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Van Nguyen T, Nguyen HTK, Wong WJ, Ahmad F, Nguyen TN. The prescription of beta-blockers in older patients with heart failure with reduced ejection fraction: an observational study in Vietnam. Sci Rep 2024; 14:12923. [PMID: 38839862 PMCID: PMC11153617 DOI: 10.1038/s41598-024-63479-w] [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: 08/25/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
This study in older hospitalized patients with heart failure with reduced ejection fraction (HFrEF) aimed to examine the prevalence of beta-blocker prescription and its associated factors. A total of 190 participants were recruited from July 2019 to July 2020. The inclusion criteria included: (1) aged ≥ 60 years, (2) having a diagnosis of chronic HFrEF in the medical records, (3) hospitalized for at least 48 h. The participants had a mean age of 75.5 ± 9.1, and 46.8% were female. Of these, 55.3% were prescribed beta-blockers during admission. To explore the factors associated with beta-blocker prescription, multivariable logistic regression analysis was applied and the results were presented as odds ratios (OR) and 95% confidence intervals (CI). On multivariate logistic regression models, higher NYHA classes (OR 0.49, 95%CI 0.26-0.94), chronic obstructive pulmonary disease (OR 0.17, 95% CI 0.04-0.85), chronic kidney disease (OR 0.40, 95% CI 0.19-0.83), and heart rate under 65 (OR 0.34, 95% CI 0.12-0.98) were associated with a reduced likelihood of prescription. In this study, we found a low rate of beta-blocker prescriptions, with only around half of the participants being prescribed beta-blockers. Further studies are needed to examine the reasons for the under-prescription of beta-blockers, and to evaluate the long-term benefits of beta-blockers in elderly patients with HFrEF in this population.
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Affiliation(s)
- Tan Van Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam.
| | - Hoa T K Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Wei Jin Wong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Fahed Ahmad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tu Ngoc Nguyen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- The George Institute of Global Health, UNSW, Sydney, Australia.
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2
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Zeymer U, Groves R, Hupfer S. Use of sacubitril/valsartan in patients with heart failure in primary care in Germany: the AURORA-HF noninterventional study. Herz 2024:10.1007/s00059-024-05248-z. [PMID: 38656397 DOI: 10.1007/s00059-024-05248-z] [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: 09/17/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sacubitril/valsartan (Sac/Val) is the first angiotensin receptor-neprilysin inhibitor indicated for symptomatic chronic heart failure (HF) with reduced ejection fraction (HFrEF). Given most patients with HF in Germany are managed by general practitioners, AURORA-HF investigated the baseline characteristics and 1‑year follow-up of patients starting Sac/Val in primary care in Germany. METHODS This was a prospective, multicenter, observational study, with all treatment decisions independent of participation. The only inclusion criteria were adults (age ≥ 18 years) with symptomatic HFrEF. The study comprised four groups, depending on therapy on entry: initiation of (1) Sac/Val or (2) other HF therapy; and no change in HF regimen that (3) included or (4) did not include Sac/Val. Baseline data were captured for all groups; 1‑year follow-up was recorded in groups 1 and 2. RESULTS Of 1278 patients in the baseline analyses, 513 (40.1%) had newly started Sac/Val (449 [87.5%] completing the 1‑year follow-up), 265 (20.7%) had newly started other HF regimens (245, 92.5%) with 1‑year follow-up, while 249 with Sac/Val (19.5%) and 251 without Sac/Val (19.6%) patients had unchanged therapies. Patients treated with Sac/Val had a higher New York Heart Association (NYHA) class at baseline and more often a left ventricular ejection fraction (LVEF) < 35%. The only baseline parameter significantly correlating with Sac/Val discontinuation during the 1‑year follow-up was diabetes mellitus (odds ratio: 2.44; 95% confidence interval: 1.14-5.24). In the Sac/Val group, 30.7% of patients were in NYHA class I/II on study entry, improving to 51.0% at 1‑year follow-up. In the no Sac/Val group, the corresponding rates of NYHA I and II classes were 49.8% and 58.2%, respectively. The overall adverse event profile of Sac/Val was good, with only 6.0% patients experiencing serious adverse events leading to permanent discontinuation. CONCLUSION In patients with symptomatic HFrEF treated in primary care, the group in whom Sac/Val was initiated was characterized by a higher NYHA class and lower LVEF compared to patients in whom Sac/Val was not initiated. Sac/Val was well tolerated, with a high proportion completing 1 year of therapy.
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Affiliation(s)
- Uwe Zeymer
- Institut für Herzinfarktforschung, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany.
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
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3
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Kim SE, Yoo BS. Treatment Strategies of Improving Quality of Care in Patients With Heart Failure. Korean Circ J 2023; 53:294-312. [PMID: 37161744 PMCID: PMC10172273 DOI: 10.4070/kcj.2023.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 04/03/2023] Open
Abstract
Heart failure (HF) is a global health problem closely related to morbidity and mortality. As the burden of HF increases, it is necessary to manage and treat this condition well. However, there are differences between real-world practice and guidelines for the optimal treatment for HF. Patient-related, healthcare provider-related, and health system-related factors contribute to poor adherence to optimal care. This review article aims to examine HF treatment patterns and treatment adherence in real-world practice, identify clinical gaps to suggest ways to improve the quality of care for HF and clinical outcomes for patients with HF. Although it is important to optimize treatment based on evidence-based guidelines to the greatest extent, it is known that there is still poor treatment adherence, and many patients do not receive guideline-directed medical therapy, especially at the early stages. To improve medication adherence, qualitative evaluation through performance measurement, as well as education of patients, caregivers and medical staff through a multidisciplinary approach are important.
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4
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Association of malnutrition with renal dysfunction and clinical outcome in patients with heart failure. Sci Rep 2022; 12:16673. [PMID: 36198898 PMCID: PMC9535020 DOI: 10.1038/s41598-022-20985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/21/2022] [Indexed: 11/08/2022] Open
Abstract
Malnutrition, glomerular damage (GD), and renal tubular damage (RTD) are common morbidities associated with poor clinical outcomes in heart failure (HF) patients. However, the association between malnutrition and renal dysfunction and its impact on clinical outcomes in HF patients have not yet been fully elucidated. We assessed the nutritional status and renal function of 1061 consecutive HF patients. Malnutrition, GD, and RTD were defined as a controlling nutritional status (CONUT) score of ≥ 5, reduced eGFR or microalbuminuria, and levels of N-acetyl-beta-d-glucosamidase of > 14.2 U/gCr according to previous reports, respectively. Patients with RTD had a higher CONUT score and a lower prognostic nutritional index and geriatric nutritional risk index than those without. Multivariate logistic analysis demonstrated that RTD, but not GD, was significantly associated with malnutrition. There were 360 cardiac events during the median follow-up period of 688 days. Multivariate Cox proportional hazard regression analysis demonstrated that comorbid malnutrition and renal dysfunction, rather than simple malnutrition, were significantly associated with cardiac events in HF patients. We found a close relationship between malnutrition and renal dysfunction in HF patients. Comorbid malnutrition and renal dysfunction were risk factors for cardiac events in HF patients, suggesting the importance of managing and treating these.
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5
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Tsigkas G, Apostolos A, Aznaouridis K, Despotopoulos S, Chrysohoou C, Naka KK, Davlouros P. Real-world implementation of guidelines for heart failure management: A systematic review and meta-analysis. Hellenic J Cardiol 2022; 66:72-79. [DOI: 10.1016/j.hjc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/23/2022] [Accepted: 04/23/2022] [Indexed: 11/04/2022] Open
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Diamant MJ, Andrade JG, Virani SA, Jhund PS, Petrie MC, Hawkins NM. Heart failure and atrial flutter: a systematic review of current knowledge and practices. ESC Heart Fail 2021; 8:4484-4496. [PMID: 34505352 PMCID: PMC8712920 DOI: 10.1002/ehf2.13526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 01/14/2023] Open
Abstract
While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia‐induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia‐mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management.
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Affiliation(s)
- Michael J Diamant
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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7
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Zeymer U, Clark AL, Barrios V, Damy T, Drożdż J, Fonseca C, Lund LH, Kalus S, Ferber PC, Hussain RI, Koch C, Maggioni AP. Utilization of sacubitril/valsartan in patients with heart failure with reduced ejection fraction: real-world data from the ARIADNE registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:469-477. [DOI: 10.1093/ehjqcco/qcab019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
To compare baseline characteristics of patients with heart failure with reduced ejection fraction (HFrEF) initiated on sacubitril/valsartan compared with patients continued on conventional heart failure (HF)-treatment in a European out-patient setting.
