospital Universitario Virgen de la VictoriaMálagaSpain
- Instituto de Investigación Biomédica de Málaga‐Plataforma BIONANDMálagaSpain
- Ciber‐CardiovascularInstituto de Salud Carlos IIIMadridSpain
- Department of Medicine and DermatologyUniversidad de MálagaMálagaSpain
| | | | | | - Juan José Gómez Doblas
- Cardiology DepartmentHospital Universitario Virgen de la VictoriaMálagaSpain
- Instituto de Investigación Biomédica de Málaga‐Plataforma BIONANDMálagaSpain
- Ciber‐CardiovascularInstituto de Salud Carlos IIIMadridSpain
- Department of Medicine and DermatologyUniversidad de MálagaMálagaSpain
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16
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Baudry G, Pereira O, Duarte K, Ferreira JP, Savarese G, Welter A, Tangre P, Lamiral Z, Agrinier N, Girerd N. Risk of readmission and death after hospitalization for worsening heart failure: Role of post-discharge follow-up visits in a real-world study from the Grand Est Region of France. Eur J Heart Fail 2024; 26:342-354. [PMID: 38059342 DOI: 10.1002/ejhf.3103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
AIMS Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow-up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU). METHODS AND RESULTS We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time-dependent survival analysis model. Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317-1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower 1-year death or rehospitalization (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88-0.94, p < 0.0001) mostly related to lower mortality (adjusted HR 0.65, 95% CI 0.62-0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR 1.19, 95% CI 1.15-1.24, p < 0.0001). When analysing components of combined FU separately, 1-year mortality was more related to cardiologist FU (HR 0.65, 95% CI 0.62-0.67, p < 0.0001), than GP FU (HR 0.87, 95% CI 0.85-0.90, p < 0.0001). CONCLUSION Combined FU is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in 1-year mortality, albeit at the expense of an increase in HF hospitalizations.
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Affiliation(s)
- Guillaume Baudry
- Université de Lorraine, CHRU-Nancy, Centre d'Investigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Vandœuvre-lès-Nancy, France
- REICATRA, Recherche et Enseignement en IC Avancée, Transplantation, Assistance, Vandœuvre-lès-Nancy, France
| | - Ouarda Pereira
- Direction Régionale du Service Médical (DRSM) Grand Est, Strasbourg, France
| | - Kévin Duarte
- Université de Lorraine, CHRU-Nancy, Centre d'Investigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Vandœuvre-lès-Nancy, France
| | - João Pedro Ferreira
- Université de Lorraine, CHRU-Nancy, Centre d'Investigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Vandœuvre-lès-Nancy, France
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adeline Welter
- Direction de la Coordination de la Gestion du Risque (DCGDR) Grand Est, Strasbourg, France
| | | | - Zohra Lamiral
- Université de Lorraine, CHRU-Nancy, Centre d'Investigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Vandœuvre-lès-Nancy, France
| | | | - Nicolas Girerd
- Université de Lorraine, CHRU-Nancy, Centre d'Investigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Vandœuvre-lès-Nancy, France
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17
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Ploux S, Strik M, Ramirez FD, Buliard S, Chauvel R, Dos Santos P, Haïssaguerre M, Jobbé‐Duval A, Picard F, Riocreux C, Eschalier R, Bordachar P. Remote management of worsening heart failure to avoid hospitalization in a real-world setting. ESC Heart Fail 2023; 10:3637-3645. [PMID: 37797957 PMCID: PMC10682851 DOI: 10.1002/ehf2.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
AIMS From a patient and health system perspective, managing worsening heart failure (WHF) as an outpatient has become a priority. Remote management allows early detection of WHF, enabling timely intervention with the aim of preventing hospitalization. The objective of the study was to evaluate the feasibility and safety of remotely managing WHF events using a multiparametric platform. METHODS AND RESULTS All patients enrolled in the heart failure remote management programme of the Bordeaux University Hospital Telemedicine Center between 1 January and 31 December 2021 were included in the study. Follow-up data were collected until 1 March 2022. Inclusion criteria were chronic heart failure (HF) with New York Heart Association ≥II symptoms and an elevated B-type natriuretic peptide (BNP > 100 pg/mL or N-terminal-pro-BNP > 1000 pg/mL). Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. In total, 161 patients (71 ± 11 years old, 79% male) were followed for a mean of 291 ± 66 days with a mean adherence to the remote monitoring system of 80 ± 20%. Over this period, 52 (32.3%) patients had 105 WHF events, of which 66 (63%) were successfully managed remotely, the remaining requiring hospitalization. Freedom from WHF events and hospitalization at 300 days were 66% and 85%, respectively (P < 0.001 for the difference). Increased level of BNP was associated with an increased risk of WHF event [hazard ratio (HR) per unit increase in BNP: 1.001; 95% confidence interval (CI) 1-1.002; P = 0.001] and hospitalization (HR 1.002; 95% CI 1.002-1.003; P = 0.002). A decrease in the level of glomerular filtration rate was associated with an increased risk of hospitalization (HR per unit decrease in estimated glomerular filtration rate: 0.946; 95% CI 0.906-0.989; P = 0.014). WHF event recurrence and (re)hospitalization rates at 1-month were similar among patients managed remotely (18% and 12%, respectively) and those requiring hospitalization (21% and 10%, respectively). Iatrogenic complications occurred more often during hospitalization than remote management (26% vs. 3%, P < 0.001). CONCLUSIONS Our study suggests that remote management of WHF events based on a multiparametric approach led by a telemedical centre is feasible and safe. Adopting such a strategy for patients with chronic HF could reduce HF-related hospitalizations with expected benefits for patients, care providers, and health care systems.
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Affiliation(s)
- Sylvain Ploux
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Marc Strik
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - F. Daniel Ramirez
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Samuel Buliard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Rémi Chauvel
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Pierre Dos Santos
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Michel Haïssaguerre
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Antoine Jobbé‐Duval
- Department of Heart Failure and Transplant‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de LyonLyonFrance
| | - François Picard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Clément Riocreux
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Romain Eschalier
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Pierre Bordachar
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
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18
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Greene SJ, Butler J. Expanding the Definition of Worsening Heart Failure and Recognizing the Importance of Outpatient Escalation of Oral Diuretics. Circulation 2023; 148:1746-1749. [PMID: 38011247 DOI: 10.1161/circulationaha.123.066915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.J.G.)
- Duke Clinical Research Institute, Durham, NC (S.J.G.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B.)
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19
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Chatur S, Vaduganathan M, Claggett BL, Cunningham JW, Docherty KF, Desai AS, Jhund PS, de Boer RA, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CS, Martinez FA, Shah SJ, Petersson M, Langkilde AM, McMurray JJ, Solomon SD. Outpatient Worsening Among Patients With Mildly Reduced and Preserved Ejection Fraction Heart Failure in the DELIVER Trial. Circulation 2023; 148:1735-1745. [PMID: 37632455 PMCID: PMC10664793 DOI: 10.1161/circulationaha.123.066506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Hospitalization is recognized as a sentinel event in the disease trajectory of patients with heart failure (HF), but not all patients experiencing clinical decompensation are ultimately hospitalized. Outpatient intensification of diuretics is common in response to symptoms of worsening HF, yet its prognostic and clinical relevance, specifically for patients with HF with mildly reduced or preserved ejection fraction, is uncertain. METHODS In this prespecified analysis of the DELIVER trial (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), we assessed the association between various nonfatal worsening HF events (those requiring hospitalization, urgent outpatient visits requiring intravenous HF therapies, and outpatient oral diuretic intensification) and rates of subsequent mortality. We further examined the treatment effect of dapagliflozin on an expanded composite end point of cardiovascular death, HF hospitalization, urgent HF visit, or outpatient oral diuretic intensification. RESULTS In DELIVER, 4532 (72%) patients experienced no worsening HF event, whereas 789 (13%) had outpatient oral diuretic intensification, 86 (1%) required an urgent HF visit, 585 (9%) had an HF hospitalization, and 271 (4%) died of cardiovascular causes as a first presentation. Patients with a first presentation manifesting as outpatient oral diuretic intensification experienced rates of subsequent mortality that were higher (10 [8-12] per 100 patient-years) than those without a worsening HF event (4 [3-4] per 100 patient-years) but similar to rates of subsequent death after an urgent HF visit (10 [6-18] per 100 patient-years). Patients with an HF hospitalization as a first presentation of worsening HF had the highest rates of subsequent death (35 [31-40] per 100 patient-years). The addition of outpatient diuretic intensification to the adjudicated DELIVER primary end point (cardiovascular death, HF hospitalization, or urgent HF visit) increased the overall number of patients experiencing an event from 1122 to 1731 (a 54% increase). Dapagliflozin reduced the need for outpatient diuretic intensification alone (hazard ratio, 0.72 [95% CI, 0.64-0.82]) and when analyzed as a part of an expanded composite end point of worsening HF or cardiovascular death (hazard ratio, 0.76 [95% CI, 0.69-0.84]). CONCLUSIONS In patients with HF with mildly reduced or preserved ejection fraction, worsening HF requiring oral diuretic intensification in ambulatory care was frequent, adversely prognostic, and significantly reduced by dapagliflozin. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03619213.
