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Ning YL, Li WJ, Lu X, Zhang Y, Zhang JW, Zhou JH. Association between heart rate and mortality in patients with septic shock: an analysis revealed by time series data. BMC Infect Dis 2024; 24:1088. [PMID: 39354354 PMCID: PMC11446028 DOI: 10.1186/s12879-024-10004-z] [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: 06/12/2024] [Accepted: 09/26/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Heart rate is crucial for patients with septic shock, but there are few studies on the scope of heart rate. Therefore, we studied the relationship between different heart rates and mortality of critically ill patients with septic shock, and explored the optimal heart rate range, in order to provide new insights for clinical treatment of septic shock. METHODS This retrospective study utilized time-series heart rate data from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients with septic shock were identified as the Sepsis 3.0 criteria and received vasopressor therapy in the first 24 h since ICU admission. We calculated the time-weighted average heart rate (TWA-HR) based on the time-series data. The restricted cubic spline (RCS) analysis was employed to investigate the nonlinear relationship between heart rate and 28-day mortality, aiming to explore the optimal heart rate control target for septic patients and using this target as the exposure factor. The primary outcome was 28-day mortality, and the secondary outcome were ICU and in-hospital mortality. For the original cohort, we applied the log-rank test to infer the relationship between heart rate and mortality. To control for bias introduced by confounders, we utilized propensity score matching (PSM) to reduce imbalances between normal TWA-HR and high TWA-HR groups, and we established a series of models [the multivariable Cox model, matching weight (MW)-adjusted Cox model, multivariable logistic regression, MW-adjusted logistic regression, and doubly robust model] as sensitivity analyses and subgroup analyses to demonstrate the robustness of our findings. RESULTS A total of 13492 patients were included in our study. The RCS analysis based on Cox and logistic regression showed increased risk of mortality (P < 0.001, non-linear P < 0.001) when TWA-HR > 85 beats per minute (bpm). The log-rank test revealed in terms of the 28-day mortality, the hazard ratio (HR) (95% confidence interval [CI]) was 1.92 (1.78-2.06, P < 0.001) for patients with high TWA-HR compared to normal TWA-HR group. Similarly, for the ICU mortality, the HR (95% CI) was 1.64 (1.52-1.78, P < 0.001), and for the in-hospital mortality, the HR (95% CI) was 1.61 (1.48-1.76, P < 0.001). Collectively, the sensitivity analysis consistently demonstrated higher 28-day mortality, ICU mortality, and in-hospital mortality in patients with TWA-HR > 85 bpm. CONCLUSION Patients with septic shock whose heart rate was controlled no more than 85 bpm during ICU stay received survival benefit in terms of 28-day, ICU and in-hospital mortality. .
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Affiliation(s)
- Yi-Le Ning
- Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Jia Li
- Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiang Lu
- Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yu Zhang
- Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
| | - Jun-Wei Zhang
- Department of Critical Care Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan, China.
| | - Ji-Hong Zhou
- Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
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Milinković I, Polovina M, Coats AJS, Rosano GMC, Seferović PM. Medical Treatment of Heart Failure with Reduced Ejection Fraction in the Elderly. Card Fail Rev 2022; 8:e17. [PMID: 35601008 PMCID: PMC9115638 DOI: 10.15420/cfr.2021.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/26/2021] [Indexed: 11/24/2022] Open
Abstract
The aging population, higher burden of predisposing conditions and comorbidities along with improvements in therapy all contribute to the growing prevalence of heart failure (HF). Although the majority of trials have not demonstrated age-dependent heterogeneity in the efficacy or safety of medical treatment for HF, the latest trials demonstrate that older participants are less likely to receive established drug therapies for HF with reduced ejection fraction. There remains reluctance in real-world clinical practice to prescribe and up-titrate these medications in older people, possibly because of (mis)understanding about lower tolerance and greater propensity for developing adverse drug reactions. This is compounded by difficulties in the management of multiple medications, patient preferences and other non-medical considerations. Future research should provide a more granular analysis on how to approach medical and device therapies in elderly patients, with consideration of biological differences, difficulties in care delivery and issues relevant to patients’ values and perspectives. A variety of approaches are needed, with the central principle being to ‘add years to life – and life to years’. These include broader representation of elderly HF patients in clinical trials, improved education of healthcare professionals, wider provision of specialised centres for multidisciplinary HF management and stronger implementation of HF medical treatment in vulnerable patient groups.
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Affiliation(s)
- Ivan Milinković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Marija Polovina
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | - Petar M Seferović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Serbian Academy of Sciences and Arts, Belgrade, Serbia
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3
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Cardoso J, de Espíndola MD, Cunha M, Netto E, Cardoso C, Novaes M, Del Carlo CH, Brancalhão E, Name AL, Barretto ACP. Is Current Drug Therapy for Heart Failure Sufficient to Control Heart Rate of Patients? Arq Bras Cardiol 2020; 115:1063-1069. [PMID: 33470302 PMCID: PMC8133726 DOI: 10.36660/abc.20190090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/12/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies have shown that heart failure (HF) patients with heart rate (HR) < 70 bpm have had a better clinical outcome and lower morbidity and mortality compared with those with HR > 70 bpm. However, many HF patients maintain an elevated HR. OBJECTIVE To evaluate HR and the prescription of medications known to reduce mortality in HF patients attending an outpatient cardiology clinic. METHODS We consecutively evaluated patients seen in an outpatient cardiology clinic, aged older than 18 years, with diagnosis of HF and left ventricular ejection fraction (LVEF) < 45%. Patients with sinus rhythm were divided into two groups - HR ≤ 70 bpm (G1) and HR > 70 bpm (G2). The Student's t-test and the chi-square test were used in the statistical analysis, and a p-value < 0.05 was considered statistically significant. The SPSS software was used for the analyses. RESULTS A total of 212 consecutive patients were studied; 41 (19.3%) had atrial fibrillation or had a pacemaker implanted and were excluded from the analysis, yielding 171 patients. Mean age of patients was 63.80 ± 11.77 years, 59.6% were men, and mean LVEF 36.64±7.79%. The most prevalent HF etiology was ischemic (n=102; 59.6%), followed by Chagasic (n=17; 9.9%). One-hundred thirty-one patients (76.6%) were hypertensive and 63 (36.8%) diabetic. Regarding HR, 101 patients had a HR ≤70 bpm (59.1%) and 70 patients (40.93%) had a HR >70 bpm (G2). Mean HR of G1 and G2 was 61.5±5.3 bpm and 81.8±9.5 bpm, respectively (p<0.001). Almost all patients (98.8%) were receiving carvedilol, prescribed at a mean dose of 42.1±18.5 mg/day in G1 and 42.5±21.1mg/day in G2 (p=0.911). Digoxin was used in 5.9% of patients of G1 and 8.5% of G2 (p=0.510). Mean dose of digoxin in G1 and G2 was 0.19±0.1 mg/day and 0.19±0.06 mg/day, respectively (p=0,999). Most patients (87.7%) used angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), and 56.7% used spironolactone. Mean dose of enalapril was 28.9±12.7 mg/day and mean dose of ARB was 87.8±29.8 mg/day. The doses of ACEI and ARB were adequate in most of patients. CONCLUSION The study revealed that HR of 40.9% of patients with HF was above 70 bpm, despite treatment with high doses of beta blockers. Further measures should be applied for HR control in HF patients who maintain an elevated rate despite adequate treatment with beta blocker. (Arq Bras Cardiol. 2020; 115(6):1063-1069).
