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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [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: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Peng Y, Liao B, Zhou Y, Zeng W. Ginsenoside Rb2 improves heart failure by down-regulating miR-216a-5p to promote autophagy and inhibit apoptosis and oxidative stress. J Appl Biomed 2023; 21:180-192. [PMID: 38112457 DOI: 10.32725/jab.2023.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Ginsenoside Rb2 is beneficial in cardiovascular disease treatment, yet its role in heart failure (HF) is obscure. This study aimed to investigate the effect and mechanism of ginsenoside Rb2 on HF. METHODS The left anterior descending branch-ligated HF rat model and oxygen-glucose deprivation/reoxygenation (OGD/R) H9c2 cell model were constructed. Ginsenoside Rb2 were applied for intervention. Heart function indexes, miR-216a-5p expression, autophagy, oxidative stress, apoptosis, cell morphology, and proliferation were detected to explore the effect of ginsenoside Rb2 on HF. Overexpression of miR-216a-5p was employed to explore the specific mechanism of ginsenoside Rb2 on HF. RESULTS Ginsenoside Rb2 improved the heart function of HF rats, including the reduction of heart rate, LVEDP, and heart weight/body weight ratio, and the increase of LVSP, +dP/dtmax, -dP/dtmax, LVEF, and LVFS. It also down-regulated miR-216a-5p expression and enhanced OGD/R-induced cardiomyocyte viability. Ginsenoside Rb2 up-regulated Bcl2, LC3B II/I, and Beclin1, and down-regulated Bax, Caspase-3, and p62 in the myocardium of HF rats and OGD/R-induced H9c2 cells. Moreover, ginsenoside Rb2 increased the levels of SOD and CAT, but decreased the levels of MDA and ROS in the myocardium of HF rats and OGD/R-induced H9c2 cells. However, overexpression of miR-216a-5p promoted the apoptosis and oxidative stress of cardiomyocytes and inhibited autophagy, thus reversing the therapeutic effect of ginsenoside Rb2 on HF in vivo and in vitro. CONCLUSION Ginsenoside Rb2 demonstrated potential as a therapeutic intervention for HF by enhancing autophagy and reducing apoptosis and oxidative stress through miR-216a-5p downregulation. Further research could explore its application in clinical trials and investigate the complex mechanism networks underlying its effects.
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Affiliation(s)
- You Peng
- The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Center of Geriatric, Changsha, Hunan, China
- Hunan Research Institute of Geriatrics, Changsha, Hunan, China
- Major Chronic Disease Research Center of Hunan Provincial Geriatric Institute, Changsha, Hunan, China
| | - Bin Liao
- The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Center of Geriatric, Changsha, Hunan, China
| | - Yan Zhou
- The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Center of Geriatric, Changsha, Hunan, China
| | - Wei Zeng
- The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Center of Geriatric, Changsha, Hunan, China
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Drissa M, Krid M, Azaiez F, Mousli E, Yahyaoui S, Aouji C, Drissa H. New onset heart failure with reduced ejection fraction management: single center, real-life Tunisian experience. Egypt Heart J 2023; 75:91. [PMID: 37934305 PMCID: PMC10630274 DOI: 10.1186/s43044-023-00417-7] [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: 07/04/2023] [Accepted: 10/07/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a serious and frequent pathology. It represents a major public health problem. We have few data about this pathology in our country. The aim of our study is to determine the epidemiological, clinical, therapeutic, and prognostic characteristics of new-onset HF with reduced left ventricular ejection fraction (HFrEF) and to study the degree of conformity of the management of HF with international recommendations. RESULTS Our study population includes 210 patients hospitalized for HFrEF newly diagnosed. The average age of our patients was 64 ± 12 years. A male predominance was noted with a sex ratio of 2.8. The main etiology of HF was ischemic heart disease noted in 97 patients (46.2%). The average LVEF is 33 ± 6%. The triple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists) was prescribed in 75 patients (35.7%). The quadruple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists + Sodium-Glucose Co-Transporter 2 inhibitors) was prescribed in 17 patients (8.1%). Myocardial revascularization was indicated in 97 patients (46.6%) and valve surgery was indicated in 49 patients (23.3%). Hospital mortality was 3.8% and at 1 year 18.1%. Among the 192 patients followed during the first year after discharge from hospital, 81 patients had to be re-hospitalized, i.e., a 1-year rehospitalization rate of 42.2%. CONCLUSIONS Our study highlighted the epidemiological and clinical features of HF in a Tunisian care center, revealing our patient management deficiency. This pushes us to have a new Tunisian register to enable a better statistical analysis and lead to more relevant conclusions.