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Affiliation(s)
- Safia Chatur
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Brian L. Claggett
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Jonathan W. Cunningham
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Kieran F. Docherty
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
| | - Akshay S. Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
| | - Rudolf A. de Boer
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands (R.A.d.B.)
| | | | | | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City (M.N.K.)
| | - Carolyn S.P. Lam
- National Heart Centre Singapore & Duke-National University of Singapore (C.S.P.L.)
| | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (M.P., A.M.K.)
| | - Anna Maria Langkilde
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands (R.A.d.B.)
- Duke University Medical Center, Durham, NC (A.F.H.)
- Yale School of Medicine, New Haven, CT (S.E.I.)
- Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City (M.N.K.)
- National Heart Centre Singapore & Duke-National University of Singapore (C.S.P.L.)
- Universidad Nacional de Córdoba, Argentina (F.A.M.)
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (M.P., A.M.K.)
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
| | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
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20
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Lavalle C, Di Lullo L, Jabbour JP, Palombi M, Trivigno S, Mariani MV, Summaria F, Severino P, Badagliacca R, Miraldi F, Bellasi A, Vizza CD. New Challenges in Heart Failure with Reduced Ejection Fraction: Managing Worsening Events. J Clin Med 2023; 12:6956. [PMID: 38002571 PMCID: PMC10672118 DOI: 10.3390/jcm12226956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with an established diagnosis of heart failure (HF) with reduced ejection fraction (HFrEF) are prone to experience episodes of worsening symptoms and signs despite continued therapy, termed "worsening heart failure" (WHF). Despite guideline-directed medical therapy, worsening of chronic heart failure accounts for almost 50% of all hospital admissions for HF, and patients experiencing WHF carry a substantially higher risk of death and hospitalization than patients with "stable" HF. New drugs are emerging as arrows in the quiver for clinicians to address the residual risk of HF hospitalization and cardiovascular deaths in patients with WHF. This question-and-answer-based review will discuss the emerging definition of WHF in light of the recent clinical consensus released by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC), the new therapeutic approaches to treat WHF and then move on to their timing and safety concerns (i.e., renal profile).
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Affiliation(s)
- Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi—Delfino Hospital, 00034 Rome, Italy;
| | - Jean Pierre Jabbour
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Marta Palombi
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Sara Trivigno
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | | | - Paolo Severino
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Fabio Miraldi
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
| | - Antonio Bellasi
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (J.P.J.); (M.P.); (S.T.); (M.V.M.); (P.S.); (R.B.); (F.M.); (C.D.V.)
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21
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Seckin M, Johnston B, Petrie MC, Stewart S, Chan YK. Characteristics of symptoms and symptom change across different heart failure subtypes: a sex-stratified analysis. Eur J Cardiovasc Nurs 2023; 22:690-700. [PMID: 36288919 DOI: 10.1093/eurjcn/zvac099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 10/12/2023]
Abstract
AIMS To examine sex-stratified differences in the association of left ventricular ejection fraction-based heart failure (HF) subtypes and the characteristics and correlates of self-reported changes in HF symptoms. METHODS AND RESULTS We report a secondary data analysis from 528 hospitalized individuals diagnosed with HF characterised by a reduced, mildly reduced, or preserved ejection fraction [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), or HF with preserved ejection fraction (HFpEF)] who completed 12-month follow-up within a multicentre disease management trial. There were 302 men (71.1 ± 11.9 years, 58% with HFrEF) and 226 women (77.1 ± 10.6 years, 49% with HFpEF). The characteristics of self-reported symptoms measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and 12-month were analysed. At baseline, shortness of breath and fatigue predominated; with key differences according to HF subtypes in bilateral ankle oedema (both sexes), walking problems (women) and depressive symptoms (men). At 12-month follow-up, most KCCQ scores had not significantly changed. However, 25% of individuals reported worse symptom. In women, those with HFpEF had worse symptoms than those with HFmrEF/HFrEF (P = 0.025). On an adjusted basis, women [odds ratios (OR): 1.78, 95% confidence interval (CI): 1.00-3.16 vs. men], those with coronary artery disease (OR: 2.01, 95% CI: 1.21-3.31) and baseline acute pulmonary oedema (OR: 1.67, 95% CI: 1.02-2.75) were most likely to report worsening symptoms. Among men, worsening symptoms correlated with a history of hypertension (OR: 2.16, 95% CI: 1.07-4.35) and a non-English-speaking background (OR: 2.30, 95% CI: 1.02-5.20). CONCLUSION We found significant heterogeneity (with potential clinical implications) in the symptomatic characteristics and subsequent symptom trajectory according to the sex and HF subtype of those hospitalized with the syndrome. TRIAL REGISTRATION ANZCTR12613000921785.
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Affiliation(s)
- Muzeyyen Seckin
- School of Medicine, Dentistry & Nursing, University of Glasgow, 57-61 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - Bridget Johnston
- School of Medicine, Dentistry & Nursing, University of Glasgow, 57-61 Oakfield Avenue, Glasgow, G12 8LL, UK
- NHS Greater Glasgow and Clyde, 1055 Great Western Rd, Glasgow, G12 0XH, UK
| | - Mark C Petrie
- NHS Greater Glasgow and Clyde, 1055 Great Western Rd, Glasgow, G12 0XH, UK
- School of Cardiovascular & Metabolic Health, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Simon Stewart
- School of Medicine, Dentistry & Nursing, University of Glasgow, 57-61 Oakfield Avenue, Glasgow, G12 8LL, UK
- Institute of Health Research, Notre Dame University of Australia, 32 Mouat St, Fremantle, WA 6160, Australia
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australia Catholic University, 215 Spring Street, Melbourne, VIC 3000, Australia
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22
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Parikh RV, Go AS, Bhatt AS, Tan TC, Allen AR, Feng KY, Hamilton SA, Tai AS, Fitzpatrick JK, Lee KK, Adatya S, Avula HR, Sax DR, Shen X, Cristino J, Sandhu AT, Heidenreich PA, Ambrosy AP. Developing Clinical Risk Prediction Models for Worsening Heart Failure Events and Death by Left Ventricular Ejection Fraction. J Am Heart Assoc 2023; 12:e029736. [PMID: 37776209 PMCID: PMC10727243 DOI: 10.1161/jaha.122.029736] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/24/2023] [Indexed: 10/02/2023]
Abstract
Background There is a need to develop electronic health record-based predictive models for worsening heart failure (WHF) events across clinical settings and across the spectrum of left ventricular ejection fraction (LVEF). Methods and Results We studied adults with heart failure (HF) from 2011 to 2019 within an integrated health care delivery system. WHF encounters were ascertained using natural language processing and structured data. We conducted boosted decision tree ensemble models to predict 1-year hospitalizations, emergency department visits/observation stays, and outpatient encounters for WHF and all-cause death within each LVEF category: HF with reduced ejection fraction (EF) (LVEF <40%), HF with mildly reduced EF (LVEF 40%-49%), and HF with preserved EF (LVEF ≥50%). Model discrimination was evaluated using area under the curve and calibration using mean squared error. We identified 338 426 adults with HF: 61 045 (18.0%) had HF with reduced EF, 49 618 (14.7%) had HF with mildly reduced EF, and 227 763 (67.3%) had HF with preserved EF. The 1-year risks of any WHF event and death were, respectively, 22.3% and 13.0% for HF with reduced EF, 17.0% and 10.1% for HF with mildly reduced EF, and 16.3% and 10.3% for HF with preserved EF. The WHF model displayed an area under the curve of 0.76 and mean squared error of 0.13, whereas the model for death displayed an area under the curve of 0.83 and mean squared error of 0.076. Performance and predictors were similar across WHF encounter types and LVEF categories. Conclusions We developed risk prediction models for 1-year WHF events and death across the LVEF spectrum using structured and unstructured electronic health record data and observed no substantial differences in model performance or predictors except for death, despite differences in underlying HF cause.