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Affiliation(s)
- Juliano Cardoso
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | | | - Mauricio Cunha
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Enock Netto
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Cristina Cardoso
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Milena Novaes
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Carlos Henrique Del Carlo
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Euler Brancalhão
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Alessandro Lyra Name
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
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4
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Varian KD, Ji X, Grodin JL, Verbrugge FH, Milinovich A, Kattan MW, Tang WW. Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta-blockers. ESC Heart Fail 2020; 7:3049-3058. [PMID: 32757485 PMCID: PMC7524238 DOI: 10.1002/ehf2.12931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022] Open
Abstract
AIMS Current guidelines recommend beta-blocker therapy in chronic heart failure with reduced ejection fraction (HFrEF) titrated according to tolerated target dose. The efficiency of this strategy to obtain adequate heart rate (HR) control remains unclear in clinical practice. The aim of this study was to determine, in a real-world setting, the proportion of HFrEF patients who fail to achieve beta-blocker target doses, whether target doses of beta-blockers have a relationship with the adequacy in reducing resting HR over time. METHODS AND RESULTS Beta-blocker dose and resting HR of consecutive ambulatory patients with a diagnosis of HFrEF (ejection fraction ≤ 35%) in sinus rhythm were reviewed at the first outpatient contact in the Cleveland Clinic Health System from the year 2000 to 2015. Patients who did not receive beta-blocker therapy, have congenital heart disease and hypertrophic cardiomyopathy, were not in sinus rhythm, or have a history of heart transplant were excluded. Patients were followed up until their last known visit at the Cleveland Clinic. Median resting HR was 71 b.p.m. [inter-quartile range (IQR) 60-84 b.p.m.] in 8041 patients (median age 65; 68% male) with 67% on carvedilol, 32% on metoprolol succinate, and 1% on bisoprolol. In 3674 subjects (56%), resting HR was ≥70 b.p.m. At final follow-up after a median of 21 months (IQR 0.1-7.2 years), resting HR was 72 b.p.m. (IQR 60-84 b.p.m.) in the subset of patients with persistently low ejection fraction ≤ 35%. HR ≥ 70 b.p.m. was observed in 55% of this group. Beta-blocker target dose was achieved in 19%, 5%, and 15% of those receiving carvedilol, metoprolol succinate, and bisoprolol, respectively. In the subset of patients who experienced beta-blocker up-titration, reduced mortality or hospitalization due to heart failure was observed in patients who experienced the lowest HR after titration. CONCLUSIONS In our single-centre experience, the majority of patients with chronic HFrEF treated with beta-blocker therapy did not achieve target doses over time, and a substantial proportion had inadequate control of resting HR. There was no relationship between achieved beta-blocker target dose and resting HR control.
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Affiliation(s)
- Kenneth D. Varian
- Department of Cardiovascular MedicineHeart and Vascular InstituteClevelandOHUSA
| | - Xinge Ji
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOHUSA
| | - Justin L. Grodin
- Department of MedicineUniversity of Texas Southwestern Medical SchoolDallasTXUSA
| | | | - Alex Milinovich
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOHUSA
| | - Michael W. Kattan
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOHUSA
| | - W.H. Wilson Tang
- Department of Cardiovascular MedicineHeart and Vascular InstituteClevelandOHUSA
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5
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Anker MS, Frey MK, Goliasch G, Bartko PE, Prausmüller S, Gisslinger H, Kornek G, Strunk G, Raderer M, Zielinski C, Hülsmann M, Pavo N. Increased resting heart rate and prognosis in treatment-naïve unselected cancer patients: results from a prospective observational study. Eur J Heart Fail 2020; 22:1230-1238. [PMID: 32202022 PMCID: PMC7540544 DOI: 10.1002/ejhf.1782] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/21/2020] [Accepted: 02/16/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Cancer patients suffer from impaired cardiovascular function. Elevated resting heart rate (RHR) has been identified as a marker for increased long-term mortality in cancer patients prior to the receipt of anticancer treatment. We aimed to establish whether RHR is associated with survival in treatment-naïve cancer patients. METHODS AND RESULTS This prospective study enrolled 548 unselected treatment-naïve cancer patients between 2011 and 2013. The median age of the cohort was 62 years; 40.9% were male and 32.7% had metastatic disease. Median RHR was 72 b.p.m. Most patients were in sinus rhythm (n = 507, 92.5%). Clinical heart failure was noted in 37 (6.8%) patients. RHR was not related to cancer stage (P = 0.504). Patients in the highest RHR tertile had higher levels of high-sensitivity troponin (P = 0.003) and N-terminal pro-B-type natriuretic peptide (P = 0.039). During a median follow-up of 25 months (interquartile range: 16-32 months; range: 0-40 months), 185 (33.8%) patients died from any cause [1-year-mortality: 17%, 95% confidence interval (CI) 13-20%]. In univariate survival analysis, RHR predicted all-cause mortality [crude hazard ratio (HR) for a 5 b.p.m. increase in RHR: 1.09, 95% CI 1.04-1.15; P < 0.001], and remained significantly associated with outcome after adjustment for age, gender, tumour entity, tumour stage, cardiac status and haemoglobin (adjusted HR for a 5 b.p.m. increase in RHR: 1.10, 95% CI 1.04-1.16; P < 0.001). There was no significant impact of metastatic/non-metastatic disease state on the predictive value of RHR (P = 0.433 for interaction). In subgroup analyses, the strongest associations for RHR with mortality were observed in lung (crude HR 1.14; P = 0.007) and gastrointestinal (crude HR 1.31; P < 0.001) cancer. CONCLUSIONS Treatment-naïve cancer patients with higher RHRs display higher levels of cardiovascular biomarkers. RHR was independently associated with all-cause mortality, especially in lung and gastrointestinal cancers. Elevated RHR and cardiovascular biomarkers may represent early signs of incipient cardiac dysfunction.
