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Bakhsh A, Jelaidan I, Chaudhary AG, Al Amro S, Alghalayini K, Almogbel O, Alqaseer M, Albackr HB, Elshaer F, Al Ayoubi F. A Case-based Implementation of Heart Failure Therapies, a Consensus Pathway by the Saudi Heart Failure Working Group. J Saudi Heart Assoc 2024; 36:79-90. [PMID: 38919506 PMCID: PMC11195662 DOI: 10.37616/2212-5043.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/28/2024] [Accepted: 05/05/2024] [Indexed: 06/27/2024] Open
Abstract
The implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) has many challenges in real-world clinical practice. The consensus document is written considering the variability of the clinical presentation of HF patients. HF medical therapies need frequent dose adjustment during hospital admission or when patients develop electrolyte imbalance, acute kidney injury, and other acute illnesses. The paper describes clinical scenarios and graphs that will aid the managing physicians in decision-making for HF therapy optimization.
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Affiliation(s)
- Abeer Bakhsh
- Heart Function Unit, Prince Sultan Cardiac Centre, Riyadh,
Saudi Arabia
| | - Ibrahim Jelaidan
- Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah,
Saudi Arabia
| | - Ammar G. Chaudhary
- Cardiovascular Diseases Department, King Faisal Specialist Hospital and Research Centre, Jeddah,
Saudi Arabia
| | - Sahar Al Amro
- Clinical Pharmacy Department, Prince Sultan Cardiac Centre, Riyadh,
Saudi Arabia
| | | | - Osama Almogbel
- King Khaled University Hospital, King Fahad Cardiac Center, King Saud University, Riyadh,
Saudi Arabia
| | | | - Hanan B. Albackr
- Department of Cardiac Science, College of Medicine, King Saud University, Riyadh,
Saudi Arabia
| | - Fayez Elshaer
- King Khaled University Hospital, King Fahad Cardiac Center, King Saud University, Riyadh,
Saudi Arabia
| | - Fakhr Al Ayoubi
- Cardiology Clinical Pharmacist, College of Medicine, Adjunct Assistant Professor, College of Pharmacy, King Saud University, Riyadh,
Saudi Arabia
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Ferrannini G, Biber ME, Abdi S, Ståhlberg M, Lund LH, Savarese G. The management of heart failure in Sweden-the physician's perspective: a survey. Front Cardiovasc Med 2024; 11:1385281. [PMID: 38807949 PMCID: PMC11130511 DOI: 10.3389/fcvm.2024.1385281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/17/2024] [Indexed: 05/30/2024] Open
Abstract
Aims To assess the barriers to guideline-directed medical therapy (GDMT) use in heart failure (HF), diagnostic workup and general knowledge about HF among physicians in Sweden. Methods A survey about the management of HF was sent to 828 Swedish physicians including general practitioners (GPs) and specialists during 2021-2022. Answers were reported as percentages and comparisons were made by specialty (GPs vs. specialists). Results One hundred sixty-eight physicians participated in the survey (40% females, median age 43 years; 41% GPs and 59% specialists). Electrocardiography and New York Heart Association class evaluations are mostly performed once a year by GPs (46%) and at every outpatient visit by specialists (40%). Echocardiography is mostly requested if there is clinical deterioration (60%). One-third of participants screen for iron deficiency only if there is anemia. Major obstacles to implementation of different drug classes in HF with reduced ejection fraction are related to side effects, with no significant differences between specialties. Device implantation is deemed appropriate regardless of aetiology (69%) and patient age (86%). Specialists answered correctly to knowledge questions more often than GPs. Eighty-six percent of participants think that GDMT should be implemented as much as possible. Most participants (57%) believe that regular patient assessment in nurse-led HF clinics improve adherence to GDMT. Conclusion Obstacles to GDMT implementation according to physicians in Sweden mainly relate to potential side effects, lack of specialist knowledge and organizational aspects. Further efforts should be placed in educational activities and structuring of nurse-led clinics.