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Affiliation(s)
- Rishi V. Parikh
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
- Department of Epidemiology and Population HealthStanford UniversityPalo AltoCAUSA
| | - Alan S. Go
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCAUSA
- Departments of Epidemiology, Biostatistics and MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of MedicineStanford UniversityPalo AltoCAUSA
| | - Ankeet S. Bhatt
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
| | - Thida C. Tan
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Amanda R. Allen
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Kent Y. Feng
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
| | - Steven A. Hamilton
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
| | - Andrew S. Tai
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
| | - Jesse K. Fitzpatrick
- Department of CardiologyKaiser Permanente Santa Clara Medical CenterSanta ClaraCAUSA
| | - Keane K. Lee
- Department of CardiologyKaiser Permanente Santa Clara Medical CenterSanta ClaraCAUSA
| | - Sirtaz Adatya
- Department of CardiologyKaiser Permanente Santa Clara Medical CenterSanta ClaraCAUSA
| | - Harshith R. Avula
- Department of CardiologyKaiser Permanente Walnut Creek Medical CenterWalnut CreekCAUSA
| | - Dana R. Sax
- Department of Emergency MedicineKaiser Permanente Oakland Medical CenterOaklandCAUSA
| | - Xian Shen
- Novartis Pharmaceuticals CorporationEast HanoverNJUSA
| | | | - Alexander T. Sandhu
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCAUSA
- Medical Service, VA Palo Alto Health Care SystemPalo AltoCAUSA
| | - Paul A. Heidenreich
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCAUSA
- Medical Service, VA Palo Alto Health Care SystemPalo AltoCAUSA
| | - Andrew P. Ambrosy
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCAUSA
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
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23
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Bellicini MG, D'Altilia FP, Gussago C, Adamo M, Lombardi CM, Tomasoni D, Inciardi RM, Metra M, Pagnesi M. Telemedicine for the treatment of heart failure: new opportunities after COVID-19. J Cardiovasc Med (Hagerstown) 2023; 24:700-707. [PMID: 37409660 DOI: 10.2459/jcm.0000000000001514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
ABSTRACT During the Coronavirus Disease 2019 (COVID-19) pandemic, the epidemiology of heart failure significantly changed with reduced access to health system resources and a worsening of patients' outcome. Understanding the causes of these phenomena could be important to refine the management of heart failure during and after the pandemic. Telemedicine was associated with an improvement in heart failure outcomes in several studies; therefore, it may help in refining the out-of-hospital care of heart failure. In this review, the authors describe the changes in heart failure epidemiology during the COVID-19 pandemic; analyse available evidence on use and benefit of telemedicine during the pandemic and prepandemic periods; and discuss approaches to optimize the home-based or outpatient heart failure management in the future, beyond the pandemic.
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Affiliation(s)
- Maria Giulia Bellicini
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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24
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Falco L, Brescia B, Catapano D, Martucci ML, Valente F, Gravino R, Contaldi C, Pacileo G, Masarone D. Vericiguat: The Fifth Harmony of Heart Failure with Reduced Ejection Fraction. J Cardiovasc Dev Dis 2023; 10:388. [PMID: 37754817 PMCID: PMC10531735 DOI: 10.3390/jcdd10090388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure with reduced ejection fraction have a high residual risk of adverse outcomes, even when treated with optimal guideline-directed medical therapy and in a clinically stable state. Worsening heart failure episodes represent a critical event in the heart failure trajectory, carrying high residual risk at discharge and dismal short- or long-term prognosis. Recently, vericiguat, a soluble guanylate cyclase stimulator, has been proposed as a novel drug whose use is already associated with a reduction in heart failure-related hospitalizations in patients in guideline-directed medical therapy. In this review, we summarized the pathophysiology of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate cascade in patients with heart failure with reduced ejection fraction, the pharmacology of vericiguat as well as the evidence regarding their use in patients with HFrEF. Finally, tips and tricks for its use in standard clinical practice are provided.
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Affiliation(s)
- Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Benedetta Brescia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Maria Luigia Martucci
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
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25
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Chimed S, Stassen J, Galloo X, Meucci MC, Knuuti J, Delgado V, van der Bijl P, Ajmone Marsan N, Bax JJ. Prognostic Relevance of Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Reduced Ejection Fraction. Am J Cardiol 2023; 202:30-40. [PMID: 37413704 DOI: 10.1016/j.amjcard.2023.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
Patients with heart failure (HF) and reduced ejection fraction (HFrEF) are complex patients who often have a high prevalence of co-morbidities and risk factors. In the present study, we investigated the prognostic significance of left ventricular (LV) global longitudinal strain (GLS) along with important clinical and echocardiographic variables in patients with HFrEF. Patients who had a first echocardiographic diagnosis of LV systolic dysfunction, defined as LV ejection fraction ≤45%, were selected. The study population was subdivided into 2 groups based on a spline curve analysis derived optimal threshold value of LV GLS (≤10%). The primary end point was occurrence of worsening HF, whereas the composite of worsening HF and all-cause death was chosen for the secondary end point. A total of 1,873 patients (mean age 63 ± 12 years, 75% men) were analyzed. During a median follow-up of 60 months (interquartile range 27 to 60 months), 256 patients (14%) experienced worsening HF and the composite end point of worsening HF and all-cause mortality occurred in 573 patients (31%). The 5-year event-free survival rates for the primary and secondary end point were significantly lower in the LV GLS ≤10% group compared with the LV GLS >10% group. After adjustment for important clinical and echocardiographic variables, baseline LV GLS remained independently associated with a higher risk of worsening HF (hazard ratio 0.95, 95% confidence interval 0.90 to 0.99, p = 0.032) and the composite of worsening HF and all-cause mortality (hazard ratio 0.94, 95% confidence interval 0.90 to 0.97, p = 0.001). In conclusion, baseline LV GLS is associated with long-term prognosis in patients with HFrEF, independent of various clinical and echocardiographic predictors.
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Affiliation(s)
- Surenjav Chimed
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Xavier Galloo
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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26
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Greene SJ, Bauersachs J, Brugts JJ, Ezekowitz JA, Filippatos G, Gustafsson F, Lam CSP, Lund LH, Mentz RJ, Pieske B, Ponikowski P, Senni M, Skopicki N, Voors AA, Zannad F, Zieroth S, Butler J. Management of Worsening Heart Failure With Reduced Ejection Fraction: JACC Focus Seminar 3/3. J Am Coll Cardiol 2023; 82:559-571. [PMID: 37532426 DOI: 10.1016/j.jacc.2023.04.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 08/04/2023]
Abstract
Despite worsening heart failure (HF) being extremely common, expensive, and associated with substantial risk of death, there remain no dedicated clinical practice guidelines for the specific management of these patients. The lack of a management guideline is despite a rapidly evolving evidence-base, as a number of recent clinical trials have demonstrated multiple therapies to be safe and efficacious in this high-risk population. Herein, we propose a framework for treating worsening HF with reduced ejection fraction with the sense of urgency it deserves. This includes treating congestion; managing precipitants; and establishing a foundation of rapid-sequence, simultaneous, and/or in-hospital initiation of quadruple medical therapy for HF with reduced ejection fraction, with the top priority being at least low doses of all 4 medications. Moreover, to maximally reduce residual clinical risk, we further propose consideration of upfront simultaneous use of vericiguat (ie, quintuple medical therapy) and administration of intravenous iron for those who are iron deficient.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jasper J Brugts
- Division of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore
| | - Lars H Lund
- Department of Medicine Solna, Unit of Cardiology, Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Michele Senni
- Cardiovascular Department and Cardiology Unit, University of Milano-Bicocca, Bergamo, Italy
| | | | - Adriaan A Voors
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Faiez Zannad
- Université de Lorraine, Centre d'Investigation Clinique-Plurithématique Inserm 1433, Centre Hospitalier Regional Universitaire, Nancy Brabois, France; Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | | | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; Department of Medicine, University of Mississippi, Jackson, Mississippi, USA.
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27
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Felker GM, North R, Mulder H, Jones WS, Anstrom KJ, Patel MJ, Butler J, Ezekowitz JA, Lam CSP, O'Connor CM, Roessig L, Hernandez AF, Armstrong PW. Classification of Heart Failure Events by Severity: Insights From the VICTORIA Trial. J Card Fail 2023; 29:1113-1120. [PMID: 37331690 PMCID: PMC10697691 DOI: 10.1016/j.cardfail.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Hospitalization due to heart failure (HFH) is a major source of morbidity, consumes significant economic resources and is a key endpoint in HF clinical trials. HFH events vary in severity and implications, but they are typically considered equivalent when analyzing clinical trial outcomes. OBJECTIVES We aimed to evaluate the frequency and severity of HF events, assess treatment effects and describe differences in outcomes by type of HF event in VICTORIA (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction). METHODS VICTORIA compared vericiguat with placebo in patients with HF with reduced ejection fraction (< 45%) and a recent worsening HF event. All HFHs were prospectively adjudicated by an independent clinical events committee (CEC) whose members were blinded to treatment assignment. We evaluated the frequency and clinical impact of HF events by severity, categorized by highest intensity of HF treatment (urgent outpatient visit or hospitalization treated with oral diuretics, intravenous diuretics, intravenous vasodilators, intravenous inotropes, or mechanical support) and treatment effect by event categories. RESULTS In VICTORIA, 2948 HF events occurred in 5050 enrolled patients. Overall total CEC HF events for vericiguat vs placebo were 43.9 vs 49.1 events/100 patient-years (P = 0.01). Hospitalization for intravenous diuretics was the most common type of HFH event (54%). HF event types differed markedly in their clinical implications for both in-hospital and post-discharge events. We observed no difference in the distribution of HF events between randomized treatment groups (P = 0.78). CONCLUSION HF events in large global trials vary significantly in severity and clinical implications, which may have implications for more nuanced trial design and interpretation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT02861534).