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Affiliation(s)
- Markus S. Anker
- Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT)German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (Campus CVK)BerlinGermany
- Department of CardiologyCharité Universitätsmedizin Berlin (Campus CBF)BerlinGermany
| | - Maria K. Frey
- Department of Internal Medicine II, Clinical Division of CardiologyMedical University of ViennaViennaAustria
| | - Georg Goliasch
- Department of Internal Medicine II, Clinical Division of CardiologyMedical University of ViennaViennaAustria
| | - Philipp E. Bartko
- Department of Internal Medicine II, Clinical Division of CardiologyMedical University of ViennaViennaAustria
| | - Suriya Prausmüller
- Department of Internal Medicine II, Clinical Division of CardiologyMedical University of ViennaViennaAustria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Clinical Division of OncologyMedical University of ViennaViennaAustria
| | - Gabriela Kornek
- Department of Internal Medicine I, Clinical Division of OncologyMedical University of ViennaViennaAustria
| | - Guido Strunk
- Department of Complexity Research, Complexity Science HubViennaAustria
- Department of Integrated Safety and SecurityUniversity of Applied Sciences, FH Campus ViennaViennaAustria
- Department of Entrepreneurship and Economic EducationFaculty of Business and Economics, Technical University DortmundDortmundGermany
| | - Markus Raderer
- Department of Internal Medicine I, Clinical Division of OncologyMedical University of ViennaViennaAustria
| | - Christoph Zielinski
- Department of Internal Medicine I, Clinical Division of OncologyMedical University of ViennaViennaAustria
| | - Martin Hülsmann
- Department of Internal Medicine II, Clinical Division of CardiologyMedical University of ViennaViennaAustria
| | - Noemi Pavo
- Department of Internal Medicine II, Clinical Division of CardiologyMedical University of ViennaViennaAustria
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6
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Chen YD, Yang XC, Pham VN, Huang SA, Fu GS, Chen XP, Truong BQ, Yang Y, Liu SW, Ma TR, Kim DS, Kim TH. Resting heart rate control and prognosis in coronary artery disease patients with hypertension previously treated with bisoprolol: a sub-group analysis of the BISO-CAD study. Chin Med J (Engl) 2020; 133:1155-1165. [PMID: 32433047 PMCID: PMC7249722 DOI: 10.1097/cm9.0000000000000802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Resting heart rate (RHR) is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients. Bisoprolol fumarate, a second-generation beta-adrenoreceptor blockers (β-blocker) is commonly prescribed drug to manage hypertension. The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease (CAD) patients from the CAD treated with bisoprolol (BISO-CAD) study who had comorbid hypertension. METHODS We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study (n = 866), which was a phase IV, multination, multi-center, single-arm, observational study carried out from October 2011 to July 2015 across China, South Korea, and Vietnam. Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome (CCCO), the results were presented as adjusted odds ratio (OR) along with 95% confidence interval (CI) and adjusted P value. RESULTS A total of 681 patients (mean age: 64.77 ± 10.33 years) with hypertension from BISO-CAD study were included in the analysis. Bisoprolol improved CCCOs in CAD patients with comorbid hypertension, with RHR <65 and <70 beats/min compared with RHR ≥65 and ≥75 beats/min, respectively, in the efficacy analysis (EA) set. In addition, it lowered RHR in both intent-to-treat (ITT) and EA groups after 6, 12, and 18 months of treatment. Further, RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients (adjusted OR: 4.34; 95% CI: 1.19-15.89; P = 0.03). Also, events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR <69 beats/min in ITT patients. CONCLUSION Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence, improve CCCO without affecting their blood pressure.