Methods and results
Between July 2016 and July 2019, ARIADNE enrolled 8787 outpatients aged ≥18 years with HFrEF from 17 European countries. Choice of therapy was solely at the investigators’ discretion. In total, 4173 patients were on conventional HF-treatment (non-S/V group), while 4614 patients were on sacubitril/valsartan either at enrolment or started sacubitril/valsartan within 1 month of enrolment (S/V group). Of these, 2108 patients started sacubitril/valsartan treatment ±1 month around enrolment [restricted S/V (rS/V) group]. The average age of the patients was 68 years. Patients on S/V were more likely to have New York Heart Association (NYHA) class III or IV symptoms (50.3%, 44.6%, 32.1% in rS/V, S/V, and non-S/V, respectively) and had lower left ventricular ejection fraction (LVEF; 32.3%, 32.7%, and 35.4% in rS/V, S/V, and non-S/V, respectively; P < 0.0001). The most frequently received HF treatments were angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB; ∼84% in non-S/V), followed by β-blockers (∼80%) and mineralocorticoid receptor antagonists (MRAs; 53%). The use of triple HF therapy (ACEI/ARB/angiotensin receptor neprilysin inhibitor with β-blockers and MRA) was higher in the S/V groups than non-S/V group (48.2%, 48.2%, and 40.2% in rS/V, S/V, and non-S/V, respectively).
Conclusion
In this large multinational HFrEF registry, patients receiving sacubitril/valsartan tended to be younger with lower LVEF and higher NYHA class. Fewer than half of the patients received triple HF therapy.
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Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Medizinische Klinik B and Institut für Herzinfarktforschung, Bremserstrasse 79, 67063 Ludwigshafen-am-Rhein, Germany
| | - Andrew L Clark
- Castle Hill Hospital, Kingston Upon Hull, Castle Rd, Cottingham HU16 5JQ, United Kingdom
| | - Vivencio Barrios
- Department of Cardiology, Ramon y Cajal Hospital, Ctra. de Colmenar Viejo km. 9,100 28034 Madrid, Spain
| | - Thibaud Damy
- Department of Cardiology, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France
| | - Jaroslaw Drożdż
- Department Cardiology Medical University of Lodz, Poland 92-213 Lodz, Pomorska 251, Poland
| | - Candida Fonseca
- Hospital de Sao Francisco Xavier, Estrada Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Lars H Lund
- Department of Medicine, Unit of Cardiology, Karolinska Institutet and Karolinska University HospitalFoU Tema Hjärta Kärl, Eugeniavägen 3, Norrbacka, S1:02, 171 76 Stockholm, Sweden
| | - Stefanie Kalus
- GKM Gesellschaft für Therapieforschung mbH, Lessingstr. 14, 80336 Munich, Germany
| | | | - Rizwan I Hussain
- Arxx Therapeutics, Gaustadalléen 21, 0349 Oslo, Norway
- Symbion Science Park, Fruebjergvej 3, 2100 Copenhagen, Denmark
| | | | - Aldo P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Via La Marmora 34, 50121 Florence, Italy
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera, 1, 48033 Cotignola RA, Italy
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8
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Pilecky D, Muk B, Majoros Z, Vágány D, Kósa K, Szabó M, Szögi E, Dékány M, Kiss RG, Nyolczas N. Proportion of Patients Eligible for Cardiac Contractility Modulation: Real-Life Data from a Single-Center Heart Failure Clinic. Cardiology 2021; 146:195-200. [PMID: 33582674 DOI: 10.1159/000512946] [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: 07/22/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Based on recently published randomized controlled trials, cardiac contractility modulation (CCM) seems to be an effective device-based therapeutic option in symptomatic chronic heart failure (HF) (CHF). The aim of the current study was to estimate what proportion of patients with CHF and left ventricular ejection fraction (LVEF) <50% could be eligible for CCM based on the inclusion criteria of the FIX-HF-5C trial. METHODS Consecutive patients referred and followed up at our HF clinic due to HF with reduced or mid-range LVEF were retrospectively assessed. After a treatment optimization period of 3-6 months, the inclusion criteria of the FIX-HF-5C trial (New York Heart Association (NYHA) class III/IV, 25% ≤ LVEF ≤45%, QRS <130 ms, and sinus rhythm) were applied to determine the number of patients eligible for CCM. RESULTS Of the 640 patients who were involved, the proportion of highly symptomatic patients in NYHA class III/IV decreased from 77.0% (n = 493) at baseline to 18.6% (n = 119) after the treatment optimization period (p < 0.001). Mean LVEF increased significantly from 29.0 ± 7.9% to 36.3 ± 9.9% (p < 0.001), while the proportion of patients with 25% ≤ LVEF ≤45% increased from 69.7% (n = 446) to 73.3% (n = 469) (p < 0.001). QRS duration was below 130 ms in 63.1% of patients, while 30.0% of patients had persistent or permanent atrial fibrillation. We found that the eligibility criteria for CCM therapy based on the FIX-HF-5C study were fulfilled for 23.0% (n = 147) of patients at baseline and 5.2% (n = 33) after treatment optimization. CONCLUSION This single-center cohort study showed that 5% of patients with CHF and impaired LVEF immediately after treatment optimization fulfilled the inclusion criteria of the FIX-HF-5C study and would be candidates for CCM.
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Affiliation(s)
- Dávid Pilecky
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary, .,Department of Internal Medicine III, Klinikum Passau, Passau, Germany,
| | - Balázs Muk
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Zsuzsanna Majoros
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Dénes Vágány
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Krisztina Kósa
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Márta Szabó
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Emese Szögi
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Miklós Dékány
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Róbert Gábor Kiss
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Noémi Nyolczas
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
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9
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Meindl C, Hochadel M, Frankenstein L, Bruder O, Pauschinger M, Hambrecht R, von Scheidt W, Pfister O, Hartmann A, Maier LS, Senges J, Unsöld B. The role of diabetes in cardiomyopathies of different etiologies-Characteristics and 1-year follow-up results of the EVITA-HF registry. PLoS One 2020; 15:e0234260. [PMID: 32525964 PMCID: PMC7289353 DOI: 10.1371/journal.pone.0234260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/21/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a major risk factor for cardiovascular diseases, e.g. coronary artery disease (CAD). But it has also been shown that diabetes can cause heart failure independently of ischemic heart disease (IHD) by causing diabetic cardiomyopathy. In contrast to diabetes and IHD, limited data exist regarding patients with diabetes and dilated cardiomyopathy (DCM). METHODS EVIdence based TreAtment in Heart Failure (EVITA-HF) comprises web-based case report data on demography, diagnostic measures, adverse events and 1-year follow-up of patients hospitalized for chronic heart failure and an ejection fraction ≤40%. In the present study we focused on the results of patients with diabetes and heart failure. RESULTS Between February 2009 and November 2015, 4101 patients with chronic heart failure were included in 16 tertiary care centers in Germany. The mortality in patients with diabetes and DCM (n = 323) was more than double (15.2%) than that of DCM patients without diabetes (6.5%, p<0.001, n = 885). In contrast the mortality rate of patients with IHD was not influenced by the presence of diabetes (17.6% in patients with IHD and diabetes n = 945, vs. 14.7% in patients with IHD and no diabetes, n = 1236, p = 0.061). The results also remained stable after performing a multivariable analysis (unadjusted p-value for interaction = 0.002, adjusted p = 0.046). CONCLUSION The influence of diabetes on the mortality rate is only significant in patients with DCM not in patients with CAD. Therefore, the underlying mechanisms of this effect should be studied in greater detail to improve patient care and outcome.