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Affiliation(s)
- G Michael Felker
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Rebecca North
- Duke Aging Center, Duke University School of Medicine, Durham, NC, USA
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Javed Butler
- Baylor University Medical Center, Dallas, TX, USA
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | | | | | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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28
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Chatur S, Kondo T, Claggett BL, Docherty K, Miao ZM, Desai AS, Jhund PS, de Boer RA, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Martinez FA, Shah SJ, Petersson M, Langkilde AM, McMurray JJV, Solomon SD, Vaduganathan M. Effects of dapagliflozin on heart failure hospitalizations according to severity of inpatient course: Insights from DELIVER and DAPA-HF. Eur J Heart Fail 2023; 25:1364-1371. [PMID: 37210608 DOI: 10.1002/ejhf.2912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023] Open
Abstract
AIMS Dapagliflozin resulted in significant and sustained reductions in first and recurrent heart failure (HF) hospitalizations among patients with HF across the spectrum of ejection fraction. How treatment with dapagliflozin differentially impacts hospitalization for HF of varying complexity is not well studied. METHODS AND RESULTS In the DELIVER and DAPA-HF trials, we examined the effects of dapagliflozin on adjudicated HF hospitalizations of varying complexity and hospital length of stay (LOS). HF hospitalizations requiring intensive care unit stay, intravenous vasoactive therapies, invasive/non-invasive ventilation, mechanical fluid removal or mechanical circulatory support were categorized as complicated. The balance was classified as uncomplicated. Of the total 1209 HF hospitalizations reported in DELIVER, 854 (71%) were uncomplicated and 355 (29%) were complicated. Of the total 799 HF hospitalizations reported in DAPA-HF, 453 (57%) were uncomplicated and 346 (43%) were complicated. Relative to patients experiencing a first uncomplicated HF hospitalization, those with complicated HF hospitalizations had a significantly higher in-hospital mortality both in DELIVER (16.7% vs. 2.3%, p < 0.001) and DAPA-HF (15.1% vs. 3.8%, p < 0.001). Dapagliflozin similarly reduced total 'uncomplicated' (DELIVER: rate ratio [RR] 0.67, 95% confidence interval [CI] 0.55-0.82 and DAPA-HF: RR 0.69, 95% CI 0.54-0.87) and 'complicated' HF hospitalizations (DELIVER: RR 0.82, 95% CI 0.63-1.06 and DAPA-HF: RR 0.75, 95% CI 0.58-0.97). Dapagliflozin consistently reduced hospitalizations irrespective of their LOS: <5 days (DELIVER: RR 0.76, 95% CI 0.58-0.99 and DAPA-HF: RR 0.58, 95% CI 0.42-0.80) or ≥5 days (DELIVER: RR 0.71, 95% CI 0.58-0.86 and DAPA-HF: RR 0.77, 95% CI 0.62-0.94). CONCLUSION A substantial proportion of hospitalizations (∼30-40%) among patients with HF irrespective of ejection fraction required intensification of treatment beyond standard intravenous diuretics. Such patients experienced significantly higher in-hospital mortality. Treatment with dapagliflozin consistently reduced HF hospitalizations regardless of severity of inpatient course or LOS. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, DELIVER (NCT03619213) and DAPA-HF (NCT03036124).
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Affiliation(s)
- Safia Chatur
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Toru Kondo
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kieran Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Bensimhon D, Weintraub WS, Peacock WF, Alexy T, McLean D, Haas D, Deering KL, Millar SJ, Goodwin MM, Mohr JF. Reduced heart failure-related healthcare costs with Furoscix versus in-hospital intravenous diuresis in heart failure patients: the FREEDOM-HF study. Future Cardiol 2023; 19:385-396. [PMID: 37609913 DOI: 10.2217/fca-2023-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Aim: Compare heart failure (HF) costs of Furoscix use at home compared with inpatient intravenous (IV) diuresis. Patients & methods: Prospective, case control study of chronic HF patients presenting to emergency department (ED) with worsening congestion discharged to receive Furoscix 80 mg/10 ml 5-h subcutaneous infusion for ≤7 days. 30-day HF-related costs in Furoscix group derived from commercial claims database compared with matched historical patients hospitalized for <72 h. Results: Of 24 Furoscix patients, 1 (4.2%) was hospitalized in 30-day period. 66 control patients identified and were well-matched for age, sex, ejection fraction (EF), renal function and other comorbidities. Furoscix patients had reduced mean per patient HF-related healthcare cost of $16,995 (p < 0.001). Conclusion: Furoscix use was associated with significant reductions in 30-day HF-related healthcare costs versus matched hospitalized controls.
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Affiliation(s)
| | | | | | - Tamas Alexy
- University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | | | | | | | - John F Mohr
- scPharmaceuticals, Burlington, MA 01803, USA
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Chiang CE, Hung CL, Wu YW, Lin TH, Ueng KC, Sung SH, Wu CK, Chao TH, Lin HJ, Lin YH, Huang JL, Chen MYC, Lin PL, Chao TF, Cheng HM, Liu ME, Wang TD, Yeh HI, Li YH, Liu PY, Yin WH, Hsieh IC, Wang CC, Chen CH, Chu PH, Lin SJ, Yeh SJ, Lin JL, Hwang JJ, Hung HF, Chen WJ, Hou CJY. 2023 Consensus of Taiwan Society of Cardiology on the Pharmacological Treatment of Chronic Heart Failure. ACTA CARDIOLOGICA SINICA 2023; 39:361-390. [PMID: 37229331 PMCID: PMC10203721 DOI: 10.6515/acs.202305_39(3).20230301a] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 05/27/2023]
Abstract
The prevalence of heart failure is increasing, causing a tremendous burden on health care systems around the world. Although mortality rate of heart failure has been significantly reduced by several effective agents in the past 3 decades, yet it remains high in observational studies. More recently, several new classes of drugs emerged with significant efficacy in reducing mortality and hospitalization in chronic heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). To integrate these effective therapies and prioritize them in the management of Asian patients, Taiwan Society of Cardiology has recently appointed a working group to formulate a consensus of pharmacological treatment in patients with chronic heart failure. Based on most updated information, this consensus provides rationales for prioritization, rapid sequencing, and in-hospital initiation of both foundational and additional therapies for patients with chronic heart failure.
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Affiliation(s)
- Chern-En Chiang
- General Clinical Research Center
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
- Institute of Biomedical Sciences, MacKay Medical College
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Kwo-Chang Ueng
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Hung-Ju Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
- National Taiwan University College of Medicine, Taipei
| | - Jin-Long Huang
- Department of Medical Education, Taichung Veterans General Hospital
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung-Hsing University, Taichung
| | - Michael Yu Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University
| | - Hao-Min Cheng
- Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University School of Medicine
- Division of Faculty Development, Taipei Veterans General Hospital
| | - Ming-En Liu
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital
| | - Hung-I Yeh
- Departments of Internal Medicine and Medical Research, MacKay Memorial Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Ping-Yen Liu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Hsian Yin
- School of Medicine, National Yang Ming Chiao Tung University
- Heart Center, Cheng-Hsin General Hospital, Taipei
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Chun-Chieh Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Chen-Huan Chen
- School of Medicine, National Yang Ming Chiao Tung University
- Department of Medical Education, Taipei Veterans General Hospital, Taipei
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Shing-Jong Lin
- Taipei Heart Institute, Taipei Medical University
- Department of Medical Research, Taipei Veterans General Hospital, Taipei
| | - San-Jou Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
- Shuan Ho Hospital, Taipei Medical University, New Taipei City
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Huei-Fong Hung
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan
| | - Charles Jia-Yin Hou
- Department of Medicine, MacKay Medical College, New Taipei City
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
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Siddiqi AK, Greene SJ, Fudim M, Mentz RJ, Butler J, Khan MS. Vericiguat for the treatment of heart failure with reduced ejection fraction. Expert Rev Cardiovasc Ther 2023; 21:245-257. [PMID: 36881733 DOI: 10.1080/14779072.2023.2189101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Despite significant therapeutic advancements in heart failure with reduced ejection fraction (HFrEF), the residual risk of all-cause mortality and hospitalizations remains high among patients with HFrEF. Vericiguat is a novel oral soluble guanylate cyclase (sGC) stimulator which was approved by the US Food and Drug administration (FDA) in January 2021 for use in patients with symptomatic chronic HF and an ejection fraction less than 45% following a hospitalization for HF or the need for outpatient intravenous diuretics. AREAS COVERED We provide a concise review of the pharmacology, clinical efficacy, and tolerability of vericiguat in HFrEF. We also discuss the role of vericiguat in current clinical practice. EXPERT OPINION Vericiguat reduces the risk of cardiovascular mortality or HF hospitalizations by an absolute event-rate reduction of 4.2 events per 100 patient-years with a number needed to treat of 24 patients, on a background of guideline-directed medical therapy. Almost 90% of the patients with HFrEF were adherent to the 10 mg dose of vericiguat in the VICTORIA trial with a favorable tolerability and safety profile. Considering the high residual risk that persists in HFrEF, vericiguat has a role to improve outcomes among patients with worsening HFrEF.