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Affiliation(s)
- Yun-Dai Chen
- Department of Cardiology, China PLA General Hospital, Beijing 100853, China
| | - Xin-Chun Yang
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Vinh Nguyen Pham
- Department of Cardiology, Tam Duc Hospital, Ho Chi Minh City 700000, Vietnam
| | - Shi-An Huang
- Department of Cardiology, Affiliated Hospital of Guangdong Medical College, Guangzhou, Guangdong 524001, China
| | - Guo-Sheng Fu
- Department of Cardiology, Sir Run Shaw Hospital, Affiliated with School of Medicine Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Xiao-Ping Chen
- Department of Cardiology, West China Hospital, Chengdu, Sichuan 610041, China
| | - Binh Quang Truong
- Department of Cardiology, University Medical Centre HCMC, Ho Chi Minh 700000, Vietnam
| | - Yu Yang
- Geriatrics Department, The Second Xiangya Hospital of Central South University, Tianxin, Changsha 410011, China
| | - Shao-Wen Liu
- Department of Cardiology, Shanghai First People's Hospital, Shanghai 200080, China
| | - Tian-Rong Ma
- Department of Medical Affairs, Merck Serono Co., Ltd., Beijing 100016, China
| | - Dong-Soo Kim
- Department of Cardiology, Inje University Busan Paik Hospital, Busan 47392, Korea
| | - Tae-hoon Kim
- Department of Cardiology, Sejong Hospital, Gyeonggi-do 14754, Korea
- Department of Cardiology, New Korea Hospital, Gyeonggi-do 10086, Korea
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7
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Mordi IR, Ouwerkerk W, Anker SD, Cleland JG, Dickstein K, Metra M, Ng LL, Samani NJ, van Veldhuisen DJ, Zannad F, Voors AA, Lang CC. Heart failure treatment up-titration and outcome and age: an analysis of BIOSTAT-CHF. Eur J Heart Fail 2020; 23:436-444. [PMID: 32216000 DOI: 10.1002/ejhf.1799] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/22/2020] [Accepted: 02/24/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Several studies have shown that older patients with heart failure with reduced ejection fraction (HFrEF) are undertreated. The aim of this study was to evaluate the association of up-titration of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and beta-blockers on outcome across the age spectrum in HFrEF patients. METHODS AND RESULTS We analysed HFrEF patients on sub-optimal doses of ACEI/ARB and/or beta-blockers from the BIOSTAT-CHF study stratified by age. Patients underwent a 3-month up-titration period. We used inverse probability weighting to adjust for the likelihood of successful up-titration to determine the association of achieved dose with mortality and/or heart failure hospitalisation, testing for an interaction with age. Over a median follow-up of 21 months in 1720 HFrEF patients (76.5% male, mean age 67 years), the primary outcome occurred in 558 patients. Increased percentage of target dose of ACEI/ARB and beta-blocker achieved at 3 months were both significantly associated with reduced incidence of the primary outcome, [ACEI-ARB: hazard ratio (HR) per 12.5% increase in dose: 0.92, 95% confidence interval (CI) 0.91-0.94, P < 0.001; beta-blocker: HR 0.98, 95% CI 0.95-1.00, P = 0.046], with a significant interaction with age seen for beta-blockers but not ACEI/ARB (P = 0.034 and P = 0.22, respectively). CONCLUSIONS Achieving higher doses of ACEI/ARB was associated with improved outcome regardless of age. However, achieving higher doses of beta-blockers was only associated with improved outcome in younger, but not in older patients.
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Affiliation(s)
- Ify R Mordi
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, Amsterdam, The Netherlands
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Dirk J van Veldhuisen
- University Medical Center Groningen, Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Faiez Zannad
- Inserm CIC-P 1433, Université de Lorraine, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | - Adriaan A Voors
- University Medical Center Groningen, Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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8
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Zelenak C, Chavanon ML, Tahirovic E, Trippel TD, Tscholl V, Stroux A, Veskovic J, Apostolovic S, Obradovic D, Zdravkovic M, Loncar G, Störk S, Herrmann-Lingen C, Düngen HD. Early NT-proBNP and MR-proANP associated with QoL 1 year after acutely decompensated heart failure: secondary analysis from the MOLITOR trial. Biomark Med 2019; 13:1493-1507. [PMID: 31659915 DOI: 10.2217/bmm-2019-0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: Heart failure negatively impacts quality of life (QoL), which in turn contributes to an adverse long-term prognosis. We aimed at identifying biomarker trajectories after an episode of acutely decompensated heart failure (ADHF) that differ between patients showing average versus impaired QoL 1 year later, thus allowing to predict impaired QoL. Methods: Biomarkers were repeatedly measured throughout the year in 104 ADHF patients. QoL was assessed at discharge and 1 year after ADHF. Logistic regression and receiver operating characteristic analyses were used to identify predictors of impaired QoL while controlling psychosocial confounders. Results: MR-proANP predicted impaired physical and mental QoL. NT-proBNP measurements were important predictors for poor physical QoL. Conclusion: MR-proANP and NT-proBNP predict poor QoL after an epidode of ADHF. The trial is registered at http://clinicaltrials.gov as MOLITOR (IMpact of therapy optimisation On the Level of biomarkers in paTients with Acute and Decompensated ChrOnic HeaRt Failure) with unique identifier: NCT01501981.
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Affiliation(s)
- Christine Zelenak
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany
| | - Mira-Lynn Chavanon
- Department of Psychology, Philipps Universität Marburg, Marburg, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Tobias Daniel Trippel
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Verena Tscholl
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany
| | - Andrea Stroux
- Department for Biometry & Clinical Epidemiology, CBF, Charité University Medicine Berlin, Berlin, Germany
| | - Jovan Veskovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Svetlana Apostolovic
- Department for Cardiovascular Diseases, Clinical Centre Niš, University of Niš, Niš, Serbia
| | - Danilo Obradovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany
| | - Marija Zdravkovic
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Department of Cardioloy, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Störk
- Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine & Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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9
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Abstract
The prevalence of heart failure increases with age. Changes in the age distribution and growing life expectancy will lead to a further rise. However, data concerning drug treatment of heart failure especially in the elderly are scarce. Subgroup analyses of the heart failure trials suggest that drug therapy in older patients should follow the recommendations in the current guidelines. In doing so, several common comorbidities in these patients (e. g., impaired renal function) have to be considered and may have an influence on the therapy (e. g., drug dose, choice of active pharmaceutical ingredient, etc.). Especially in old, multimorbid patients, possible interaction of drugs might play a substantial role. In many cases the main goal of the therapy, especially in the very elderly, is to improve symptoms and quality of life.
