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Galván Ruiz M, Fernández de Sanmamed Girón M, Del Val Groba Marco M, Rojo Jorge L, Peña Saavedra C, Martín Bou E, Andrade Guerra R, Caballero Dorta E, García Quintana A. Clinical profile, associated events and safety of vericiguat in a real-world cohort: The VERITA study. ESC Heart Fail 2024. [PMID: 39155141 DOI: 10.1002/ehf2.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024] Open
Abstract
AIMS The aim of this study was to determine the clinical profile, associated events and safety of vericiguat in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF). METHODS This study is a prospective and observational cohort study of patients with HFrEF and recent HF worsening episodes requiring intravenous therapy who initiated vericiguat in an HF outpatient clinic. A subanalysis of patients with ≥6 months' follow-up was performed separately. RESULTS Out of 103 patients initially included, 52 had a follow-up of at least 6 months (median follow-up of 303 days). At baseline, the mean age was 71.3 ± 9.4 years, 27.2% were women, the median left ventricular ejection fraction was 34% (28%-39%) and 99% were taking beta-blockers, 96.1% sodium-glucose cotransporter-2 (SGLT2) inhibitors, 95.1% sacubitril-valsartan, 90.3% aldosterone antagonists and 93.2% loop diuretics. During follow-up, New York Heart Association (NYHA) functional class improved (from 67.3% and 32.7% in classes III and II, respectively, to 22.4% and 75.5% at study end; P < 0.001), as did the EuroQol-5D (EQ-5D) and visual analogue scale (VAS) scores (from 0.83 ± 0.13 to 0.87 ± 0.12, P = 0.032, and from 60 to 79, P = 0.005, respectively). Vericiguat was well tolerated (13.5% had symptomatic hypotension, and 11.5% had discontinued treatment), and 78.8% of patients achieved the target dose of 10 mg. The number of HF-related hospitalizations/decompensations within the previous 12 months was 2.3 ± 1.4 and decreased with vericiguat to 0.79 ± 1.14 (P < 0.001). At study end, 7.7% died (50% for HF). CONCLUSIONS In clinical practice, treatment with vericiguat is associated with substantial improvements in functional class and quality of life and a reduction in hospitalizations for HF, with a low risk of adverse effects.
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Affiliation(s)
- Mario Galván Ruiz
- Department of Cardiology, Hospital Universitario de Gran Canaria Doctor Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - María Del Val Groba Marco
- Department of Cardiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Lorena Rojo Jorge
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Claudia Peña Saavedra
- Department of Cardiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Elvira Martín Bou
- Department of Cardiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Rubén Andrade Guerra
- Department of Cardiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Eduardo Caballero Dorta
- Department of Cardiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Antonio García Quintana
- Department of Cardiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
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Michel A, Lecomte C, Ohlmeier C, Raad H, Basedow F, Haeckl D, Beier D, Evers T. Treatment Patterns, Outcomes, and Persistence to Newly Started Heart Failure Medications in Patients with Worsening Heart Failure: A Cohort Study from the United States and Germany. Am J Cardiovasc Drugs 2024; 24:409-418. [PMID: 38573461 DOI: 10.1007/s40256-024-00643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Data are limited regarding guideline-directed medical therapy (GDMT) treatment patterns in patients with worsening heart failure (HF). METHODS We used administrative claims databases in Germany and the USA to conduct a retrospective cohort study of patients with worsening HF. Two cohorts of patients with prevalent HF and a HF hospitalization (HFH) from 2016 to 2019, alive at discharge (N = 75,140 USA; N = 47,003 Germany) were identified. Index date was the first HFH during the study period. One-year HF rehospitalization and mortality rates were calculated and a composite endpoint of both outcomes assessed using Kaplan-Meier estimation. We evaluated HF medication patterns in the 6 months before and after the index date. New users of a HF medication (at discharge/after index HFH) were followed for 1 year to evaluate persistence (no treatment gaps > 2 months) RESULTS: One-year HF rehospitalization rates were 36.2% (USA) and 47.7% (Germany). One year mortality rates were 30.0% (USA) and 23.0% (Germany), and the composite endpoint (mortality/HF rehospitalization) was reached in 55.1 % (USA) and 56.6% (Germany). Kaplan-Meier plots showed the risk for the composite endpoint was high in the early post discharge period. Comparison of patterns pre- and postindex HFH showed some increase in use of mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitor (ARNI), and triple therapy; use of angiotensin-converting enzyme (ACE) inhibitor/ angiotensin receptor blocker (ARB) plus beta-blockers remained constant/slightly declined; < 20% patients received triple therapy (ACE inhibitor/ARB plus beta-blocker plus MRA). A third of patients were new users; 1 year persistence rates were often low. CONCLUSIONS Morbidity, mortality, and rehospitalization risk is high among patients with worsening HF; uptake and continuation of GDMT is suboptimal.