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Affiliation(s)
- Ahmed K Siddiqi
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Stephen J Greene
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Robert J Mentz
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Medicine, University of Mississippi, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, Tx, USA
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Khan MS, Xu H, Fonarow GC, Lautsch D, Hilkert R, Allen LA, DeVore AD, Alhanti B, Yancy CW, Albert NM, Butler J, Greene SJ. Applicability of Vericiguat to Patients Hospitalized for Heart Failure in the United States. JACC. HEART FAILURE 2023; 11:211-223. [PMID: 36754528 PMCID: PMC11045268 DOI: 10.1016/j.jchf.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND In January 2021, vericiguat, a soluble guanylate cyclase stimulator, was approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of cardiovascular death and heart failure (HF) hospitalization among patients with a recent worsening HF event based on the VICTORIA (VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) trial. OBJECTIVES This study sought to leverage a contemporary U.S. registry of patients hospitalized for heart failure (HF) to characterize patients who may be candidates for vericiguat based on FDA label and the VICTORIA trial eligibility criteria. METHODS The authors studied patients hospitalized for HF with ejection fraction (EF) <45% across 525 sites in the GWTG-HF (Get With The Guidelines-Heart Failure) registry between January 2014 and December 2020. Approximate FDA label criteria (excluding estimated glomerular filtration rate [eGFR] <15 mL/min/1.73 m2, dialysis, or patients with heart transplantation or durable mechanical circulatory support) and eligibility criteria for the VICTORIA trial were applied to the GWTG-HF cohort. RESULTS Among 241,057 patients with EF <45% in the GWTG-HF registry, 221,730 (92%) could be candidates for vericiguat under the FDA label and 92,249 (38%) would have been eligible for the VICTORIA trial. The most frequent reasons for ineligibility for the FDA label were eGFR <15 mL/min/1.73 m2 (5.7%) and dialysis (1.6%). Although there were greater proportions of women and Black patients in the GWTG-HF registry, most clinical characteristics were qualitatively similar with patients enrolled in the VICTORIA trial. Among Medicare beneficiaries in the GWTG-HF registry eligible for vericiguat by either FDA label or VICTORIA trial criteria, 12-month postdischarge rates of mortality (36%-37%), HF hospitalization (33%-35%), all-cause hospitalization (64%-66%), and mean health care expenditure (U.S. $25,106-$25,428) were high. CONCLUSIONS Data from a large, contemporary U.S. registry of patients actively hospitalized for HF with EF <45% suggest that approximately 4 in 10 patients meet the criteria of the VICTORIA trial and that more than 9 in 10 patients are potential candidates for vericiguat based on the FDA label. Contemporary Medicare beneficiaries hospitalized for HF with EF <45% and eligible for vericiguat face high rates of postdischarge mortality and readmission and accrue substantial health care costs.
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Affiliation(s)
- Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | | | | | - Larry A Allen
- Division of Cardiology and Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam D DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Brooke Alhanti
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
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Inácio H, De Carvalho A, Gamelas De Carvalho J, Maia A, Durão-Carvalho G, Duarte J, Rodrigues C, Araújo I, Henriques C, Fonseca C. Real-Life Data on Readmissions of Worsening Heart Failure Outpatients in a Heart Failure Clinic. Cureus 2023; 15:e35611. [PMID: 37007323 PMCID: PMC10063241 DOI: 10.7759/cureus.35611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
Introduction Recurrent hospitalizations for worsening heart failure (WHF) represent a major global public health concern, resulting in significant individual morbimortality and socioeconomic costs. This real-life study aimed to determine the rate and predictors of readmission for WHF in a cohort of outpatients with chronic heart failure (CHF) followed in a heart failure clinic (HFC) at a university hospital. Methods We conducted a longitudinal, observational, and retrospective study of all consecutive CHF patients seen at the HFC of the São Francisco Xavier Hospital, Lisbon, by a multidisciplinary team in 2019. The patients were followed for one year and were on optimized therapy. The inclusion criteria for the study were patients who had been hospitalized and subsequently discharged at least three months prior to their enrollment. Patient demographics, heart failure (HF) characterization, comorbidities, pharmacological treatment, treatments of decompensated HF in the day hospital (DH), hospitalizations for WHF, and death were recorded. We applied logistic regression analysis to assess predictors of hospital readmission for HF. Results A total of 351 patients were included: 90 patients (26%) had WHF requiring treatment with intravenous diuretics in the DH; 45 patients (mean age: 79.1 ± 9.0 years) were readmitted for decompensated HF within one year (12.8%) with no gender difference, while 87.2% of the patients (mean age: 74.9 ± 12.1 years) were never readmitted. Readmitted patients were significantly older than those who were not (p=0.031). Additionally, they had a higher New York Heart Association (NYHA) functional classification (p<.001), were on a higher daily dose of furosemide (p=0.008) at the time of the inclusion visit, were more frequently affected by the chronic obstructive pulmonary disease (COPD) (p=0.004); had been treated more often in the DH for WHF (p<.001) and had a higher mortality rate (p<.001) at one year. Conclusions This study aimed to determine WHF patient readmission rates and predictors. According to our results, a higher NYHA class, the need for treatment in the DH for WHF, a daily dose of furosemide equal to or greater than 80 mg, and COPD were predictors of readmission for WHF. CHF patients continue to experience WHF and recurrent hospitalizations despite therapeutic advances and close follow-up in the HFC with the multidisciplinary team. Besides COPD, the HF readmission risk factors found were mainly related to advanced disease. Furthermore, the structured and multidisciplinary approach of our disease management program likely contributed to our relatively low rate of readmissions.
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Affiliation(s)
- Hugo Inácio
- Internal Medicine, Centro Hospitalar Universitário Lisboa Central - Hospital de Santo António dos Capuchos, Lisbon, PRT
| | | | | | - André Maia
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro - Hospital de Vila Real, Vila Real, PRT
| | - Gonçalo Durão-Carvalho
- Internal Medicine, Centro Hospitalar do Oeste - Unidade de Caldas da Rainha, Caldas da Rainha, PRT
| | - Joana Duarte
- Intermediate Medical Care Unit, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de São Francisco Xavier, Lisbon, PRT
| | - Catarina Rodrigues
- Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de São Francisco Xavier, Lisbon, PRT
| | - Inês Araújo
- Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de São Francisco Xavier, Lisbon, PRT
| | - Célia Henriques
- Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de São Francisco Xavier, Lisbon, PRT
| | - Candida Fonseca
- Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de São Francisco Xavier, Lisbon, PRT
- Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School - Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, PRT
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Worsening Heart Failure: Nomenclature, Epidemiology, and Future Directions: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:413-424. [PMID: 36697141 DOI: 10.1016/j.jacc.2022.11.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 01/25/2023]
Abstract
Heart failure (HF) is a progressive disease characterized by variable durations of symptomatic stability often punctuated by episodes of worsening despite continued therapy. These periods of clinical worsening are increasingly recognized as a distinct phase in the history of HF, termed worsening HF (WHF). The definition of WHF continues to evolve from a historical focus solely on hospitalization to now include nonhospitalization events (eg, need for intravenous diuretic therapy in the emergency or outpatient setting). Most HF clinical trials to date have had HF hospitalization and death as primary endpoints, and only recently, some studies have included other WHF events regardless of location of care. This article reviews the evolution of the WHF definition, highlights the importance of considering the onset of WHF as an event that marks a new phase of HF, summarizes the latest clinical trials investigating novel therapies, and outlines unmet needs regarding identification and treatment of WHF.