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10
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Chen Y, Yang X, Huang S, Fu G, Chen X, Yang Y, Liu S, Xu H, Ma T, Zhou X, Lv Z, Yang M, Gan X, Xu D, Cao F, Liu H, Li J, Zheng Q, Wang N, Yuan Y, Liu W, Yang T. Occurrence of composite cardiac endpoints with change in resting heart rate among Chinese patients with coronary artery disease: Chinese cohort from the real-world BISO-CAD study. Curr Med Res Opin 2018; 34:1921-1926. [PMID: 29557206 DOI: 10.1080/03007995.2018.1454895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We evaluated change in resting heart rate (RHR) and its impact on prognosis in Chinese coronary artery disease (CAD) patients treated with bisoprolol, and also assessed drug safety and tolerability. METHODS This phase IV, single arm observational study was a sub-study of the BISO-CAD study conducted across 20 hospitals in China between October 2011 and July 2015 with follow-up at 6, 12 and 18 months after baseline. The primary endpoint was occurrence of composite cardiac events. RESULTS A total of 663 CAD patients (baseline RHR 75.47 ± 6.62 bpm) were enrolled in the intent-to-treat (ITT) set, and 513 patients were included in the efficacy analysis (EA) set. In the ITT set, the risk and the number of composite cardiac events in patients with mean RHR 69-74 bpm were significantly higher than in the <65 bpm group (ITT: estimate 1.03 ± 0.47, p = .029). The incidence of the composite cardiac endpoint was not affected by continuous mean RHR (p = .5070). RHR significantly decreased from baseline to 18 months, most obviously in the first 6 months (p < .0001). Ejection fraction and fractional shortening significantly improved in both the ITT and EA sets. An average RHR of 69-74 bpm had a significant effect on admission to hospital for acute coronary syndrome in the ITT (estimate 1.10, HR 3.004, p = .0196) and EA (estimate 1.26, HR 3.526, p = .0132) groups. Seven (1.1%) patients reported drug related adverse events. CONCLUSION Reduction in RHR with bisoprolol lowered the incidence of composite cardiac events along with an acceptable safety and tolerability profile.
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Affiliation(s)
- Yundai Chen
- a Department of Cardiology , China PLA General Hospital , Beijing , China
| | - Xinchun Yang
- b Department of Cardiology , Beijing Chao-Yang Hospital, Capital Medical University , Beijing , China
| | - Shi'an Huang
- c Affiliated Hospital of Guangdong Medical College , China
| | - Guosheng Fu
- d Sir Run Run Shaw Hospital Affiliated with School of Medicine , Zhejiang University , China
| | | | - Yu Yang
- f The Second Xiangya Hospital of Central South University , China
| | | | - Haiyan Xu
- h Merck Serono China R&D , Beijing , China
| | | | - Xuchen Zhou
- j First Affiliated Hospital of Dalian Medical University , China
| | - Zhan Lv
- k Affiliated Hospital of North Sichuan Medical College , China
| | - Ming Yang
- l Fu Xing Hospital, Capital Medical University , China
| | - Xuedong Gan
- m Zhongnan Hospital of Wuhan University , China
| | - Dong Xu
- n Xuanwu Hospital Capital Medical University , China
| | - Feng Cao
- o The First Affiliated Hospital of the Fourth Military Medical University , China
| | - Huiliang Liu
- p Chinese Armed Police Force General Hospital , China
| | - Junxia Li
- q PLA, the Military General Hospital of Beijing , China
| | - Qiangsun Zheng
- r The Second Affiliated Hospital of the Fourth Military Medical University , China
| | - Ningfu Wang
- s The First People's Hospital of Hangzhou , China
| | - Yong Yuan
- t The People's Hospital of Zhongshan City , China
| | - Wenxian Liu
- u Beijing Anzhen Hospital Capital Medical University , China
| | - Tianlun Yang
- v Xiangya Hospital of Central South University , China
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11
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Abstract
PURPOSE OF REVIEW Heart failure is a major chronic illness with no definitive cure. With improving healthcare and with an aging population in many countries, heart failure has become a common disease of the elderly. Pharmacological management of heart failure in the elderly remains a challenge. The syndrome of heart failure cannot be isolated from other comorbidities, which are very common in this population. The purpose of this review is to assist practicing clinicians to more effectively make decisions about management of heart failure in the elderly. RECENT FINDINGS In this review, we will try to integrate recent research studies, recent guidelines, and new treatment modalities, and discuss some controversies. SUMMARY In general, the elderly patient with heart failure should be treated according to current heart failure guidelines; however, untailored heart failure management may cause untoward effects in this age group and may worsen clinical outcome.
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Affiliation(s)
- Faisal Alghamdi
- aDivision of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute bDivision of Cardiology, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
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12
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Corletto A, Fröhlich H, Täger T, Hochadel M, Zahn R, Kilkowski C, Winkler R, Senges J, Katus HA, Frankenstein L. Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy. Clin Res Cardiol 2018; 107:1040-1049. [PMID: 29774407 DOI: 10.1007/s00392-018-1277-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate. METHODS AND RESULTS We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51-69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (p < 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50-70 bpm (p = 0.054). CONCLUSIONS Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.
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Affiliation(s)
- Anna Corletto
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Tobias Täger
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Matthias Hochadel
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Ralf Zahn
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Caroline Kilkowski
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Ralph Winkler
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063, Ludwigshafen am Rhein, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany.
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13
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Chen Y, Yang X, Nguyen Pham V, Huang S, Fu G, Chen X, Quang Truong B, Yang Y, Liu S, Chen X, Ma T, Kim DS, Kim TH. Heart rate control is associated with reduced cardiovascular events in Asian patients with coronary artery disease treated with bisoprolol (BISO-CAD): results from a multi-national, real-world experience. Curr Med Res Opin 2018; 34:217-225. [PMID: 28766382 DOI: 10.1080/03007995.2017.1363729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the association between decrease in resting heart rate (RHR) and occurrence of composite cardiac clinical outcomes in coronary artery disease (CAD) patients after bisoprolol treatment. METHODS This phase IV, multi-national, single-arm, open-label, non-randomized, observational trial was conducted between October 2011 and July 2015 across 42 hospitals from China, South Korea and Vietnam. RESULTS Analysis of 866 patients (mean age 63.85 ± 10.35; mean RHR at baseline 75.71 ± 6.87 bpm in intent-to-treat [ITT]; 75.56 ± 6.73 in efficacy analysis [EA] sets) was performed. Patients with lower mean RHR had fewer composite cardiac events and patients with RHR of 69-74 bpm reported significantly higher outcomes than patients with RHR <65 bpm (p = .0449). A significant association with occurrence of the composite cardiac outcome and hospital admission for unstable angina or revascularization was reported in the EA set (regression estimate: 0.03, 95% CI 0.00-0.07, p = .0412) and not in the ITT set for bisoprolol treated CAD patients. Composite cardiac outcomes significantly increased in patients with mean RHR ≥70 bpm compared to patients with mean RHR <70 bpm (p = .0328). Adverse events (AEs) were reported in 206 (23.8%) patients, of whom 102 (11.8%) patients had serious adverse event (SAEs). Among the patients with SAEs, 11 (1.3%) patients died. Treatment related adverse events were only 12 (1.4%). No treatment related SAE happened. CONCLUSION The findings showed bisoprolol to be efficacious, in terms of lowering RHR and causing a significant decrease in the occurrence of the composite cardiac outcome, as well as safe in Asian patients with CAD.