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Affiliation(s)
- Alexander Michel
- Bayer Consumer Care AG, Pharmaceuticals, Peter Merian Straße 84, 4052, Basel, Switzerland.
| | | | | | | | - Frederike Basedow
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
| | | | - Dominik Beier
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
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Wahid M, Islam S, Sepehrvand N, Dover DC, McAlister FA, Kaul P, Ezekowitz JA. Iron Deficiency, Anemia, and Iron Supplementation in Patients With Heart Failure: A Population-Level Study. Circ Heart Fail 2024; 17:e011351. [PMID: 38572652 DOI: 10.1161/circheartfailure.123.011351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Studies have shown an association between iron deficiency (ID) and clinical outcomes in patients with heart failure (HF), irrespective of the presence of ID anemia (IDA). The current study used population-level data from a large, single-payer health care system in Canada to investigate the epidemiology of ID and IDA in patients with acute HF and those with chronic HF, and the iron supplementation practices in these settings. METHODS All adult patients with HF in Alberta between 2012 and 2019 were identified and categorized as acute or chronic HF. HF subtypes were determined through echocardiography data, and ID (serum ferritin concentration <100 μg/L, or ferritin concentration between 100 and 300 μg/L along with transferrin saturation <20%), and IDA through laboratory data. Broad eligibility for 3 clinical trials (AFFIRM-AHF [Study to Compare Ferric Carboxymaltose With Placebo in Patients With Acute HF and ID], IRONMAN [Intravenous Iron Treatment in Patients With Heart Failure and Iron Deficiency], and HEART-FID [Randomized Placebocontrolled Trial of Ferric Carboxymaltose as Treatment for HF With ID]) was determined. RESULTS Among the 17 463 patients with acute HF, 38.5% had iron studies tested within 30 days post-index-HF episode (and 34.2% of the 11 320 patients with chronic HF). Among tested patients, 72.6% of the acute HF and 73.9% of the chronic HF were iron-deficient, and 51.4% and 49.0% had IDA, respectively. Iron therapy was provided to 41.8% and 40.5% of patients with IDA and acute or chronic HF, respectively. Of ID patients without anemia, 19.9% and 21.7% were prescribed iron therapy. The most common type of iron therapy was oral (28.1% of patients). Approximately half of the cohort was eligible for each of the AFFIRM-AHF, intravenous iron treatment in patients with HF and ID, and HEART-FID trials. CONCLUSIONS Current practices for investigating and treating ID in patients with HF do not align with existing guideline recommendations. Considering the gap in care, innovative strategies to optimize iron therapy in patients with HF are required.
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Affiliation(s)
- Muizz Wahid
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
| | - Sunjidatul Islam
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
| | - Nariman Sepehrvand
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
| | - Douglas C Dover
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
| | - Finlay A McAlister
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
- Alberta Strategy for Patient-Oriented Research Support Unit, Edmonton, AB, Canada (F.A.M.)