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González-Juanatey JR, Comín-Colet J, Pascual Figal D, Bayes-Genis A, Cepeda JM, García-Pinilla JM, García-Quintana A, Manzano L, Zamorano JL. Optimization of Patient Pathway in Heart Failure with Reduced Ejection Fraction and Worsening Heart Failure. Role of Vericiguat. Patient Prefer Adherence 2023; 17:839-849. [PMID: 36999163 PMCID: PMC10044168 DOI: 10.2147/ppa.s400403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
Heart failure (HF) is a progressive condition with periods of apparent stability and repeated worsening HF events. Over time, unless optimization of HF treatment, worsening HF events become more frequent and patients enter into a cycle of recurrent events with high morbidity and mortality. In patients with HF there is an activation of deleterious neurohormonal pathways, such as the renin angiotensin aldosterone system and the sympathetic system, and an inhibition of protective pathways, including natriuretic peptides and guanylate cyclase. Therefore, HF burden can be reduced only through a holistic approach that targets all neurohormonal systems. In this context, vericiguat may play a key role, as it is the only HF drug that activates the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate system. On the other hand, it has been described relevant disparities in the management of HF population. Consequently, it is necessary to homogenize the management of these patients, through an integrated patient-care pathway that should be adapted at the local level. In this context, the development of new technologies (ie, video call, specific platforms, remote control devices, etc.) may be very helpful. In this manuscript, a multidisciplinary group of experts analyzed the current evidence and shared their own experience to provide some recommendations about the therapeutic optimization of patients with recent worsening HF, with a particular focus on vericiguat, and also about how the integrated patient-care pathway should be performed.
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Affiliation(s)
- José Ramón González-Juanatey
- Cardiology Department, Hospital Clínico Universitario Santiago de Compostela, Centro de investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain
- Correspondence: José Ramón González-Juanatey, Email
| | - Josep Comín-Colet
- Cardiology Department, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Domingo Pascual Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - Antoni Bayes-Genis
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jose Maria Cepeda
- Department of Internal Medicine, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - José M García-Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
- Department of Medicine and Dermatology, Universidad de Málaga, Málaga, Spain
| | - Antonio García-Quintana
- Cardiology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Luis Manzano
- Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Jose Luis Zamorano
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Aronson D, Nitzan Y, Petcherski S, Bravo E, Habib M, Burkhoff D, Abraham WT. Enhancing Sweat Rate Using a Novel Device for the Treatment of Congestion in Heart Failure. Circ Heart Fail 2023; 16:e009787. [PMID: 36321445 DOI: 10.1161/circheartfailure.122.009787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Current treatment of fluid retention in heart failure relies primarily on diuretics. However, adequate decongestion is not achieved in many patients. We aimed to study the feasibility and short-term performance of a novel approach to remove fluids and sodium directly from the interstitial compartment by enhancing sweat rate. METHODS We used a device designed to enhance fluid and salt loss via the eccrine sweat glands. Skin temperature in the lower body was increased from 35 °C to 38 °C, where the slope of the relationship between temperature and sweat production is linear. The sweat evaporates instantaneously, thus avoiding the awareness of perspiration. The primary efficacy endpoint was the ability to increase skin temperature to the desired range. A secondary efficacy endpoint was a clinically meaningful hourly sweat output, defined as ≥150 mL/h. The primary safety endpoint was any procedure-related adverse events. RESULTS We studied 6 normal subjects and 18 patients with congestion. Participants underwent 3 treatment sessions of up to 4 hours. Skin temperature increased to a median of 37.5 °C (interquartile range, 37.1-37.9 °C) with the median core temperature increasing by 0.2 °C (interquartile range, 0.1-0.3 °C). The median hourly weight loss during treatment was 215 g/h (interquartile range, 165-285; range, 100-344 g/h). In 80% of treatment procedures, the average sweat rate was ≥150 mL/h. There were no significant changes in hemodynamic variables or renal function and no procedure-related adverse events. CONCLUSIONS Enhancing sweat rate was safe and resulted in a clinically meaningful fluid removal and weight loss. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04578353.
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Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel (D.A., S.P., E.B., M.H.)
| | | | - Sirouch Petcherski
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel (D.A., S.P., E.B., M.H.)
| | - Evgeny Bravo
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel (D.A., S.P., E.B., M.H.)
| | - Manhal Habib
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel (D.A., S.P., E.B., M.H.)
| | - Daniel Burkhoff
- Cardiovascular Research Foundation and Columbia University, New York, NY (D.B.)
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.)
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Zilberberg MD, Nathanson BH, Sulham K, Mohr JF, Goodwin MM, Shorr AF. Descriptive Epidemiology and Outcomes of Patients with Short Stay Hospitalizations for the Treatment of Congestive Heart Failure in the US. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:139-149. [PMID: 36875284 PMCID: PMC9975205 DOI: 10.2147/ceor.s400882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Background Congestive heart failure (CHF) hospitalizations cost the US $35 billion annually. Two-thirds of these admissions, generally requiring </=3 days in the hospital, are solely for the purpose of diuresis, and may be avoidable. Methods Among patients discharged with CHF as the principal diagnosis (PD), we compared characteristics and outcomes between those with hospital length of stay (LOS) </=3 days (short, SLOS) and >3 days (long, LLOS) in a cross-sectional multicenter analysis within the 2018 National Inpatient Sample. We applied complex survey methods to calculate nationally representative results. Results Among 4,979,350 discharges with any CHF code, 1,177,910 (23.7%) had CHF-PD, of whom 511,555 (43.4%) had SLOS. Patients with SLOS were younger (>/=65 years: 68.3% vs 71.9%), less likely covered by Medicare (71.9% vs 75.4%), and had a lower comorbidity burden (Charlson: 3.9 [2.1] vs 4.5 [2.2) than patients with LLOS; they less frequently developed acute kidney injury (0.4% vs 2.9%) or a need for mechanical ventilation (0.7% vs 2.8%). A higher proportion with SLOS than with LLOS underwent no procedures (70.4% vs 48.4%). Mean LOS (2.2 [0.8] vs 7.7 [6.5]), direct hospital costs ($6150 [$4413]) vs $17,127 [$26,936]), and aggregate annual hospital costs $3,131,560,372 vs $11,359,002,072) were all lower with SLOS than LLOS. All comparisons reached alpha = 0.001. Conclusion Among patients admitted for CHF, nearly ½ have LOS </=3 days, and almost ¾ of them requires no inpatient procedures. A more aggressive outpatient heart failure management strategy may allow many patients to avoid hospitalizations and their potential complications and costs.
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Davidge J, Ashfaq A, Ødegaard KM, Olsson M, Costa-Scharplatz M, Agvall B. Clinical characteristics and mortality of patients with heart failure in Southern Sweden from 2013 to 2019: a population-based cohort study. BMJ Open 2022; 12:e064997. [PMID: 36526318 PMCID: PMC9764664 DOI: 10.1136/bmjopen-2022-064997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To describe clinical characteristics and prognosis related to heart failure (HF) phenotypes in a community-based population by applying a novel algorithm to obtain ejection fractions (EF) from electronic medical records. DESIGN Retrospective population-based cohort study. SETTING Data were collected for all patients with HF in Southwest Sweden. The region consists of three acute care hospitals, 40 inpatient wards, 2 emergency departments, 30 outpatient specialty clinics and 48 primary healthcare. PARTICIPANTS 8902 patients had an HF diagnosis based on the International Classification of Diseases, Tenth Revision during the study period. Patients <18 years as well as patients declining to participate were excluded resulting in a study population of 8775 patients. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was distribution of HF phenotypes by echocardiography. The secondary outcome measures were 1 year all-cause mortality and HR for all-cause mortality using Cox regression models. RESULTS Out of 8775 patients with HF, 5023 (57%) had a conclusive echocardiography distributed into HF with reduced EF (35%), HF with mildly reduced EF (27%) and HF with preserved EF (38%). A total of 43% of the cohort did not have a conclusive echocardiography, and therefore no defined phenotype (HF-NDP). One-year all-cause mortality was 42% within the HF-NDP group and 30% among those with a conclusive EF. The HR of all-cause mortality in the HF-NDP group was 1.27 (95% CI 1.17 to 1.37) when compared with the confirmed EF group. There was no significant difference in survival within the HF phenotypes. CONCLUSIONS This population-based study showed a distribution of HF phenotypes that varies from those in selected HF registries, with fewer patients with HF with reduced EF and more patients with HF with preserved EF. Furthermore, 1-year all-cause mortality was significantly higher among patients with HF who had not undergone a conclusive echocardiography at diagnosis, highlighting the importance of correct diagnostic procedure to improve treatment strategies and outcomes.