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Affiliation(s)
- Yundai Chen
- a Department of Cardiology , China PLA General Hospital , Beijing , China
| | - Xinchun Yang
- b Department of Cardiology , Beijing Chao-Yang Hospital, Capital Medical University , Beijing , China
| | | | - Shian Huang
- d Department of Cardiology , Affiliated Hospital of Guangdong Medical College , Guangdong , China
| | - Guosheng Fu
- e Department of Cardiology , Sir Run Shaw Hospital, Affiliated with School of Medicine Zhejiang University , Zhejiang , China
| | - Xiaoping Chen
- f Department of Cardiology , West China Hospital , Sichuan , China
| | - Binh Quang Truong
- g Department of Cardiology , University Medical Centre HCMC , Vietnam
| | - Yu Yang
- h Geriatrics Department , The Second Xiangya Hospital of Central South University , Changsha , China
| | - Shaowen Liu
- i Department of Cardiology , Shanghai First People's Hospital , Shanghai , China
| | - Xuan Chen
- j Department of Medical Affairs , Merck Serono Co. Ltd. , Beijing , China
| | - Tianrong Ma
- j Department of Medical Affairs , Merck Serono Co. Ltd. , Beijing , China
| | - Dong-Soo Kim
- k Department of Cardiology , Inje University Busan Paik Hospital , Busan , Korea
| | - Tae-Hoon Kim
- l Department of Cardiology , Sejong Hospital , Gyeonggi-do , Korea
- m Department of Cardiology , New Korea Hospital , Gyeonggi-do , Korea
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14
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Nikolovska Vukadinović A, Vukadinović D, Borer J, Cowie M, Komajda M, Lainscak M, Swedberg K, Böhm M. Heart rate and its reduction in chronic heart failure and beyond. Eur J Heart Fail 2017. [DOI: 10.1002/ejhf.902] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Davor Vukadinović
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
| | - Jeffrey Borer
- Division of Cardiovascular Medicine and the Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular Translational Research; State University of New York Downstate Medical Center; New York NY USA
| | | | | | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education; Celje Slovenia
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - Michael Böhm
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
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15
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Kotecha D, Flather MD, Altman DG, Holmes J, Rosano G, Wikstrand J, Packer M, Coats AJS, Manzano L, Böhm M, van Veldhuisen DJ, Andersson B, Wedel H, von Lueder TG, Rigby AS, Hjalmarson Å, Kjekshus J, Cleland JGF. Heart Rate and Rhythm and the Benefit of Beta-Blockers in Patients With Heart Failure. J Am Coll Cardiol 2017; 69:2885-2896. [PMID: 28467883 DOI: 10.1016/j.jacc.2017.04.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The relationship between mortality and heart rate remains unclear for patients with heart failure with reduced ejection fraction in either sinus rhythm or atrial fibrillation (AF). OBJECTIVES This analysis explored the prognostic importance of heart rate in patients with heart failure with reduced ejection fraction in randomized controlled trials comparing beta-blockers and placebo. METHODS The Beta-Blockers in Heart Failure Collaborative Group performed a meta-analysis of harmonized individual patient data from 11 double-blind randomized controlled trials. The primary outcome was all-cause mortality, analyzed with Cox proportional hazard ratios (HR) modeling heart rate measured at baseline and approximately 6 months post-randomization. RESULTS A higher heart rate at baseline was associated with greater all-cause mortality for patients in sinus rhythm (n = 14,166; adjusted HR: 1.11 per 10 beats/min; 95% confidence interval [CI]: 1.07 to 1.15; p < 0.0001) but not in AF (n = 3,034; HR: 1.03 per 10 beats/min; 95% CI: 0.97 to 1.08; p = 0.38). Beta-blockers reduced ventricular rate by 12 beats/min in both sinus rhythm and AF. Mortality was lower for patients in sinus rhythm randomized to beta-blockers (HR: 0.73 vs. placebo; 95% CI: 0.67 to 0.79; p < 0.001), regardless of baseline heart rate (interaction p = 0.35). Beta-blockers had no effect on mortality in patients with AF (HR: 0.96, 95% CI: 0.81 to 1.12; p = 0.58) at any heart rate (interaction p = 0.48). A lower achieved resting heart rate, irrespective of treatment, was associated with better prognosis only for patients in sinus rhythm (HR: 1.16 per 10 beats/min increase, 95% CI: 1.11 to 1.22; p < 0.0001). CONCLUSIONS Regardless of pre-treatment heart rate, beta-blockers reduce mortality in patients with heart failure with reduced ejection fraction in sinus rhythm. Achieving a lower heart rate is associated with better prognosis, but only for those in sinus rhythm.
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Affiliation(s)
- Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, United Kingdom; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Marcus D Flather
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jane Holmes
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy; Cardiovascular and Cell Science Institute, St. George's University of London, London, United Kingdom
| | - John Wikstrand
- Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
| | - Andrew J S Coats
- Monash University, Melbourne, Victoria, Australia; University of Warwick, Warwick, United Kingdom
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert Andersson
- Department of Cardiology, Sahlgrenska University Hospital and Gothenburg University, Gothenburg, Sweden
| | - Hans Wedel
- Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas G von Lueder
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Alan S Rigby
- Academic Cardiology, Castle Hill Hospital, Kingston upon Hull, United Kingdom
| | - Åke Hjalmarson
- Department of Cardiology, Sahlgrenska University Hospital and Gothenburg University, Gothenburg, Sweden
| | - John Kjekshus
- Rikshospitalet University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom.