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Affiliation(s)
- Giulia Ferrannini
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Internal Medicine Unit, Södertälje Hospital, Södertälje, Sweden
| | - Mattia Emanuele Biber
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Studies, University of Trieste School of Medicine, Trieste, Italy
| | - Sam Abdi
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine, Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Ståhlberg
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lars H. Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Muk B, Bánfi-Bacsárdi F, Vámos M, Pilecky D, Majoros Z, Török GM, Vágány D, Polgár B, Solymossi B, Borsányi TD, Andréka P, Duray GZ, Kiss RG, Dékány M, Nyolczas N. The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction. Diagnostics (Basel) 2024; 14:131. [PMID: 38248008 PMCID: PMC10814730 DOI: 10.3390/diagnostics14020131] [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: 10/29/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher (p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401-0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation.
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Affiliation(s)
- Balázs Muk
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Fanni Bánfi-Bacsárdi
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Máté Vámos
- Cardiac Electrophysiology Division, Cardiology Center, Internal Medicine Clinic, University of Szeged, 6720 Szeged, Hungary
| | - Dávid Pilecky
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Zsuzsanna Majoros
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Gábor Márton Török
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Dénes Vágány
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Balázs Polgár
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Balázs Solymossi
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Tünde Dóra Borsányi
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Péter Andréka
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Gábor Zoltán Duray
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Róbert Gábor Kiss
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Miklós Dékány
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Noémi Nyolczas
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
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Masarone D, Kittleson MM, D'Onofrio A, Falco L, Fumarulo I, Massetti M, Crea F, Aspromonte N, Pacileo G. Basic science of cardiac contractility modulation therapy: Molecular and electrophysiological mechanisms. Heart Rhythm 2024; 21:82-88. [PMID: 37769793 DOI: 10.1016/j.hrthm.2023.09.021] [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: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
In heart failure with reduced ejection fraction and heart failure with preserved ejection fraction, profound cellular and molecular changes have recently been documented in the failing myocardium. These changes include altered calcium handling and metabolic efficiency of the cardiac myocyte, reactivation of the fetal gene program, changes in the electrophysiological properties of the heart, and accumulation of collagen (fibrosis) at the interstitial level. Cardiac contractility modulation therapy is an innovative device-based therapy currently approved for heart failure with reduced ejection fraction in patients with narrow QRS complex and under investigation for the treatment of heart failure with preserved ejection fraction. This therapy is based on the delivery of high-voltage biphasic electrical signals to the septal wall of the right ventricle during the absolute refractory period of the myocardium. At the cellular level, in patients with heart failure with reduced ejection fraction, cardiac contractility modulation therapy has been shown to restore calcium handling and improve the metabolic status of cardiac myocytes, reverse the heart failure-associated fetal gene program, and reduce the extent of interstitial fibrosis. This review summarizes the preclinical literature on the use of cardiac contractility modulation therapy in heart failure with reduced and preserved ejection fraction, correlating the molecular and electrophysiological effects with the clinical benefits demonstrated by this therapy.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy.
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Antonio D'Onofrio
- Electrophysiology Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy
| | | | - Massimo Massetti
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nadia Aspromonte
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy
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Patel T. Comment on: The Role of a Multidisciplinary Heart Failure Clinic in Optimization of Guideline-Directed Medical Therapy: HF-optimize. Curr Probl Cardiol 2023:101905. [PMID: 37394199 DOI: 10.1016/j.cpcardiol.2023.101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
I'm writing to provide more information about the study by Theresa et al., "The Role of a Multidisciplinary Heart Failure Clinic in Optimization of Guideline-Directed Medical Therapy: HF-optimize [1]." While the study examines how a multidisciplinary approach might be used to enhance medical care for heart failure patients controlled by guidelines, some restrictions, and factors should be discussed.
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DeFilippis EM, Mentz RJ, Lala A. Lifting and Healing as We Climb: Women's Heart Month. J Card Fail 2023; 29:121-123. [PMID: 36797008 DOI: 10.1016/j.cardfail.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Ersilia M DeFilippis
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
| | - Robert J Mentz
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA
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