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Division of Cardiology, Department of Medicine (J.A.E.), University of Alberta, Edmonton, AB, Canada
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Puthenpura M, Wilcox J, Tang WHW. Worsening heart failure: a concept in evolution. Curr Opin Cardiol 2024; 39:119-127. [PMID: 38116785 DOI: 10.1097/hco.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Worsening heart failure (WHF) has developed as a unique definition within heart failure (HF) in recent years. It captures the disease as a dynamic process. This review describes what is currently known about WHF, why it should be considered a discrete scientific endpoint, and future directions for research. RECENT FINDINGS There is no single agreed upon definition for WHF. It can be identified as being due to treatment side-effects, related to concomitant comorbidity, or true disease progression. Risk scores based on criteria like those already developed for HF can be created to stratify risk for WHF. CONCLUSIONS WHF is an emerging entity within HF that defines itself as a unique point of interest. Understanding it as a clinical measure of where a patient's HF is evolving allows for identifying patients that require a refreshed approach to their care. Keeping this in mind will help redefine more patient-centric outcome measures in research to come.
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Affiliation(s)
| | - Jennifer Wilcox
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute
| | - W H Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Shakoor A, Abou Kamar S, Malgie J, Kardys I, Schaap J, de Boer RA, van Mieghem NM, van der Boon RMA, Brugts JJ. The different risk of new-onset, chronic, worsening, and advanced heart failure: A systematic review and meta-regression analysis. Eur J Heart Fail 2024; 26:216-229. [PMID: 37823229 DOI: 10.1002/ejhf.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all-cause mortality and HF hospitalizations associated with new-onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. METHODS AND RESULTS We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30-day and 1-year all-cause mortality, as well as 1-year HF hospitalization. Studies were pooled using random effects meta-analysis, and mixed-effects meta-regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30-day mortality rates did not reveal a significant distinction between hospital-admitted patients, with rates of 10.13% for new-onset HF and 8.11% for WHF (p = 0.10). However, the 1-year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24-9.89) for CHF, 21.15% (95% CI 17.78-24.95) for new-onset HF, 26.84% (95% CI 23.74-30.19) for WHF, and 29.74% (95% CI 24.15-36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. CONCLUSIONS Our meta-analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF.
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Affiliation(s)
- Abdul Shakoor
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jishnu Malgie
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
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Perea-Armijo J, López-Aguilera J, González-Manzanares R, Pericet-Rodriguez C, Castillo-Domínguez JC, Heredia-Campos G, Roldán-Guerra Á, Urbano-Sánchez C, Barreiro-Mesa L, Aguayo-Caño N, Delgado-Ortega M, Crespín-Crespín M, Ruiz-Ortiz M, Mesa-Rubio D, Osorio MPÁ, Anguita-Sánchez M. The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients. J Clin Med 2023; 12:6082. [PMID: 37763022 PMCID: PMC10531712 DOI: 10.3390/jcm12186082] [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: 08/15/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term. METHODS A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0-1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed. RESULTS The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month. CONCLUSIONS Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.
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Affiliation(s)
- Jorge Perea-Armijo
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - José López-Aguilera
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Rafael González-Manzanares
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Cristina Pericet-Rodriguez
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Juan Carlos Castillo-Domínguez
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Gloria Heredia-Campos
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Álvaro Roldán-Guerra
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Cristina Urbano-Sánchez
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Lucas Barreiro-Mesa
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Nerea Aguayo-Caño
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Mónica Delgado-Ortega
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Manuel Crespín-Crespín
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Martín Ruiz-Ortiz
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Dolores Mesa-Rubio
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Manuel Pan-Álvarez Osorio
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
| | - Manuel Anguita-Sánchez
- Heart Failure Unit, Cardiology Departament, Reina Sofía University Hospital, Av. Menendez Pidal s/n, 14004 Cordoba, Spain; (J.P.-A.); (R.G.-M.); (C.P.-R.); (J.C.C.-D.); (G.H.-C.); (Á.R.-G.); (C.U.-S.); (L.B.-M.); (N.A.-C.); (M.C.-C.); (M.R.-O.); (D.M.-R.); (M.P.-Á.O.); (M.A.-S.)