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Affiliation(s)
- Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany
| | | | - Rainer Hambrecht
- Department of Internal Medicine II, Hospital Links der Weser, Bremen, Germany
| | - Wolfgang von Scheidt
- Department of Internal Medicine I, University Hospital Augsburg, Augsburg, Germany
| | - Otmar Pfister
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Hartmann
- Department of Cardiology and Internal Intensive Care, St. Georg Hospital Leipzig, Leipzig, Germany
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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10
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Atrial fibrillation in chronic heart failure patients with reduced ejection fraction: The CHECK-HF registry. Int J Cardiol 2020; 308:60-66. [DOI: 10.1016/j.ijcard.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022]
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11
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Raafs AG, Linssen GCM, Brugts JJ, Erol-Yilmaz A, Plomp J, Smits JPP, Nagelsmit MJ, Oortman RM, Hoes AW, Brunner-LaRocca HP. Contemporary use of devices in chronic heart failure in the Netherlands. ESC Heart Fail 2020; 7:1771-1780. [PMID: 32395914 PMCID: PMC7373943 DOI: 10.1002/ehf2.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/26/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
Aims Despite previous surveys regarding device implantation rates in heart failure (HF), insight into the real‐world management with devices is scarce. Therefore, we investigated device implantation rates in HF with reduced left ventricular ejection fraction (LVEF) in 34 Dutch centres. Methods and results A cross‐sectional outpatient registry was conducted in 6666 patients with LVEF < 50% and with information about device implantation available [74 (66–81) years of age; 64% male]. Patients were classified into conventional pacemakers (PM, n = 562), implantable cardioverter defibrillators (ICD, n = 1165), and cardiac resynchronization therapy with defibrillator function (CRT‐D, n = 885) or pacemaker function only (CRT‐P, n = 248), or no device (n = 3806). Centres were divided into ICD‐implanting and CRT‐implanting and referral centres. Overall, 17.5% had an ICD, 13.3% CRT‐D, 3.7% CRT‐P, and 8.4% PM. Of those with LVEF ≤ 30%, 42.5% had ICD or CRT‐D therapy. A large variation in implantation rates existed between centres: 3–51% for ICD therapy, 0.3–44% for CRT‐D therapy, 0–11% for CRT‐P therapy, and 0–25% PM therapy. Implantation centres showed higher implantation rates of ICD, CRT‐D, and CRT‐P compared with referral centres [36% vs. 25% for defibrillators (ICD or CRT‐D) and 17% vs. 9% for CRT devices (CRT‐D or CRT‐P), respectively, P < 0.001], independently of other factors. A large number of clinical factors were predictive for device usage. Among other, LVEF < 40% and male sex were independent positive predictors for ICD/CRT‐D use [odds ratio (OR) = 3.33, P < 0.001; OR = 1.87, P = 0.019, respectively]. Older age was independently associated with less ICD/CRT‐D (OR = 0.96 per year, P < 0.001) and more CRT‐P/PM use (OR = 1.03 per year, P = 0.006). Conclusions In this large Dutch HF registry, less than half of the patients with reduced LVEF received an ICD or CRT, even if LVEF was ≤30%, and a large variation between centres existed. Patients from implantation centres had more often ICD or CRT. More uniformity regarding guideline‐based use of device therapy in clinical practice is needed.
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Affiliation(s)
- Anne G Raafs
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus Medical Centre, Thoraxcentre, Rotterdam, The Netherlands
| | | | - Jacobus Plomp
- Department of Cardiology, Tergooi, Blaricum/Hilversum, The Netherlands
| | - Jeroen P P Smits
- Department of Cardiology, Zuwe Hofpoort Hospital, Woerden, The Netherlands
| | | | - Remko M Oortman
- Department of Cardiology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Arno W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Hans-Peter Brunner-LaRocca
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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12
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Zeymer U, Clark AL, Barrios V, Damy T, Drożdż J, Fonseca C, Lund LH, Comite GD, Hupfer S, Maggioni AP. Management of heart failure with reduced ejection fraction in Europe: design of the ARIADNE registry. ESC Heart Fail 2020; 7:727-736. [PMID: 32027782 PMCID: PMC7160498 DOI: 10.1002/ehf2.12569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS The introduction of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor) is likely to change the approach to the management of patients with chronic heart failure with reduced ejection fraction (HFrEF). The Assessment of Real Life Care-Describing European Heart Failure Management (ARIADNE) registry will evaluate patient characteristics, practice patterns, outcomes, and healthcare resource utilization in the outpatient setting across Europe, with the main focus on factors that guide physicians' decisions to start and continue sacubitril/valsartan in patients with HFrEF. METHODS AND RESULTS ARIADNE, a prospective, observational registry will enrol 9000 ambulatory patients with HFrEF in 23 European countries Supplement 1. The study will describe 4500 patients treated with conventional treatment (including an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker), and 4500 patients started on sacubitril/valsartan. In each country, patients will be enrolled consecutively over an expected period of 12 months, and followed-up for 12 months. The primary objective is to describe the baseline clinical and demographic characteristics of patients with chronic HFrEF, which guide the decision of the treating physician to initiate sacubitril/valsartan or to continue conventional treatment. A co-primary objective is to identify the baseline characteristics that are associated with the likelihood of reaching the target dose of sacubitril/valsartan 97/103 mg twice daily during follow-up. CONCLUSIONS The ARIADNE registry will provide a comprehensive profile of patients with chronic HFrEF in Europe, will elucidate how management varies between countries, and will help clarify the usage and outcomes associated with use of sacubitril/valsartan in real life.
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Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Institut für Herzinfarktforschung LudwigshafenBremserstrasse 79Ludwigshafen67063Germany
| | - Andrew L. Clark
- Department of CardiologyHull York Medical School, Castle Hill HospitalKingston upon HullUK
| | | | - Thibaud Damy
- Department of CardiologyHenri Mondor HospitalCreteilFrance
| | | | - Candida Fonseca
- S. Francisco Xavier Hospital, NOVA Medical School, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal
| | - Lars H. Lund
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
| | | | | | - Aldo P. Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research CenterFlorenceItaly
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Vinogradova NG, Polyakov DS, Fomin IV. [The risks of re-hospitalization of patients with heart failure with prolonged follow-up in a specialized center for the treatment of heart failure and in real clinical practice.]. ACTA ACUST UNITED AC 2020; 60:59-69. [PMID: 32375617 DOI: 10.18087/cardio.2020.3.n1002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/29/2020] [Indexed: 11/18/2022]
Abstract
Relevance The number of patients with functional class III-IV chronic heart failure (CHF) characterized by frequent rehospitalization for acute decompensated HF (ADHF) has increased. Rehospitalizations significantly increase the cost of patient management and the burden on health care system.Objective To determine the effect of long-term follow-up at a specialized center for treatment of HF (Center for Treatment of Chronic Heart Failure, CTCHF) on the risk of rehospitalization for patients after ADHF.Materials and Methods The study successively included 942 patients with CHF after ADHF. Group 1 consisted of 510 patients who continued the outpatient follows-up at the CTCHF, and group 2 included 432 patients who refused of the follow-up at the CTCHF and were managed at outpatient clinics at their place of residence. CHF patient compliance with recommendations and frequency of rehospitalization for ADHF were determined by outpatient medical records and structured telephone calls. A rehospitalization for ADHF was recorded if the patient stayed for more than one day in the hospital and required intravenous loop diuretics. The follow-up period was two years. Statistical analyses were performed using a Statistica 7.0 software for Windows, SPSS, and a R statistical package.Results Patients of group 2 were significantly older, more frequently had FC III CHF and less frequently had FC I CHF than patients of group 1. Both groups contained more women and HF patients with preserved ejection fraction. Using the method of binary multifactorial logit-regression a mathematical model was created, which showed that risk of rehospitalization during the entire follow-up period did not depend on age and sex but was significantly increased 2.4 times for patients with FC III-IV CHF and 3.4 times for patients of group 2. Multinomial multifactorial logit-regression showed that the risk of one, two, three or more rehospitalizations within two years was significantly higher in group 2 than in group 1 (2.9-4.5 times depending on the number of rehospitalizations) and for patients with FC III-IV CHF compared to patients with FC I-II CHF (2-3.2 times depending on the number of rehospitalizations). Proportion of readmitted patients during the first year of follow-up was significantly greater in group 2 than in group 1 (55.3 % vs. 39.8 % of patients [odd ratio (OR) =1.9; 95% confidence interval (CI), 1.4-2.4; р<0.001]; during the second year, the proportion was 67.4 % vs. 28.2 % (OR=5.3; 95 % CI, 3.9-7.1; р<0.001). Patients of group 1 were readmitted more frequently during the first year than during the second year (р<0,001) whereas patients of group 2 were readmitted more frequently during the second than the first year of follow-up (р<0.001). Total proportion of readmitted patients for two years of follow-up was significantly greater in group 2 (78.0 % vs. 50.6 %) (OR=3.5; 95 % CI, 2.6-4.6; р<0.001). Reasons for rehospitalizations were identified in 88.7 % and 45.9 % of the total number of readmitted patients in groups 1 and 2, respectively. The main cause for ADHF was non-compliance with recommendations in 47.4 % and 66.7 % of patients of groups 1 and 2, respectively (р<0.001).Conclusion Follow-up in the system of specialized health care significantly decreases the risk of rehospitalization during the first and second years of follow-up and during two years in total for both patients with FC I-II CHF and FC III-IV CHF. Despite education of patients, personal contacts with medical personnel, and telephone support, main reasons for rehospitalization were avoidable.