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Affiliation(s)
- Jason Davidge
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Capio Vårdcentral Halmstad, Capio AB, Halmstad, Sweden
| | - Awais Ashfaq
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
| | | | - Mattias Olsson
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
| | | | - Björn Agvall
- Department of Research and Development, Region Halland, Halmstad, Sweden
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Rosner CM, Lee SB, Badrish N, Maini AS, Young KD, Vorgang CM, Bagnola A, Desai SS, Hahndorf C, Looby M, Psotka MA, O'Connor CM, Cooper LB. Advanced Practice Provider Urgent Outpatient Clinic for Patients With Decompensated Heart Failure. J Card Fail 2022; 29:536-539. [PMID: 36526217 DOI: 10.1016/j.cardfail.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | - Seiyon Ben Lee
- Department of Statistics, George Mason University, Fairfax, Virginia
| | | | - Aneel S Maini
- Georgetown University Medical School, Washington, D.C
| | - Karl D Young
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Aaron Bagnola
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Mary Looby
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Lauren B Cooper
- Inova Heart and Vascular Institute, Falls Church, Virginia; Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York
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Wierda E, van Maarschalkerwaart W(W, van Seumeren E, Dickhoff C, Montanus I, de Boer D, Kop E, de Mol BA, Schroeder‐Tanka JM, van Heerbeek L. Outpatient treatment of worsening heart failure with intravenous diuretics: first results from a multicentre 2-year experience. ESC Heart Fail 2022; 10:594-600. [PMID: 36377206 PMCID: PMC9871674 DOI: 10.1002/ehf2.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS The aim of this study is to examine the safety and efficacy of outpatient treatment of worsening heart failure (WHF) with intravenous diuretics. METHODS AND RESULTS This is a multicentre retrospective observational research study. Patients with all types of heart failure (HF) were included: heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). Patients included in this study were 18 years or older, had symptoms of WHF, had weight gain of more than 2 kg, and were not responding to uptitrating of oral diuretic therapy. Patients were treated for one or more days at the outpatient department with administration of intravenous loop diuretics with or without a bolus. In this study, 259 patients were included (mean age of 76 years, mean left ventricular ejection fraction of 41%). Rehospitalization rates for HF were 30.5% and 53.3%, respectively, at 30 days and 1 year. All-cause mortality was 5.8% and 26.3%, respectively, at 30 days and 1 year. Rehospitalization rates for HF and all-cause mortality were highest in patients with HFrEF. In a total of 322 individual outpatient treatments with intravenous diuretics, only one adverse event was registered. CONCLUSIONS Outpatient treatment with intravenous diuretics of patients with WHF is a safe alternative strategy compared with the same treatment in hospitalized patients. However, only non-randomized data are available and rehospitalization rates for this group with WHF are high. No data are available on the best selection criteria and the cost-effectiveness of outpatient treatment with intravenous diuretics.
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Affiliation(s)
- Eric Wierda
- Department of CardiologyDijklander ZiekenhuisHoornThe Netherlands
| | | | | | | | | | | | - Esther Kop
- Department of CardiologyOLVGAmsterdamThe Netherlands
| | - Bas A.J.M. de Mol
- Department of Cardiothoracic SurgeryAmsterdam University Medical CenterAmsterdamThe Netherlands
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Greene SJ, Goto D, Wang D, Hilkert R, Lautsch D, Fonarow GC. Outpatient versus inpatient intravenous diuretic therapy for heart failure in the United States. Eur J Heart Fail 2022; 24:2199-2202. [PMID: 36334074 DOI: 10.1002/ejhf.2727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | | | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA, USA
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Vinson DR, Hofmann ER, Johnson EJ, Rangarajan S, Huang J, Isaacs DJ, Shan J, Wallace KL, Rauchwerger AS, Reed ME, Mark DG. Management and Outcomes of Adults Diagnosed with Acute Pulmonary Embolism in Primary Care: Community-Based Retrospective Cohort Study. J Gen Intern Med 2022; 37:3620-3629. [PMID: 35020167 PMCID: PMC9585133 DOI: 10.1007/s11606-021-07289-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The management and outcomes of patients diagnosed with acute pulmonary embolism in primary care have not been characterized. OBJECTIVE To describe 30-day outcomes stratified by initial site-of-care decisions DESIGN: Multicenter retrospective cohort study PARTICIPANTS: Adults diagnosed with acute pulmonary embolism in primary care in a large, diverse community-based US health system (2013-2019) MAIN MEASURES: The primary outcome was a composite of 30-day serious adverse events (recurrent venous thromboembolism, major bleeding, and all-cause mortality). The secondary outcome was 7-day pulmonary embolism-related hospitalization, either initial or delayed. KEY RESULTS Among 652 patient encounters (from 646 patients), median age was 64 years; 51.5% were male and 70.7% identified as non-Hispanic white. Overall, 134 cases (20.6%) were sent home from primary care and 518 cases (79.4%) were initially referred to the emergency department (ED) or hospital. Among the referred, 196 (37.8%) were discharged home from the ED without events. Eight patients (1.2%; 95% CI 0.5-2.4%) experienced a 30-day serious adverse event: 4 venous thromboemboli (0.6%), 1 major bleed (0.2%), and 3 deaths (0.5%). Seven of these patients were initially hospitalized, and 1 had been sent home from primary care. All 3 deaths occurred in patients with known metastatic cancer initially referred to the ED, hospitalized, then enrolled in hospice following discharge. Overall, 328 patients (50.3%) were hospitalized within 7 days: 322 at the time of the index diagnosis and 6 following initial outpatient management (4 clinic-only and 2 clinic-plus-ED patients). CONCLUSIONS Patients diagnosed with acute pulmonary embolism in this primary care setting uncommonly experienced 30-day adverse events, regardless of initial site-of-care decisions. Over 20% were managed comprehensively by primary care. Delayed 7-day pulmonary embolism-related hospitalization was rare among the 51% treated as outpatients. Primary care management of acute pulmonary embolism appears to be safe and could have implications for cost-effectiveness and patient care experience.
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Affiliation(s)
- David R Vinson
- The Permanente Medical Group, Oakland, CA, USA.
- Kaiser Permanente Division of Research, Oakland, CA, USA.
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, 1600 Eureka Road, Roseville, CA, 95661, USA.
| | - Erik R Hofmann
- The Permanente Medical Group, Oakland, CA, USA
- Department of Emergency Medicine, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| | | | - Suresh Rangarajan
- The Permanente Medical Group, Oakland, CA, USA
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jie Huang
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Dayna J Isaacs
- School of Medicine, University of California, Davis, Sacramento, CA, USA
- Internal Medicine Residency Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Judy Shan
- Kaiser Permanente Division of Research, Oakland, CA, USA
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Karen L Wallace
- The Permanente Medical Group, Oakland, CA, USA
- Department of Radiology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA
| | | | - Mary E Reed
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Dustin G Mark
- The Permanente Medical Group, Oakland, CA, USA
- Kaiser Permanente Division of Research, Oakland, CA, USA
- Departments of Emergency and Critical Care Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Chimed S, Stassen J, Galloo X, Meucci MC, van der Bijl P, Knuuti J, Delgado V, Marsan NA, Bax JJ. Impact of Worsening Heart Failure on Long-Term Prognosis in Patients With Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2022; 184:63-71. [PMID: 36154967 DOI: 10.1016/j.amjcard.2022.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022]
Abstract
Worsening heart failure (HF), defined as hospitalization for worsening signs and symptoms of HF or the need for urgent intravenous diuretics, is often considered a surrogate of poor prognosis in clinical trials. However, data on the prognostic implications of worsening HF in patients with HF and reduced ejection fraction is limited. Patients who had a first echocardiographic diagnosis of left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) ≤45%, were identified. Worsening HF was defined as hospitalization for HF or urgent need for intravenous diuretics. All-cause mortality was chosen as the study end point. A total of 1,801 patients (mean age 64 ± 12 years, 74% men) were analyzed. Worsening HF was observed in 275 patients (15%) during a median follow-up of 20 months, while, 435 patients (24%) died during a median follow-up of 60 months (Interquartile range 28 to 60 months). The 5-year survival rate was significantly lower in the worsening HF cohort compared with the non-worsening HF cohort (Log-rank p <0.0001), and it was significantly different between the worsening HF cohort and the nonworsening HF cohort for LVEF ≤25% (log-rank p <0.0001) and LVEF 26% to 34% (log-rank p = 0.038) but not for LVEF 35% to 45% (log-rank p = 0.14). After adjustment for important clinical and echocardiographic predictors, worsening HF was independently associated with a higher risk of all-cause mortality (hazard ratio 1.46, 95% confidence interval 1.09 to 1.96, p = 0.011). In conclusion, worsening HF, defined by HF hospitalization or the urgent need for intravenous diuretics, is independently associated with poor long-term prognosis in patients with HF and reduced ejection fraction.