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, 14004 Cordoba, Spain
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Nguyen NV, Lindberg F, Benson L, Ferrannini G, Imbalzano E, Mol PGM, Dahlström U, Rosano GMC, Ezekowitz J, Butler J, Lund LH, Savarese G. Eligibility for vericiguat in a real-world heart failure population according to trial, guideline and label criteria: Data from the Swedish Heart Failure Registry. Eur J Heart Fail 2023; 25:1418-1428. [PMID: 37323078 DOI: 10.1002/ejhf.2939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
AIM We investigated the eligibility for vericiguat in a real-world heart failure (HF) population based on trial, guideline and label criteria. METHODS AND RESULTS From the Swedish HF registry, 23 573 patients with HF with reduced ejection fraction (HFrEF) enrolled between 2000 and 2018, with a HF duration ≥6 months, were considered. Eligibility for vericiguat was calculated based on criteria from (i) the Vericiguat Global Study in Subjects with Heart Failure and Reduced Ejection Fraction (VICTORIA) trial; (ii) European and American guidelines on HF; (iii) product labelling according to the Food and Drug Administration and European Medicines Agency. Estimated eligibility for vericiguat in the trial, guidelines, and label scenarios was 21.4%, 47.4%, and 47.4%, respectively. Prior HF hospitalization within 6 months was the criterion limiting eligibility the most in all scenarios (met by 49.1% of the population). In the trial scenario, other criteria meaningfully limiting eligibility were elevated N-terminal pro-B-type natriuretic peptide levels and nitrate use. In all scenarios, eligibility was higher among patients hospitalized for HF at baseline (44.3% vs. 21.4% [trial scenario] and 97.3% vs. 47.4% [guideline/label scenarios] for hospitalized vs. non-hospitalized patients). Overall, eligible patients were older, had more severe HF, more comorbidities, and consequently higher cardiovascular mortality and HF hospitalization rates compared with ineligible patients across all scenarios. CONCLUSION In a large and contemporary real-world HFrEF cohort, we estimated that 21.4% of patients would be eligible for vericiguat according to the VICTORIA trial selection criteria, 47.4% based on guidelines and labelling. Eligibility for vericiguat translated into the selection of a population at high risk of morbidity/mortality.
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Affiliation(s)
- Ngoc V Nguyen
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Felix Lindberg
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Ferrannini
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Peter G M Mol
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Justin Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Institute, Dallas, TX, USA
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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8
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Pitt B, Bhatt DL, Szarek M, Cannon CP, Leiter LA, McGuire DK, Lewis JB, Riddle MC, Voors AA, Metra M, Lund LH, Komajda M, Testani JM, Wilcox CS, Ponikowski P, Lopes RD, Ezekowitz JA, Sun F, Davies MJ, Verma S, Kosiborod MN, Steg PG. Effect of Sotagliflozin on Early Mortality and Heart Failure-Related Events: A Post Hoc Analysis of SOLOIST-WHF. JACC. HEART FAILURE 2023; 11:879-889. [PMID: 37558385 DOI: 10.1016/j.jchf.2023.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/05/2023] [Accepted: 05/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Approximately 25% of patients admitted to hospitals for worsening heart failure (WHF) are readmitted within 30 days. OBJECTIVES The authors conducted a post hoc analysis of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post-WHF) trial to evaluate the efficacy of sotagliflozin versus placebo to decrease mortality and HF-related events among patients who began study treatment on or before discharge from their index hospitalization. METHODS The main endpoint of interest was cardiovascular death or HF-related event (HF hospitalization or urgent care visit) occurring within 90 and 30 days after discharge for the index WHF hospitalization. Treatment comparisons were by proportional hazards models, generating HRs, 95% CIs, and P values. RESULTS Of 1,222 randomized patients, 596 received study drug on or before their date of discharge. Sotagliflozin reduced the main endpoint at 90 days after discharge (HR: 0.54 [95% CI: 0.35-0.82]; P = 0.004) and at 30 days (HR: 0.49 [95% CI: 0.27-0.91]; P = 0.023) and all-cause mortality at 90 days (HR: 0.39 [95% CI: 0.17-0.88]; P = 0.024). In subgroup analyses, sotagliflozin reduced the 90-day main endpoint regardless of sex, age, estimated glomerular filtration rate, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, or mineralocorticoid receptor agonist use. Sotagliflozin was well-tolerated but with slightly higher rates of diarrhea and volume-related events than placebo. CONCLUSIONS Starting sotagliflozin before discharge in patients with type 2 diabetes hospitalized for WHF significantly decreased cardiovascular deaths and HF events through 30 and 90 days after discharge, emphasizing the importance of beginning sodium glucose cotransporter treatment before discharge.