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Affiliation(s)
- N G Vinogradova
- 1 - Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation 2 - City Center for the Treatment of Heart Failure City Clinical Hospital No. 38 Nizhny Novgorod
| | - D S Polyakov
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - I V Fomin
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
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Vinogradova NG. [The prognosis of patients with chronic heart failure, depending on adherence to observation in a specialized heart failure treatment center]. ACTA ACUST UNITED AC 2019; 59:13-21. [PMID: 31876458 DOI: 10.18087/cardio.n613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/11/2019] [Indexed: 11/18/2022]
Abstract
Actuality. The risk of death of patients with chronic heart failure (CHF) after acute decompensation of heart failure (ADHF) is directly related to the quality of the treatment of CHF after discharge from the hospital. In order to achieve the maximum effect of therapy in patients with CHF, experts in Europe and the USA recommend the creation of centers of specialized medical care for patients with CHF. Objective: to determine the risks of general, cardiovascular mortality and death from ADHF in patients with CHF during two years of observation, depending on their adherence to observation in a specialized center for the treatment of chronic heart failure (center CHF). Materials and methods. The study consistently included 942 patients with CHF after ADHF. The adherence of patients to follow up in center CHF was analyzed and 4 groups were distinguished: group 1 (n = 313) included patients who were observed continuously for two years; group 2 (n = 382) included patients who, after discharge, had never been observed in the center CHF; group 3 (n = 197) consisted of patients who were monitored at center CHF during the first year and then discontinued, and group 4 (n = 49) united patients who, when included in the study, abandoned observation, but after a year began to be constantly observed during the second year center CHF. Results. Statistically significant differences in age were registered only between groups 1 and 2 (69.6+9.9 and 71.8+11 years, respectively, р1/2=0.006). The overall mortality over the 2 years of follow-up was significantly higher in group 2 (32.4%) versus group 1 (1.2%, OR=3.8, 95% CI 2.5-5.7; p1/2<0.001 ); compared with group 3 (9.1%, OR=4.8, 95% CI 2.8-8.1; p2/3<0.001) and group 4 (8,2%, OR = 5.4, 95% CI 1.9-15.3; p2/4=0.0005). Cardiovascular mortality (CVM) for 2 years of follow-up was significantly higher in group 2 versus group 1 (8.1% and 1.3% of cases, OR=6.8, 95% CI 2.4-19.5; p1/2<0.001), as well as in comparison with group 3 (CVM 3% for 2 years, OR=2.8, 95% CI 1.1-6.8; p2/3=0.02). CVM in group 4 (6.1%) was 5 times higher in comparison with group 1 (OR=5.0, 95% CI 1.1-23.2; p1/4=0.02). The risks of death from ADHF over the 2 years of follow-up were significantly higher in group 2 (16.4%) compared with all groups: with group 1 (6.4%) OR=2.9, 95% CI 1.7-4, 9, p1/2<0.001; with group 3 (5.1%) OR=3.7, 95% CI 1.8-7.3, p2/3<0.001; and with group 4 (2%) OR=9.5, 95% CI 1.3-69.7, p2/4= 0.008. The combined endpoint (CVM and death from ADHF in 2 years of follow-up) was also significantly higher in group 2 (24.5%) compared with all compared groups: group 1 (7.7%), OR=3.9, 95% CI 2.4-6.3, p1/2<0.001; group 3 (8.1%), OR=3.7, 95% CI 2.1-6.5, p2/3<0.001; and group 4 (8.2%), OR=3.7, 95% CI 1.3-10.4; p2/4=0.01. Conclusion. Surveillance of patients with CHF after an episode of ADHF in a specialized center CHF, both for a long time (two years) and partially during the first year of observation, reduces the risk of all-cause death, CVM and death from ADHF.
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Affiliation(s)
- N G Vinogradova
- Privolzhsky Research Medical University; Municipal Clinical Hospital #38
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The impact of kidney dysfunction categorized by urinary to serum creatinine ratio on clinical outcomes in patients with heart failure. Heart Vessels 2019; 35:187-196. [PMID: 31332507 DOI: 10.1007/s00380-019-01472-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
Kidney dysfunction (KD) is closely associated with poor clinical outcome in patients with heart failure (HF). KD is classified as intrinsic and pre-renal KD. However, the impact of each KD on the clinical outcome in patients with HF has not yet been fully elucidated. We measured the urinary to serum creatinine (UC/SC) ratio, a marker for intrinsic and pre-renal KD, in 1009 consecutive patients with HF at admission. There were 314 cardio-renal events including HF and advanced end-stage renal dysfunction during the median follow-up period of 1154 days. There were 63 (6%) patients with intrinsic KD (UC/SC ratio < 20), 118 (12%) patients with intermediate KD (UC/SC ratio 20-40), 607 (60%) patients with pre-renal KD (UC/SC ratio > 40), and 221 (22%) patients with no KD. Multivariate Cox's proportional hazard regression analysis demonstrated that intrinsic and intermediate KDs were significantly associated with poor clinical outcome. The prediction model for cardio-renal events was significantly improved by the addition of UC/SC ratio to the confounding risk factors. Subgroup analysis in patients with HF with severely reduced glomerular filtration rates showed that the prevalence rates of intrinsic, intermediate, and pre-renal KDs were 23%, 30%, and 47%, respectively. The cardio-renal event rate was the highest in the intrinsic KD group compared with that in the other groups. Intrinsic KD was closely associated with extremely poor clinical outcome in patients with HF. The UC/SC ratio could provide important clinical information for the treatment and management of KD in patients with HF.
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Otaki Y, Watanabe T, Sato N, Shirata T, Kato S, Tamura H, Nishiyama S, Arimoto T, Takahashi H, Shishido T, Morikane K, Watanabe M. Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Cardio-Renal Anemia Syndrome ― Difference in Prognostic Ability ―. Circ Rep 2019. [DOI: 10.1253/circrep.cr-18-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Naohito Sato
- Division of Clinical Laboratory, Yamagata University Hospital
| | - Toru Shirata
- Division of Clinical Laboratory, Yamagata University Hospital
| | - Shigehiko Kato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
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Xu XR, Meng XC, Wang X, Hou DY, Liang YH, Zhang ZY, Liu JM, Zhang J, Xu L, Wang H, Zhao WS, Zhang L. A severity index study of long-term prognosis in patients with chronic heart failure. Life Sci 2018; 210:158-165. [DOI: 10.1016/j.lfs.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/24/2022]
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Jackson JD, Cotton SE, Bruce Wirta S, Proenca CC, Zhang M, Lahoz R, Balas B, Calado FJ. Care pathways and treatment patterns for patients with heart failure in China: results from a cross-sectional survey. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2311-2321. [PMID: 30100706 PMCID: PMC6067623 DOI: 10.2147/dddt.s166277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose The objective of this study was to describe the clinical care pathways, management and treatment patterns, and hospitalizations for patients with heart failure (HF) in China. Subjects and methods A cross-sectional survey of cardiologists and their patients with HF was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Patients for whom a patient record form was completed were invited to complete a patient self-completion questionnaire. Results Most of the 1,500 patients (mean [SD] age 66 [10] years; 55% male) included in the study received care in tier-2 and -3 hospitals in large cities. Cardiologists were responsible for initial consultation, diagnosis, and treatment of patients with HF. The use of guideline-recommended diagnostics was high. However, guideline-recommended double- and triple-combination therapy was received by only 51% and 18% of patients, respectively. In total, 20% of patients with HF reported that they were not consulted on the choice of therapy. Concordance was high (≥80%) between matched cardiologist and patient pairs for the occurrence of side effects, while cardiologists more often under- than overreported the occurrence of side effects of treatment reported by patients. Conclusion The management of HF was predominantly overseen by cardiologists. The use of diagnostic tests was high, but the use of guideline-recommended treatment was low in this population. Improved communication between patients and cardiologists is essential to optimize treatment decision making and to increase awareness of treatment side effects.