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16
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Barywani S, Petzold M. Prognostic impact of heart rate in elderly with systolic heart failure and concomitant atrial fibrillation. SCAND CARDIOVASC J 2017; 51:190-196. [DOI: 10.1080/14017431.2017.1314549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Salim Barywani
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- Department of biostatistics, University of Gothenburg, Gothenburg, Sweden
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17
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Saitoh M, Ishida J, Doehner W, von Haehling S, Anker MS, Coats AJS, Anker SD, Springer J. Sarcopenia, cachexia, and muscle performance in heart failure: Review update 2016. Int J Cardiol 2017; 238:5-11. [PMID: 28427849 DOI: 10.1016/j.ijcard.2017.03.155] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 02/06/2023]
Abstract
Cachexia in the context of heart failure (HF) has been termed cardiac cachexia, and represents a progressive involuntary weight loss. Cachexia is mainly the result of an imbalance in the homeostasis of muscle protein synthesis and degradation due to a lower activity of protein synthesis pathways and an over-activation of protein degradation. In addition, muscle wasting leads to of impaired functional capacity, even after adjusting for clinical relevant variables in patients with HF. However, there is no sufficient therapeutic strategy in muscle wasting in HF patients and very few studies in animal models. Exercise training represents a promising intervention that can prevent or even reverse the process of muscle wasting, and worsening the muscle function and performance in HF with muscle wasting and cachexia. The pathological mechanisms and effective therapeutic approach of cardiac cachexia remain uncertain, because of the difficulty to establish animal cardiac cachexia models, thus novel animal models are warranted. Furthermore, the use of improved animal models will lead to a better understanding of the pathways that modulate muscle wasting and therapeutics of muscle wasting of cardiac cachexia.
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Affiliation(s)
- Masakazu Saitoh
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Junichi Ishida
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfram Doehner
- Charité - Campus Virchow (CVK), Center for Stroke Research, Berlin, Germany
| | - Stephan von Haehling
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus S Anker
- Charité - Campus Benjamin Franklin (CBF), Department of Cardiology, Berlin, Germany Charité - Campus Virchow (CVK), Center for Stroke Research, Berlin, Germany
| | | | - Stefan D Anker
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Springer
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
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18
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Cvetinovic N, Loncar G, Farkas J. Heart failure management in the elderly - a public health challenge. Wien Klin Wochenschr 2016; 128:466-473. [PMID: 27900534 DOI: 10.1007/s00508-016-1138-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/09/2016] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) is a rapidly growing public health problem and the leading cause of morbidity, mortality, and hospitalization in populations > 65 years. The elderly HF patients have an increased prevalence of HF with preserved ejection fraction and comorbidities, may present with atypical symptoms and signs, have a higher risk for adverse drug reactions, and worse prognosis as compared with younger patients. Moreover, there is a lack of evidence-based therapies for this population because they are underrepresented in the clinical trials. The elderly are less likely to be evaluated by a cardiologist and to be treated in accordance with recommendations of the current HF guidelines. Although the treatment is improving, it is still suboptimal; therefore, HF in elderly patients requires mobilization of public health services and improvement of treatment strategies.
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Affiliation(s)
- Natasa Cvetinovic
- Cardiology Department, Clinical Hospital Center Zvezdara, Belgrade, Serbia
| | - Goran Loncar
- Cardiology Department, Clinical Hospital Center Zvezdara, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jerneja Farkas
- National Institute of Public Health, Ljubljana, Slovenia.
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19
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Anker MS, Ebner N, Hildebrandt B, Springer J, Sinn M, Riess H, Anker SD, Landmesser U, Haverkamp W, von Haehling S. Resting heart rate is an independent predictor of death in patients with colorectal, pancreatic, and non-small cell lung cancer: results of a prospective cardiovascular long-term study. Eur J Heart Fail 2016; 18:1524-1534. [DOI: 10.1002/ejhf.670] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/28/2016] [Accepted: 09/02/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Markus S. Anker
- Charité-Campus Benjamin Franklin (CBF); Department of Cardiology; Berlin Germany
| | - Nicole Ebner
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Bert Hildebrandt
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Jochen Springer
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Marianne Sinn
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Hanno Riess
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Stefan D. Anker
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Ulf Landmesser
- Charité-Campus Benjamin Franklin (CBF); Department of Cardiology; Berlin Germany
| | - Wilhelm Haverkamp
- Charité-Campus Virchow-Klinikum (CVK); Department of Cardiology; Berlin Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
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20
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Metra M, Carubelli V, Ravera A, Stewart Coats AJ. Heart failure 2016: still more questions than answers. Int J Cardiol 2016; 227:766-777. [PMID: 27838123 DOI: 10.1016/j.ijcard.2016.10.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/23/2016] [Accepted: 10/23/2016] [Indexed: 12/21/2022]
Abstract
Heart failure has reached epidemic proportions given the ageing of populations and is associated with high mortality and re-hospitalization rates. This article reviews and summarizes recent advances in the diagnosis, assessment and treatment of the patients with heart failure. Data are discussed based also on the most recent guidelines indications. Open issues and unmet needs are highlighted.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy.
| | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Alice Ravera
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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21
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Inkrot S, Lainscak M, Edelmann F, Loncar G, Stankovic I, Celic V, Apostolovic S, Tahirovic E, Trippel T, Herrmann-Lingen C, Gelbrich G, Düngen HD. Poor self-rated health predicts mortality in patients with stable chronic heart failure. Eur J Cardiovasc Nurs 2016; 15:504-512. [DOI: 10.1177/1474515115615254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Simone Inkrot
- Department of Internal Medicine – Cardiology, Charité-Universitätsmedizin Berlin, Germany
| | - Mitja Lainscak
- University Department of Cardiology, General Hospital Celje, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Frank Edelmann
- Department of Internal Medicine – Cardiology, Charité-Universitätsmedizin Berlin, Germany
- Department of Cardiology and Pneumology, University of Göttingen, Germany
- German Center for Cardiovascular Research, Germany
| | - Goran Loncar
- Department of Cardiology, Clinical Hospital Zvezdara, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Serbia
| | - Vera Celic
- School of Medicine, University of Belgrade, Serbia
- Cardiology Department, University Clinical Hospital Center “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia
| | | | - Elvis Tahirovic
- Department of Internal Medicine – Cardiology, Charité-Universitätsmedizin Berlin, Germany
| | - Tobias Trippel
- Department of Internal Medicine – Cardiology, Charité-Universitätsmedizin Berlin, Germany
| | - Christoph Herrmann-Lingen
- German Center for Cardiovascular Research, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine – Cardiology, Charité-Universitätsmedizin Berlin, Germany
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[Competence Network Heart Failure (CNHF). Together against heart failure]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:506-13. [PMID: 26979718 DOI: 10.1007/s00103-016-2322-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heart failure is one of the most urgent medical and socio-economic challenges of the 21(st) century. Up to three million people are affected in Germany; this means one in ten people over the age of 65 live with heart failure. The current demographic changes will accentuate the importance of this grave health problem. The care of patients with heart failure, as well as the associated research mandates a comprehensive, multidisciplinary approach. The Competence Network Heart Failure (CNHF) pursues this objective. CNHF is a research alliance with 11 sites in Germany and was funded by the Federal Ministry of Research (BMBF) from 2003 through 2014. Since January 2015, the network has been an associate cooperating partner of the German Centre for Cardiovascular Research (DZHK). During the 12-year funding period by the BMBF, scientists in the field of heart failure from 30 university hospitals, 5 research institutes, 7 heart centers, 17 cardiovascular clinics, over 200 general practitioners, 4 rehabilitation clinics, as well as numerous organizations and associations were involved in cooperative CNHF research. In the context of 22 projects, the CNHF covered basic, clinical, and health care research, and generated numerous groundbreaking insights into disease mechanisms, as well as diagnosis and treatment of heart failure, which are documented in more than 350 publications. With its central study database and bank of biomaterials, the network has set up a Europe-wide unique research resource, which can be used in the future for national and international cooperations with the DZHK and other partners. Furthermore, the CNHF strongly promotes nation- and Europe-wide public relations and heart failure awareness activities.
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Tahirović E, Lashki DJ, Trippel TD, Tscholl V, Fritschka M, Musial-Bright L, Busjahn A, Kolip P, Störk S, Rauchfuß M, Inkrot S, Lainscak M, Apostolović S, Vesković J, Lončar G, Doehner W, Zelenak C, Düngen HD. Validation of the FEW16 questionnaire for the assessment of physical well-being in patients with heart failure with reduced ejection fraction: results from the CIBIS-ELD study. ESC Heart Fail 2015; 2:194-203. [PMID: 27708856 PMCID: PMC5034814 DOI: 10.1002/ehf2.12045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 11/26/2022] Open
Abstract
Aims Patients with heart failure (HF) commonly suffer from severe impairment of quality of life (QoL). One main goal of HF treatment is improvement of QoL. Physical well‐being is an essential component of QoL. To enable assessment of physical well‐being in HF patients, we validated the FEW16 questionnaire in a prospective study with patients from the Cardiac Insufficiency Bisoprolol Study in ELDerly. Methods and results In 127 HF patients (age 73 ± 5.5 years, 72% male, 60% New York Heart Association class II, left ventricular ejection fraction 37 ± 8.5%), we measured physical well‐being (FEW16), QoL [36‐Item Short‐Form Health Survey (SF36)], and depressive symptoms [PRIME MD Patient Health Questionnaire German short version for depression (PHQ‐D)] at baseline and two follow‐up visits, and correlated FEW16 scores with QoL data and clinical parameters. FEW16 mean scores are 3.04 ± 1.04 at baseline, 3.19 ± 0.94 after 3 months, and 2.77 ± 0.94 after 2–4 years. We assessed data quality, scale assumptions, and construct validity and reliability. Cronbach's alpha for subscales resilience: 0.84; ability to enjoy: 0.80; vitality: 0.88; inner peace: 0.87; total score: 0.95. Intraclass correlation coefficient (ICC) is 0.87 (95% CI 0.84–0.89, ICC (1.4). Pearson's correlations of FEW16 with SF36 and PHQ‐D were significant. Six minutes walking distance and heart rate correlated significantly with the FEW16 total score. Conclusions The FEW16 showed good reliability, internal consistency, and intraclass correlation. FEW16 scores correlated well with psychological and physical well‐being (SF36) and clinical markers of exercise tolerance (6 min walk test and heart rate). Our results indicate a strong correlation of self‐reported physical well‐being with psychological factors. FEW16 values at baseline predicted the development of several aspects of QoL during beta‐blocker up‐titration.
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Affiliation(s)
- E Tahirović
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - D J Lashki
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - T D Trippel
- Department of Internal Medicine - CardiologyCharité University Medicine BerlinGermany; German Center for Cardiovascular Research (DZHK)Site BerlinGermany
| | - V Tscholl
- Medical Clinic for Cardiology and Pulmonology, Campus Benjamin Franklin Charité University Medicine Berlin Germany
| | - M Fritschka
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - L Musial-Bright
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | | | - P Kolip
- Department of Prevention and Health Promotion, School of Public Health Bielefeld University Bielefeld Germany
| | - S Störk
- Comprehensive Heart Failure Center University of Würzburg Germany
| | - M Rauchfuß
- Centre of Internal Medicine and Dermatology, Clinic for Internal Medicine and Psychosomatics Charité University Medicine Berlin Germany
| | - S Inkrot
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - M Lainscak
- Department of Cardiology and Department of Research and EducationGeneral Hospital Celje, Slovenia and Faculty of Medicine, University of LjubljanaCeljeSlovenia; Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - S Apostolović
- Clinical Center Niš, Department of Internal Medicine University of Niš Serbia
| | - J Vesković
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - G Lončar
- Cardiology Department Zvezdara University Medical Center Belgrade Serbia
| | - W Doehner
- Center for Stroke Research Charité University Medicine Berlin Germany
| | - C Zelenak
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - H D Düngen
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
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