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Affiliation(s)
- Bertram Pitt
- Department of Internal Medicine (Emeritus), University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Michael Szarek
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA; University of Colorado School of Medicine, Aurora, CO, USA; CPC Clinical Research, Aurora, Colorado, USA
| | - Christopher P Cannon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, Texas, USA
| | - Julia B Lewis
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Adriaan A Voors
- University of Groningen-University Medical Center Groningen, Groningen, the Netherlands
| | - Marco Metra
- Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Michel Komajda
- Paris Sorbonne University and Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Justin A Ezekowitz
- University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Franklin Sun
- Lexicon Pharmaceuticals Inc., The Woodlands, Texas, USA
| | - Michael J Davies
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Subodh Verma
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Mikhail N Kosiborod
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Ph Gabriel Steg
- Université Paris-Cité, Institut Universitaire de France, INSERM U-1148, FACT (French Alliance for Cardiovascular Trials) and AP-HP (Assistance Publique-Hôpitaux de Paris), Hopital Bichat Paris, Paris, France
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9
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Shiba M, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Seko Y, Yamamoto E, Yoshikawa Y, Kitai T, Yamashita Y, Iguchi M, Nagao K, Kawase Y, Morinaga T, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. Heterogeneity in Characteristics and Outcomes of Patients who met the Indications for Vericiguat Approved by the Japanese Agency: From the KCHF Registry. J Card Fail 2023; 29:976-978. [PMID: 37059291 DOI: 10.1016/j.cardfail.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Masayuki Shiba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yasutaka Inuzuka
- Cardiovascular Medicine, Shiga General Hospital, Moriyama, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Tenri, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Division of Heart Failure, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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10
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Di Fusco SA, Alonzo A, Aimo A, Matteucci A, Intravaia RCM, Aquilani S, Cipriani M, De Luca L, Navazio A, Valente S, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. ANMCO position paper on vericiguat use in heart failure: from evidence to place in therapy. Eur Heart J Suppl 2023; 25:D278-D286. [PMID: 37213802 PMCID: PMC10194817 DOI: 10.1093/eurheartjsupp/suad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In the growing therapeutic armamentarium for heart failure (HF) management, vericiguat represents an innovative therapeutic option. The biological target of this drug is different from that of other drugs for HF. Indeed, vericiguat does not inhibit neuro-hormonal systems overactivated in HF or sodium-glucose co-transporter 2 but stimulates the biological pathway of nitric oxide and cyclic guanosine monophosphate, which is impaired in patients with HF. Vericiguat has recently been approved by international and national regulatory authorities for the treatment of patients with HF and reduced ejection fraction who are symptomatic despite optimal medical therapy and have worsening HF. This ANMCO position paper summarises key aspects of vericiguat mechanism of action and provides a review of available clinical evidence. Furthermore, this document reports use indications based on international guideline recommendations and local regulatory authority approval at the time of writing.
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Affiliation(s)
- Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Alessandro Alonzo
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Alberto Aimo
- Interdisciplinary Center for Health Science, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà 33, Pisa, 56127, Italy
| | - Andrea Matteucci
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Rita Cristina Myriam Intravaia
- Cardiologia 4-Diagnostica e Riabilitativa, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, Milan, 20162, Italy
| | - Stefano Aquilani
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Manlio Cipriani
- U.O. Cardiologia, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-ISMETT, Via Ernesto Tricomi 5, Palermo, 90127, Italy
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, Rome, 00152, Italy
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia—IRCCS, Viale Risorgimento 80, Reggio Emilia, 42123, Italy
| | - Serafina Valente
- Dipartimento Cardio-Toracico, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Viale Mario Bracci 16, Siena, 53100, Italy
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Via Palermo 636, Catania, 95122, Italy
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, Rome, 00152, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Via Alfonso la Marmora 36, Firenze, 50121, Italy
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, Milan, 20162, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
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