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Affiliation(s)
| | - Sarah E Cotton
- Real World Research, Adelphi Real World, Bollington, UK,
| | - Sara Bruce Wirta
- Real World Evidence, Cardio-Metabolic Franchise, Novartis Sweden AB, Stockholm, Sweden
| | | | - Milun Zhang
- Health Economics and Outcomes Research, Novartis Pharma China, Beijing, China
| | - Raquel Lahoz
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Bogdan Balas
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Frederico J Calado
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
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Real-world heart failure management in 10,910 patients with chronic heart failure in the Netherlands : Design and rationale of the Chronic Heart failure ESC guideline-based Cardiology practice Quality project (CHECK-HF) registry. Neth Heart J 2018; 26:272-279. [PMID: 29564639 PMCID: PMC5910310 DOI: 10.1007/s12471-018-1103-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aims Data from patient registries give insight into the management of patients with heart failure (HF), but actual data from unselected real-world HF patients are scarce. Therefore, we performed a cross sectional study of current HF care in the period 2013–2016 among more than 10,000 unselected HF patients at HF outpatient clinics in the Netherlands. Methods In 34 participating centres, all 10,910 patients with chronic HF treated at cardiology centres were included in the CHECK-HF registry. Of these, most (96%) were managed at a specific HF outpatient clinic. Heart failure was typically diagnosed according to the ESC guidelines 2012, based on signs, symptoms and structural and/or functional cardiac abnormalities. Information on diagnostics, treatment and co-morbidities were recorded, with specific focus on drug therapy and devices. In our cohort, the mean age was 73 years (SD 12) and 60% were male. Frequent co-morbidities reported in the patient records were diabetes mellitus 30%, hypertension 43%, COPD 19%, and renal insufficiency 58%. In 47% of the patients, ischaemia was the origin of HF. In our registry, the prevalence of HF with preserved ejection fraction was 21%. Conclusion The CHECK-HF registry will provide insight into the current, real world management of patient with chronic HF, including HF with reduced ejection fraction, preserved ejection fraction and mid-range ejection fraction, that will help define ways to improve quality of care. Drug and device therapy and guideline adherence as well as interactions with age, gender and co-morbidities will receive specific attention.
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The treatment gap in patients with chronic systolic heart failure: a systematic review of evidence-based prescribing in practice. Heart Fail Rev 2018; 21:675-697. [PMID: 27465132 DOI: 10.1007/s10741-016-9575-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The extent and impact of under-prescribing of evidence-based pharmacological therapies among heart failure patients with reduced ejection fraction (HFREF) in contemporary practice is unclear. We sought to examine the prescribing patterns of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β-blockers (BBs) and mineralocorticoid receptor antagonists (MRAs), and to quantify the estimated 'treatment gap' among HFREF patients in the 'real-world' setting. The MEDLINE, PubMed, EMBASE, CINAHL and CENTRAL databases were searched for registry- or survey-based studies which examined the prescribing rates of ACE inhibitors, ARBs, BBs and MRAs among HFREF patients. Searches were limited to those published in the years 2000-2015. A total of 23 reports, including 83,605 patients, were evaluated. Overall, ACE inhibitors/ARBs, BBs and MRAs were prescribed to 79.8, 81.4 and 36.4 % of patients, respectively. The estimated treatment gaps in the overall population were 13.1 % for ACE inhibitors/ARBs, 3.9 % for BBs and 16.8 % for MRAs. The proportion of patients who received ≥50 % of the guideline-recommended target doses was 72 % for ACE inhibitors, 51 % for ARBs, 49 % for BBs, 53 % for the combination of ACE inhibitors/ARBs and BBs and 83 % for MRAs. Prescribing these drugs according to contemporary guidelines was associated with lower mortality risk. Patients who were elderly, female and with comorbidities were less likely to receive optimal treatment as recommended by the guidelines. ACE inhibitors, ARBs, BBs and MRAs are under-prescribed in eligible HFREF patients. Efforts should be made to improve approaches to closing the treatment gap at both systems of care and individual levels.
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Treatment of chronic heart failure in Germany: a retrospective database study. Clin Res Cardiol 2017; 106:923-932. [PMID: 28748266 PMCID: PMC5655600 DOI: 10.1007/s00392-017-1138-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
Abstract
Background Adherence to treatment guidelines affects outcomes in patients with chronic heart failure (HF). We investigated patient pathways and treatment patterns for HF in Germany. Methods This retrospective study used anonymous healthcare claims data from the German Health Risk Institute on individuals with statutory health insurance. Patients with uninterrupted data from 1 January 2009 to 31 December 2013 or death (whichever occurred first), and ≥2 recorded HF-related diagnoses in 2011, were included. Patients with newly diagnosed HF were identified. Use of treatment patterns recommended by the European Society of Cardiology (2008) and German Nationale VersorgungsLeitlinien (2011) guidelines was evaluated. Results Of 123,925 patients with HF, 21.3% were newly diagnosed. Overall, 63.2% of new HF diagnoses were made in the ambulatory setting; 61.6% of these were made by family practitioners and 14.8% by cardiologists. In the ambulatory setting, family practitioners were primarily responsible for treatment; specialists in internal medicine (70.3% cardiologists) were mainly responsible for performing HF-related technical diagnostics. One-fifth (20.9%) of patients received a New York Heart Association (NYHA) classification; 45.1% of these received a guideline-based treatment pattern. Application of the recommended treatment pattern decreased with advancing disease severity (NYHA class IV: 21.1% application) and older age (≥90 years: 28.3% application). Conclusions Family practitioners play a key role in the diagnosis and initial treatment of HF in Germany. A substantial proportion of patients do not receive guideline-recommended pharmacotherapy. These findings should be reflected in the planning of national disease management programmes. Electronic supplementary material The online version of this article (doi:10.1007/s00392-017-1138-6) contains supplementary material, which is available to authorized users.
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Adams KF, Giblin EM, Pearce N, Patterson JH. Integrating New Pharmacologic Agents into Heart Failure Care: Role of Heart Failure Practice Guidelines in Meeting This Challenge. Pharmacotherapy 2017; 37:645-656. [PMID: 28394465 DOI: 10.1002/phar.1934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Heart failure is well recognized as a major public health concern not only due to severe and frequent adverse health outcomes but also related to the major financial burden this syndrome presents with advancing age in Western societies. Despite the dire need for more efficacious therapies and better application of existing advances, treatment gaps persist, and outcomes in heart failure remain poor, with continually high mortality and morbidity. Treatment guidelines provide one strategy for advancing quality of care in patients with heart failure. This approach, with well-known potential strengths and weaknesses, has both adherents and detractors. Heart failure treatment guidelines have been in sharp focus recently due to updates that address the United States Food and Drug Administration (FDA) approval in 2015 of two new pharmacologic therapies for heart failure with reduced ejection fraction: sacubitril-valsartan and ivabradine. Our commentary will revisit issues in guideline methodology and discuss these in the context of the updates addressing the FDA approval of new pharmacologic agents for heart failure with reduced ejection fraction.
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Affiliation(s)
- Kirkwood F Adams
- Division of Cardiology, Department of Medicine and Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erika M Giblin
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Natalie Pearce
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - J Herbert Patterson
- Division of Cardiology, Department of Medicine and Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina
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True rate of mineralocorticoid receptor antagonists-related hyperkalemia in placebo-controlled trials: A meta-analysis. Am Heart J 2017; 188:99-108. [PMID: 28577687 DOI: 10.1016/j.ahj.2017.03.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/20/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRA) improve survival in heart failure with reduced ejection fraction but are often underused, mostly due to concerns of hyperkalemia. Because hyperkalemia occurs also on placebo, we aimed to determine the truly MRA-related rate of hyperkalemia. METHODS We performed a meta-analysis including randomized, placebo-controlled trials reporting hyperkalemia on MRAs in patients after myocardial infarction or with chronic heart failure. We evaluated the truly MRA-related rate of hyperkalemia that represents hyperkalemia on MRA, corrected for hyperkalemia on placebo (Pla), according to the equation: True MRA (%)=(MRA (%) - Pla (%))/MRA (%). RESULTS A total number of 16,065 patients from 7 trials were analyzed. Hyperkalemia was more frequently observed on MRA (9.3%) vs placebo (4.3%) (risk ratio 2.17, 95% CI 1.92-2.45, P<.0001). Truly MRA-related hyperkalemia was 54%, whereas 46% were non-MRA related. In trials using eplerenone, hyperkalemia was documented in 5.0% on eplerenone and in 2.6% on placebo (P<.0001). In spironolactone trials, hyperkalemia was documented in 17.5% and in 7.5% of patients on placebo (P=.0001). Hypokalemia occurred less frequently in patients on MRA (9.3%) compared with placebo (14.8%) (risk ratio 0.58, CI 0.47-0.72, P<.0001). CONCLUSION This meta-analysis shows that in clinical trials, 54% of hyperkalemia cases were specifically related to the MRA treatment and 46% to other reasons. Therefore, non-MRA-related rises in potassium levels might be underestimated and should be rigorously explored before cessation of the evidence-based therapy with MRAs.