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Affiliation(s)
- Surenjav Chimed
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Xavier Galloo
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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Dahiya G, Bensimhon D, Goodwin MM, Mohr JF, Alexy T. From Oral to Subcutaneous Furosemide: The Road to Novel Opportunities to Manage Congestion. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100076. [PMID: 37288336 PMCID: PMC10242578 DOI: 10.1016/j.shj.2022.100076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 06/09/2023]
Abstract
The steadily rising prevalence of heart failure (HF) and the associated increase in health care expenditures represent a significant burden for patients, caregivers, and society. Ambulatory management of worsening congestion is a complex undertaking that requires diuretic escalation, yet clinical success is often hindered by the progressively declining bioavailability of oral agents. Once beyond a threshold, patients with acute on chronic HF often require hospital admission for intravenous diuresis. A novel, pH neutral formulation of furosemide that is administered by a biphasic drug delivery profile (80 mg total over 5 hours) via an automated, on-body infusor was designed to overcome these limitations. Early studies have shown that it has equivalent bioavailability with comparable diuresis and natriuresis to the intravenous formulation, leads to significant decongestion, and improvement in quality of life. It was shown to be safe and is well tolerated by patients. Although there is one ongoing clinical trial, available data have demonstrated the potential to shift hospital-administered, intravenous diuresis to the outpatient setting. Reduction in the need for recurrent hospital admissions would be highly desirable by most patients with chronic HF and would lead to a significant reduction in health care expenditures. In this article, we describe the rationale and evolution of this novel PH neutral formulation of furosemide administered subcutaneously, summarize its pharmacokinetic and pharmacodynamic profiles, and review emerging clinical trials demonstrating its clinical safety, efficacy, and potential to reduce health care expenditures.
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Affiliation(s)
- Garima Dahiya
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Bensimhon
- Division of Cardiovascular Medicine, Cone Health, Greensboro, North Carolina, USA
| | - Matthew M. Goodwin
- Clinical Development and Medical Affairs, scPharmaceuticals, Burlington, Massachusetts, USA
| | - John F. Mohr
- Clinical Development and Medical Affairs, scPharmaceuticals, Burlington, Massachusetts, USA
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Ambrosy AP, Parikh RV, Sung SH, Tan TC, Narayanan A, Masson R, Lam PQ, Kheder K, Iwahashi A, Hardwick AB, Fitzpatrick JK, Avula HR, Selby VN, Ku IA, Shen X, Sanghera N, Cristino J, Go AS. Analysis of Worsening Heart Failure Events in an Integrated Health Care System. J Am Coll Cardiol 2022; 80:111-122. [DOI: 10.1016/j.jacc.2022.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022]
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Kim J, Kim KH, Lim YH, Heo S, Moon K, Oh MS, An M. Validity and Reliability of the Korean Version of the Revised Self-Care of Heart Failure Index v7.2. Clin Nurs Res 2022; 31:1296-1307. [PMID: 35726492 DOI: 10.1177/10547738221106590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The psychometric properties of the Korean version of the revised Self-Care of Heart Failure Index (SCHFI) remain undetermined; therefore, we aimed to evaluate the construct and convergent validity and reliability of the Korean version of the SCHFI in Korean patients with heart failure (HF). Using a cross-sectional design, 207 patients with HF provided data on self-care and self-efficacy in self-care for this psychometric testing. The confirmatory factor analysis supported the construct validity of the Korean version with a three-factor structure: Self-Care Maintenance, Symptom Perception, and Self-Care Management. Convergent validity was supported by the significant relationships between self-efficacy and each scale of the Korean version of the SCHFI (r = .425-.549, p < .001). The reliability estimates were marginally adequate, with a Cronbach's alpha of .655 to .776, McDonald's omega of .710 to .836, and composite reliability coefficients of .704 to .834. The SCHFI was supported as a valid and reliable measure of self-care for Koreans with HF. However, the marginal levels of the Cronbach's alpha coefficients still require validation in a larger sample.
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Affiliation(s)
| | - Kye Hun Kim
- Chonnam National University, Gwangju, South Korea
| | | | | | - Keumyi Moon
- Chonnam National University Hospital, Gwangju, South Korea
| | - Mi Sook Oh
- Chonnam National University Hospital, Gwangju, South Korea
| | - Minjeong An
- Chonnam National University, Gwangju, South Korea
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Ostrominski JW, Vaduganathan M. Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction. Clin Cardiol 2022; 45 Suppl 1:S40-S51. [PMID: 35789014 PMCID: PMC9254675 DOI: 10.1002/clc.23849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Heart failure (HF) is a chronic, progressive, and increasingly prevalent syndrome characterized by stepwise declines in health status and residual lifespan. Despite significant advancements in both pharmacologic and nonpharmacologic management approaches for chronic HF, the burden of HF hospitalization-whether attributable to new-onset (de novo) HF or worsening of established HF-remains high and contributes to excess HF-related morbidity, mortality, and healthcare expenditures. Owing to a paucity of evidence to guide tailored interventions in this heterogeneous group, management of acute HF events remains largely subject to clinician discretion, relying principally on alleviation of clinical congestion, as-needed correction of hemodynamic perturbations, and concomitant reversal of underlying trigger(s). Following acute stabilization, the subsequent phase of care primarily involves interventions known to improve long-term outcomes and rehospitalization risk, including initiation and optimization of disease-modifying pharmacotherapy, targeted use of adjunctive therapies, and attention to contributing comorbid conditions. However, even with current standards of care many patients experience recurrent HF hospitalization, or after admission incur worsening clinical trajectories. These patterns highlight a persistent unmet need for evidence-based approaches to inform in-hospital HF care and call for renewed focus on urgent implementation of interventions capable of ameliorating risk of worsening HF. In this review, we discuss key contemporary and emerging therapeutic strategies for patients hospitalized with de novo or worsening HF.
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Affiliation(s)
- John W. Ostrominski
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical SchoolBostonMAUSA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical SchoolBostonMAUSA
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Sax DR, Mark DG, Rana JS, Reed ME, Lindenfeld J, Stevenson LW, Storrow AB, Butler J, Pang PS, Collins SP. Current Emergency Department Disposition of Patients with Acute Heart Failure: An Opportunity for Improvement. J Card Fail 2022; 28:1545-1559. [DOI: 10.1016/j.cardfail.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 12/26/2022]
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Girerd N, Mewton N, Tartière JM, Guijarro D, Jourdain P, Damy T, Lamblin N, Bayes-Génis A, Pellicori P, Januzzi J, Rossignol P, Roubille F. Practical outpatient management of worsening chronic heart failure. Eur J Heart Fail 2022; 24:750-761. [PMID: 35417093 PMCID: PMC9325366 DOI: 10.1002/ejhf.2503] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 11/12/2022] Open
Abstract
Management of worsening heart failure (WHF) has traditionally been hospital‐based, but with the rising burden of heart failure (HF), the pressure on healthcare systems exerted by this disease necessitates a different strategy than long (and costly) hospital stays. A strategy for outpatient intravenous (IV) diuretic treatment of WHF has been developed in certain American centres in the past 10 years, whereas European centres have been mostly favouring ‘classic’ in‐hospital management of WHF. Embracing novel, outpatient approaches for treating WHF could substantially reduce the burden on healthcare systems while improving patient's satisfaction and quality of life. The present article is intended to provide essential knowledge and practical guidelines aimed at helping clinicians implement these new ambulatory approaches using day hospital and/or at‐home hospitalization. The topics addressed by our group of HF experts include the pathophysiological background of diuretic therapy, the most suitable profile of WHF that may be managed in an ambulatory setting, the pharmacological protocols that can be used, as well as a detailed description of healthcare structures that can be proposed to deliver these ambulatory care interventions. The practical aspects of day hospital and hospital‐at‐home IV diuretic administration are specifically emphasized. The algorithm provided along with the practical IV diuretic protocols should assist HF clinicians in implementing this new approach in their local clinical setting.
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Affiliation(s)
- Nicolas Girerd
- Université de Lorraine, Centre d'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel Hospices Civils de Lyon Heart Failure Department Clinical Investigation Center Inserm 1407 CarMeN Inserm 1060, University Claude Bernard Lyon 1 28 Avenue Doyen Lépine 69500, Bron
| | | | - Damien Guijarro
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, F-44000, France
| | - Patrick Jourdain
- Covidom regional telemedicine platform, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiology Department, University Hospital of Bicêtre, Assistance Publique-Hôpitaux de Paris, Kremlin Bicêtre, France
| | - Thibaud Damy
- Réseau cardiogen, Department of Cardiology, centre français de référence de l'amylose cardiaque (CRAC), CHU d'Henri-Mondor, AP-HP, 94000, Créteil, France
| | - Nicolas Lamblin
- Department of Cardiology, Université de Lille, 59000, Lille, France
| | - Antoni Bayes-Génis
- CIBERCV; Servicio de Cardiología. Hospital Germans Trias i Pujol. Universitat Autònoma de Barcelona. Barcelona., Spain
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James Januzzi
- Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Harvard Medical School, Boston, MA, USA
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
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