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Seyler C, Meder B, Weis T, Schwaneberg T, Weitmann K, Hoffmann W, Katus HA, Dösch A. TranslatiOnal Registry for CardiomyopatHies (TORCH) - rationale and first results. ESC Heart Fail 2017; 4:209-215. [PMID: 28772045 PMCID: PMC5542726 DOI: 10.1002/ehf2.12145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/02/2017] [Accepted: 02/10/2017] [Indexed: 11/07/2022] Open
Abstract
AIMS Non-ischemic cardiomyopathies (CMPs) comprise heart muscle disorders of different causes with high variability in disease phenotypes and clinical progression. The lack of national structures for the efficient recruitment, clinical and molecular classification, and follow-up of patients with non-ischemic CMPs limit the thorough analysis of disease mechanisms and the evaluation of novel diagnostic and therapeutic strategies. This paper describes a national, prospective, multicenter registry for patients with non-ischemic CMPs. The main objective of this registry is to create a central hub for clinical outcome studies, a joint resource for diagnostic and therapeutic trials, a common biomaterial bank, and a resource for detailed molecular analyses utilizing patients' biomaterials. METHODS AND RESULTS A comprehensive characterization of the register population and patients' subgroups is planned. First analyses will include descriptive methods evaluating the distribution of outcome variables and possible risk factors followed by test statistics in a cross-sectional design. The aim of the current study is to recruit 2300 patients all over Germany. Eligible participants are patients with primary non-ischemic cardiomyopathies, including hereditary and inflammatory dilated CMP (DCM), left-ventricular noncompaction CMP (LVNC), hypertrophic CMP (HCM), arrhythmogenic right-ventricular CMP (ARVC), myocarditis, and amyloidosis. Of already recruited patients 70% are male and 30% female. With 56% of patients included, DCM is most common. CONCLUSION/OUTCOME The primary outcome is all-cause death. Key secondary endpoints are cardiovascular death, adequate ICD shock, survived sudden cardiac death, syncope, documented potentially life-threatening arrhythmia, cardiac transplantation, hospitalization due to worsening of heart failure (HF), and any non-elective cardiovascular hospitalization.
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Affiliation(s)
- Claudia Seyler
- Department of Cardiology, Medical University Hospital Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Medical University Hospital Heidelberg, Germany
| | - Tanja Weis
- Department of Cardiology, Medical University Hospital Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Thea Schwaneberg
- Institute for Community Medicine, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Kerstin Weitmann
- Institute for Community Medicine, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Andreas Dösch
- Department of Cardiology, Medical University Hospital Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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Kawauchi TS, Umeda IIK, Braga LM, Mansur ADP, Rossi-Neto JM, Guerra de Moraes Rego Sousa A, Hirata MH, Cahalin LP, Nakagawa NK. Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial. Clin Res Cardiol 2017; 106:676-685. [PMID: 28255812 DOI: 10.1007/s00392-017-1089-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/08/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inspiratory and peripheral muscle training improves muscle strength, exercise tolerance, and quality of life in patients with chronic heart failure (HF). However, studies investigating different workloads for these exercise modalities are still lacking. OBJECTIVE To examine the effects of low and moderate intensities on muscle strength, functional capacity, and quality of life. DESIGN A randomized controlled trial. METHODS Thirty-five patients with stable HF (aged >18 years, NYHA II/III, LVEF <40%) were randomized to: non-exercise control group (n = 9), low-intensity training group (LIPRT, n = 13, 15% maximal inspiratory workload, and 0.5 kg of peripheral muscle workload) or moderate-intensity training group (MIPRT, n = 13, 30% maximal inspiratory workload and 50% of one maximum repetition of peripheral muscle workload). The outcomes were: respiratory and peripheral muscle strength, pulmonary function, exercise tolerance by the 6-minute walk test, symptoms based on the NYHA functional class, and quality of life using the Minnesota Living with Heart Failure Questionnaire. RESULTS All groups showed similar quality-of-life improvements. Low and moderate intensities training programs improved inspiratory muscle strength, peripheral muscle strength, and walking distance. However, only moderate intensity improved expiratory muscle strength and NYHA functional class in HF patients. CONCLUSIONS The low-intensity inspiratory and peripheral resistance muscle training improved inspiratory and peripheral muscle strength and walking distance, demonstrating that LIPRT is an efficient rehabilitation method for debilitated HF patients. In addition, the moderate-intensity resistance training also improved expiratory muscle strength and NYHA functional class in HF patients.
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Affiliation(s)
- Tatiana Satie Kawauchi
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil
| | - Iracema Ioco Kikuchi Umeda
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Lays Magalhães Braga
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil
| | - Antonio de Pádua Mansur
- Heart Institute - HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, Brazil
| | - João Manoel Rossi-Neto
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | | | - Mário Hiroyuki Hirata
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami, Coral Gables, FL, USA
| | - Naomi Kondo Nakagawa
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil.
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26
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Wienbergen H, Pfister O, Hochadel M, Michel S, Bruder O, Remppis BA, Maeder MT, Strasser R, von Scheidt W, Pauschinger M, Senges J, Hambrecht R. Usefulness of Iron Deficiency Correction in Management of Patients With Heart Failure [from the Registry Analysis of Iron Deficiency-Heart Failure (RAID-HF) Registry]. Am J Cardiol 2016; 118:1875-1880. [PMID: 27756479 DOI: 10.1016/j.amjcard.2016.08.081] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 01/28/2023]
Abstract
Iron deficiency (ID) has been identified as an important co-morbidity in patients with heart failure (HF). Intravenous iron therapy reduced symptoms and rehospitalizations of iron-deficient patients with HF in randomized trials. The present multicenter study investigated the "real-world" management of iron status in patients with HF. Consecutive patients with HF and ejection fraction ≤40% were recruited and analyzed from December 2010 to October 2015 by 11 centers in Germany and Switzerland. Of 1,484 patients with HF, iron status was determined in only 923 patients (62.2%), despite participation of the centers in a registry focusing on ID and despite guideline recommendation to determine iron status. In patients with determined iron status, a prevalence of 54.7% (505 patients) for ID was observed. Iron therapy was performed in only 8.5% of the iron-deficient patients with HF; 2.6% were treated with intravenous iron therapy. The patients with iron therapy were characterized by a high rate of symptomatic HF and anemia. In conclusion, despite strong evidence of beneficial effects of iron therapy on symptoms and rehospitalizations, diagnostic and therapeutic efforts on ID in HF are low in the actual clinical practice, and the awareness to diagnose and treat ID in HF should be strongly enforced.
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27
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Otaki Y, Watanabe T, Kinoshita D, Yokoyama M, Takahashi T, Toshima T, Sugai T, Murase T, Nakamura T, Nishiyama S, Takahashi H, Arimoto T, Shishido T, Miyamoto T, Kubota I. Association of plasma xanthine oxidoreductase activity with severity and clinical outcome in patients with chronic heart failure. Int J Cardiol 2016; 228:151-157. [PMID: 27865177 DOI: 10.1016/j.ijcard.2016.11.077] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/05/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Oxidative stress due to purine degradation is associated with the development of chronic heart failure (CHF). Xanthine oxidoreductase (XOR) is a rate-limiting enzyme of purine degradation that plays a key role in uric acid (UA) production with a resultant increase in reactive oxygen species. However, the relationship between plasma XOR activity and CHF severity and clinical outcome remains unclear. METHODS AND RESULTS We measured XOR activity in 440 patients with CHF and 44 control subjects. Abnormally high and low XOR activities were identified based on the results for 95% of the control subjects (high and low XOR activities ≥120 and <33pmol/100μL/h, respectively). The prevalence rates of high and low XOR activities increased with advancing New York Heart Association functional class. There were 158 cardiac events during a median follow-up period of 1034days. Multivariate Cox proportional hazard regression analysis showed that both high and low XOR activities were significantly associated with cardiac events in patients with CHF after adjustment for confounding risk factors including serum UA and loop diuretic use. Kaplan-Meier analysis revealed that the cardiac event rate was significantly higher in patients with either high or low XOR activity. The net reclassification index was significantly improved by adding XOR activity to the basic risk factors. CONCLUSIONS We provide the first evidence of an association of plasma XOR activity with CHF severity and clinical outcome. Plasma XOR activity could be used to identify high-risk CHF patients and could be a therapeutic target for XOR inhibitors.
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Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Daisuke Kinoshita
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Miyuki Yokoyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsuya Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Taku Toshima
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takayuki Sugai
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takayo Murase
- Radioisotope and Chemical Analysis Center, Laboratory Management Department, Sanwa Kagaku Kenkyusho Co., Ltd., Mie, Japan
| | - Takashi Nakamura
- Pharmacological Study Group, Pharmaceutical Research Laboratories, Sanwa Kagaku Kenkyusho Co., Ltd., Mie, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takuya Miyamoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Hammoudi N, Laveau F, Helft G, Cozic N, Barthelemy O, Ceccaldi A, Petroni T, Berman E, Komajda M, Michel PL, Mallet A, Le Feuvre C, Isnard R. Low level exercise echocardiography helps diagnose early stage heart failure with preserved ejection fraction: a study of echocardiography versus catheterization. Clin Res Cardiol 2016; 106:192-201. [PMID: 27695989 DOI: 10.1007/s00392-016-1039-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Increased left ventricular end-diastolic pressure (LVEDP) with exercise is an early sign of heart failure with preserved left ventricular ejection fraction (LVEF). The abnormal exercise increase in LVEDP is nonlinear, with most change occurring at low-level exercise. Data on non-invasive approach of this condition are scarce. Our objective was assessing E/e' to estimate low level exercise LVEDP using a direct invasive measurement as the reference method. METHODS AND RESULTS Sixty patients with LVEF >50 % prospectively underwent both exercise cardiac catheterization and echocardiography. E/e' was measured at rest and during low-level exercise. Abnormal LVEDP was defined as >16 mmHg. Patients with a history of coronary artery disease and/or abnormal LV morphology were classified as having apparent cardiac disease (CD). Thirty-four (57 %) patients had elevated LVEDP only during exercise. Most of the change in LVEDP occurred since the first exercise level (25 W). There was a correlation between LVEDP and septal E/e' at rest and during exercise. Lateral E/e' and E/average e' ratio had worse correlations with LVEDP. In the whole population, exercise septal E/e' at 25 W had the best accuracy for abnormal exercise LVEDP, area under curve (AUC) = 0.79. However, while low-level exercise septal E/e' had a high accuracy in CD patients (n = 26, AUC = 0.96), E/e' was not linked to LVEDP in patients without CD (n = 34). CONCLUSION Low-level exercise septal E/e' is valuable for predicting abnormal exercise LVEDP in patients with preserved LVEF and apparent CD. However, this new diagnosis approach appears not reliable in patients with normal LV morphology and without coronary artery disease. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov . Unique identifier: NCT01714752.
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Affiliation(s)
- Nadjib Hammoudi
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France.
| | - Florent Laveau
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Gérard Helft
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Nathalie Cozic
- Département de Biostatistiques, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Paris 6, Paris, France
| | - Olivier Barthelemy
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Alexandre Ceccaldi
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Thibaut Petroni
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Emmanuel Berman
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Michel Komajda
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Pierre-Louis Michel
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Alain Mallet
- Département de Biostatistiques, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Paris 6, Paris, France
| | - Claude Le Feuvre
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Richard Isnard
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
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29
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Shah M, Bhalla V, Patnaik S, Maludum O, Lu M, Figueredo VM. Heart failure and the holidays. Clin Res Cardiol 2016; 105:865-72. [DOI: 10.1007/s00392-016-0995-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
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Carroll R, Mudge A, Suna J, Denaro C, Atherton J. Prescribing and up-titration in recently hospitalized heart failure patients attending a disease management program. Int J Cardiol 2016; 216:121-7. [PMID: 27153136 DOI: 10.1016/j.ijcard.2016.04.084] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/11/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Heart failure (HF) medications improve clinical outcomes, with optimal doses defined in clinical trials. Patient, provider and system barriers may limit achievement of optimal doses in real life settings, although disease management programs (HF-DMPs) can facilitate up-titration. METHODS AND RESULTS Secondary analysis of a prospective cohort of 216 participants recently hospitalized with systolic HF, attending 5 HF-DMPs in Queensland, Australia. Medication history at baseline (6weeks after discharge) and 6months provided data to describe prescription rates, dosage and optimal titration of HF medications, and associations with patient and system factors were explored. At baseline, 94% were on an angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB), 94% on a beta-blocker (BB) and 42% on a mineralocorticoid receptor antagonist (MRA). The proportion of participants on optimal doses of ACEI/ARB increased from 38% (baseline) to 52% (6months, p=0.001) and on optimal BB dose from 23% to 49% (p<0.001). Significant barriers to ACEI/ARB up-titration were body mass index (BMI)<25, female gender, polypharmacy, previously diagnosed HF, and tertiary hospital. Significant barriers for BB up-titration were BMI<25, previously diagnosed HF and non-cardiologist care. CONCLUSIONS Effective up-titration in HF DMPs is influenced by patient, disease and service factors. Better understanding of barriers to effective up-titration in women, normal weight, and established HF patients may help provide targeted strategies for improving outcomes in these groups.
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Affiliation(s)
- Robert Carroll
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield St., Herston, Qld 4006, Australia; University of Queensland School of Medicine, 288 Herston Road, Qld 4006, Australia.
| | - Alison Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield St., Herston, Qld 4006, Australia; University of Queensland School of Medicine, 288 Herston Road, Qld 4006, Australia
| | - Jessica Suna
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield St., Herston, Qld 4006, Australia
| | - Charles Denaro
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield St., Herston, Qld 4006, Australia; University of Queensland School of Medicine, 288 Herston Road, Qld 4006, Australia
| | - John Atherton
- University of Queensland School of Medicine, 288 Herston Road, Qld 4006, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Butterfield St., Herston, Qld 4006, Australia
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Auswirkung einer leitliniengerechten Behandlung auf die Mortalität bei Linksherzinsuffizienz. Herz 2016; 41:614-624. [DOI: 10.1007/s00059-016-4401-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/04/2016] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
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32
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General practitioners' adherence to chronic heart failure guidelines regarding medication: the GP-HF study. Clin Res Cardiol 2015; 105:441-50. [DOI: 10.1007/s00392-015-0939-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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Fox H, Bitter T, Horstkotte D, Oldenburg O. Cardioversion of atrial fibrillation or atrial flutter into sinus rhythm reduces nocturnal central respiratory events and unmasks obstructive sleep apnoea. Clin Res Cardiol 2015; 105:451-9. [DOI: 10.1007/s00392-015-0940-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/29/2015] [Indexed: 12/26/2022]
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Franke J, Keppler J, Abadei AK, Bajrovic A, Meme L, Zugck C, Raake PW, Zitron E, Katus HA, Frankenstein L. Long-term outcome of patients with and without super-response to CRT-D. Clin Res Cardiol 2015; 105:341-8. [DOI: 10.1007/s00392-015-0926-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
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Salzwedel A, Reibis R, Wegscheider K, Eichler S, Buhlert H, Kaminski S, Völler H. Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin Res Cardiol 2015; 105:257-67. [PMID: 26377430 DOI: 10.1007/s00392-015-0917-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Return to work (RTW) is a pivotal goal of cardiac rehabilitation (CR) in patients after acute cardiac event. We aimed to evaluate cardiopulmonary exercise testing (CPX) parameters as predictors for RTW at discharge after CR. METHODS We analyzed data from a registry of 489 working-age patients (51.5 ± 6.9 years, 87.9 % men) who had undergone inpatient CR predominantly after percutaneous coronary intervention (PCI 62.6 %), coronary artery bypass graft (CABG 17.2 %), or heart valve replacement (9.0 %). Sociodemographic and clinical parameters, noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening data, as well as CPX findings, were merged with RTW data from the German statutory pension insurance program and analyzed for prognostic ability. RESULTS During a mean follow-up of 26.5 ± 11.9 months, 373 (76.3 %) patients returned to work, 116 (23.7 %) did not, and 60 (12.3 %) retired. After adjustment for covariates, elective CABG (HR 0.68, 95 % CI 0.47-0.98; p = 0.036) and work intensity (per level HR 0.83, 95 % CI 0.73-0.93; p = 0.002) were negatively associated with the probability of RTW. Exercise capacity in CPX (in Watts) and the VE/VCO2-slope had independent prognostic significance for RTW. A higher work load increased (HR 1.17, 95 % CI 1.02-1.35; p = 0.028) the probability of RTW, while a higher VE/VCO2 slope decreased (HR 0.85, 95 % CI 0.76-0.96; p = 0.009) it. CPX also had prognostic value for retirement: the likelihood of retirement decreased with increasing exercise capacity (HR 0.50, 95 % CI 0.30-0.82; p = 0.006). CONCLUSION CPX is a valid tool for assessing patients' ability to return to work. Therefore, it may be an essential part of functional assessment during CR for predicting participation in employment.
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Affiliation(s)
- Annett Salzwedel
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Eichler
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany
| | - Hermann Buhlert
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
| | - Stefan Kaminski
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany.
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany.
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RILLIG ANDREAS, MAKIMOTO HISAKI, WEGNER JASCHA, LIN TINA, HEEGER CHRISTIAN, LEMES CHRISTINE, FINK THOMAS, METZNER ANDREAS, WISSNER ERIK, MATHEW SHIBU, WOHLMUTH PETER, KUCK KARLHEINZ, TILZ ROLANDRICHARD, OUYANG FEIFAN. Six-Year Clinical Outcomes After Catheter Ablation of Atrial Fibrillation in Patients With Impaired Left Ventricular Function. J Cardiovasc Electrophysiol 2015. [DOI: 10.1111/jce.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- ANDREAS RILLIG
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - HISAKI MAKIMOTO
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - JASCHA WEGNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - TINA LIN
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTIAN HEEGER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTINE LEMES
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - THOMAS FINK
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ANDREAS METZNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ERIK WISSNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - SHIBU MATHEW
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | | | - KARL-HEINZ KUCK
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | | | - FEIFAN OUYANG
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
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Comorbid renal tubular damage and hypoalbuminemia exacerbate cardiac prognosis in patients with chronic heart failure. Clin Res Cardiol 2015. [DOI: 10.1007/s00392-015-0899-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Özcan EE, Szilagyi S, Sallo Z, Molnar L, Zima E, Szeplaki G, Osztheimer I, Öztürk A, Merkely B, Geller L. Comparison of the Effects of Epicardial and Endocardial Cardiac Resynchronization Therapy on Transmural Dispersion of Repolarization. Pacing Clin Electrophysiol 2015; 38:1099-105. [PMID: 26096799 DOI: 10.1111/pace.12678] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/22/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite significant improvements in cardiac output and functional capacity with cardiac resynchronization therapy (CRT), incidence of sudden cardiac death still remains high. Reversal of physiological myocardial activation sequence during epicardial pacing increases the transmural dispersion of repolarization (TDR). The aim of this study was to compare the effects of endocardial and epicardial biventricular pacing on repolarization parameters in the same patient group. METHODS Seven patients who had transseptal endocardial left ventricle (LV) lead placement, in whom epicardial CRT had failed due to coronary sinus (CS) lead dislodgement after successful implantation, were admitted to the study. LV endocardial leads were implanted through the interatrial septum in a lateral position. Electrocardiograms (ECGs) were scanned before and after successful epicardial and endocardial biventricular pacing and analyzed using digital calipers. ECG markers of TDR (TpTe and TpTe/QT ratio) were measured and compared. RESULTS Baseline QRS durations (161.7 ± 15.9 ms vs 162.2 ± 17.8 ms, P = 0.95), TpTe values (107.1 ± 20.5 ms vs 108.5 ± 17.6 ms, P = 0.89), and TpTe/QT ratios (0.24 ± 0.05 vs 0.24 ± 0.03, P = 0.88) were similar before epicardial and endocardial CRT. QRS interval reduction was similar (-28.3 ± 11.6 ms vs -29.1 ± 11.4 ms, P = 0.89) in both groups. Compared to transseptal endocardial CRT, epicardial CRT was associated with a significant increase in TpTe (17.1 ± 19.5 ms vs -12.6 ± 18.9 ms, P = 0.01) and TpTe/QT ratio (0.03 ± 0.04 vs -0.02 ± 0.03, P = 0.04). CONCLUSION Transseptal LV endocardial pacing is associated with significant reduction in TDR characteristics compared to epicardial pacing in CRT. Further studies are warranted to determine whether these effects may contribute to reduction of arrhythmias in patients with CRT.
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Affiliation(s)
| | | | - Zoltan Sallo
- Heart Center, Semmelweis University, Budapest, Hungary
| | | | - Endre Zima
- Heart Center, Semmelweis University, Budapest, Hungary
| | | | | | - Ali Öztürk
- Department of Cardiology, Sifa University, Izmir, Turkey
| | - Béla Merkely
- Heart Center, Semmelweis University, Budapest, Hungary
| | - Laszlo Geller
- Heart Center, Semmelweis University, Budapest, Hungary
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Vizzardi E, Sciatti E, Bonadei I, D'Aloia A, Tartière-Kesri L, Tartière JM, Cohen-Solal A, Metra M. Effects of spironolactone on ventricular-arterial coupling in patients with chronic systolic heart failure and mild symptoms. Clin Res Cardiol 2015; 104:1078-87. [PMID: 26058790 DOI: 10.1007/s00392-015-0877-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/01/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies demonstrated that mineralocorticoid receptor antagonists (MRAs) are able to prevent myocardial and vascular fibrosis, and left ventricular (LV) remodeling in patients with systolic chronic heart failure (HF) and mild symptoms. Ventricular-arterial coupling (VAC) should be influenced by anti-fibrotic interventions. We have assessed the effects of spironolactone on VAC and its components, aortic elastance (Ea) and end-systolic LV elastance (Ees), in patients with HF. METHODS AND RESULTS Changes from baseline in VAC were compared between 65 patients treated with spironolactone and 32 controls not receiving MRAs. All patients had HF, reduced LVEF with reduced LV ejection fraction (LVEF) and New York Heart Association (NYHA) functional class I-II symptoms, and underwent transthoracic echocardiography at baseline and after 6 months. VAC was estimated by the modified single-beat method as Ea/Ees. Parameters of LV function improved after 6 month treatment with spironolactone with an increase in the LVEF from 34 ± 8 to 39 ± 8 % (p < 0.001). Spironolactone increased Ees from 1.32 ± 0.38 to 1.57 ± 0.42 mmHg/mL (p < 0.001) and reduced VAC from 2.03 ± 0.59 to 1.66 ± 0.31 (p < 0.001), but did not affect Ea and V0 (LV volume at end-systolic pressure of 0 mmHg). No change in any of these parameters occurred in the control group. CONCLUSIONS 6-month therapy with spironolactone improved VAC mainly through its effect on Ees in patients with mild HF.
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Affiliation(s)
- Enrico Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy. .,, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Edoardo Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy
| | - Ivano Bonadei
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy
| | - Antonio D'Aloia
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy
| | - Lamia Tartière-Kesri
- Cardiac Rehabilitation, Léon Bérard Hospital, Hyères, France.,Cardiology Department, Sainte Musse Hospital, Toulon, France
| | - Jean-Michel Tartière
- Cardiology Department, Sainte Musse Hospital, Toulon, France.,INSERM U942, Paris, France
| | - Alain Cohen-Solal
- Cardiology Department, Lariboisière Hospital and Denis Diderot University, Paris, France.,INSERM U942, Paris, France
| | - Marco Metra
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy
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Böhm M, Tschöpe C, Wirtz JH, Lokies J, Turgonyi E, Bramlage P, Lins K, Strunz AM, Tebbe U. Treatment of heart failure in real-world clinical practice: findings from the REFLECT-HF registry in patients with NYHA class II symptoms and a reduced ejection fraction. Clin Cardiol 2015; 38:200-7. [PMID: 25733185 DOI: 10.1002/clc.22375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/18/2014] [Accepted: 11/22/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Optimal medical therapy (OMT) for patients with chronic heart failure and a reduced ejection fraction (HF-REF) includes angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists, plus a diuretic. HYPOTHESIS We hypothesized that OMT is less often prescribed in HF-REF patients (≤35%) with New York Heart Association (NYHA) class II symptoms compared with those with NYHA class III/IV symptoms. METHODS This was a cross-sectional, observational, multicenter survey of hospital-based cardiologists, office-based cardiologists, and general practitioners in Germany. RESULTS Out of a total of 384 patients enrolled, 144 had REF ≤35%. Patients with REF had NYHA class II symptoms in 39.6% (n = 57) and NYHA class III/IV symptoms in 60.4% (n = 87). The REF/NYHA class II group had a higher proportion of males than the REF/NYHA class III/IV group. For angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and β-blockers, prescription rates were high and comparable between groups. However, prescription rates for mineralocorticoid receptor antagonists were lower compared with other guideline-recommended treatments. Multivariate analyses indicated that OMT prescription was reduced for older patients and increased for patients cared for by an office-based cardiologist. CONCLUSIONS Given the high proportion of patients with reduced left ventricular systolic function but only minor symptoms, HF-REF appears to be underdiagnosed, and a higher proportion of patients than are currently recognized could potentially be candidates for OMT.
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Affiliation(s)
- Michael Böhm
- Internal Medicine Clinic III, Saarland University Medical Center, Homburg/Saar, Germany
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Substernal lead implantation: a novel option to manage DFT failure in S-ICD patients. Clin Res Cardiol 2014; 104:189-91. [DOI: 10.1007/s00392-014-0764-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
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