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Affiliation(s)
- Meriem Drissa
- Cardiology Department, La Rabta University Hospital Tunis, Tunis, Tunisia.
| | - Marouan Krid
- Cardiology Department, Mongi Slim University Hospital Tunis, Tunis, Tunisia
| | - Fares Azaiez
- Cardiology Department, Mongi Slim University Hospital Tunis, Tunis, Tunisia
| | - Essia Mousli
- Cardiology Department, La Rabta University Hospital Tunis, Tunis, Tunisia
| | - Soumaya Yahyaoui
- Cardiology Department, Mongi Slim University Hospital Tunis, Tunis, Tunisia
| | - Cyrine Aouji
- Cardiology Department, La Rabta University Hospital Tunis, Tunis, Tunisia
| | - Habiba Drissa
- Cardiology Department, La Rabta University Hospital Tunis, Tunis, Tunisia
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Singh GK, Bowers AP, Ferguson C, Ivynian SE, Chambers S, Davidson PM, Hickman LD. Hospital-service use in the last year of life by patients aged ⩾60 years who died of heart failure or cardiomyopathy: A retrospective linked data study. Palliat Med 2023; 37:1232-1240. [PMID: 37306096 PMCID: PMC10503248 DOI: 10.1177/02692163231180912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding patterns of health care use in the last year of life is critical in health services planning. AIM To describe hospital-based service and palliative care use in hospital in the year preceding death for patients who died of heart failure or cardiomyopathy in Queensland from 2008 to 2018 and had at least one hospitalisation in the year preceding death. DESIGN A retrospective data linkage study was conducted using administrative health data relating to hospitalisations, emergency department visits and deaths. PARTICIPANTS AND SETTING Participants included were those aged ⩾60 years, had a hospitalisation in their last year of life and died of heart failure or cardiomyopathy in Queensland, Australia. RESULTS Of the 4697 participants, there were 25,583 hospital admissions. Three quarters (n = 3420, 73%) of participants were aged ⩾80 years and over half died in hospital (n = 2886, 61%). The median number of hospital admissions in the last year of life was 3 (interquartile range [IQR] 2-5). The care type was recorded as 'acute' for 89% (n = 22,729) of hospital admissions, and few (n = 853, 3%) hospital admissions had a care type recorded as 'palliative.' Of the 4697 participants, 3458 had emergency department visit(s), presenting 10,330 times collectively. CONCLUSION In this study, patients who died of heart failure or cardiomyopathy were predominantly aged ⩾80 years and over half died in hospital. These patients experienced repeat acute hospitalisations in the year preceding death. Improving timely access to palliative care services in the outpatient or community setting is needed for patients with heart failure.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Alison P Bowers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | | | - Serra E Ivynian
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
| | - Shirley Chambers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Rezapour A, Souresrafil A, Shamsaei M, Barzegar M, Tashakori-Miyanroudi M, Ketabchi E. Economic evaluation of ferric carboxymaltose compared with placebo in iron-deficient patients with heart failure: a systematic review. Int J Clin Pharm 2023:10.1007/s11096-022-01532-2. [PMID: 36805379 DOI: 10.1007/s11096-022-01532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/20/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND It has been shown that ferric carboxymaltose (FCM) improves symptoms and quality of life in iron-deficient patients with heart failure (HF). AIM We aimed to systematically review studies conducted on the cost-effectiveness of FCM compared to placebo in iron-deficient patients with HF. METHOD We searched PubMed, EMBASE, Scopus, and Web of Science to find the relevant studies. After removing duplicates, two authors independently evaluated the titles, abstracts, and full texts. We included studies that investigated the full economic evaluations of FCM in HF patients with iron deficiency (cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis) and used the CHEERS tool to evaluate the quality of the studies. RESULTS Seven studies were included which evaluated the economic analysis of treatments with FCM in iron-deficient patients with HF. The CHEERS scores for most of the studies (n = 6) were 0.77 or higher (very good quality). The lowest incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALY) of FCM ($1801.96) was from Italy, and the highest ICER per QALY of FCM ($25,981.28) South Korea. Results of the studies showed that FCM, compared to placebo, was cost-effective in iron-deficient patients with HF. CONCLUSION FCM is a cost-effective treatment for iron-deficient patients with HF. Considering the fact that all the included studies in the present systematic review took place in high-income countries, we recommend further studies investigating the cost-effectiveness of FCM in low- and middle-income countries.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Aghdas Souresrafil
- Department of Health Services and Health Promotion, School of Health, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Monireh Shamsaei
- Department of Health Services Management, School of Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Barzegar
- Department of English Language Teaching, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Tashakori-Miyanroudi
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ensiyeh Ketabchi
- Department of Health Services Management, School of Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Tezcan H, Tunçez A, Demir K, Altunkeser BB, Aygül N, Yalcin MU, Ates MS, Aydoğan C, Polat OC, Toprak AM. Effect of candesartan treatment on echocardiographic indices of cardiac remodeling in post-myocardial infarction patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:78-84. [PMID: 36629645 PMCID: PMC9937609 DOI: 10.1590/1806-9282.20220720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/17/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Myocardial infarction has unfavorable effect on structural and functional properties of the myocardium, referred to as cardiac remodeling. Left ventricular mass, left ventricular mass index, and relative wall thickness are important predictors of cardiac remodeling. In this study, we investigated the effect of candesartan treatment in comparison with zofenopril treatment on echocardiographic indices of cardiac remodeling in post myocardial infarction patients. MATERIAL AND METHODS In this prospective study, patients who underwent successful percutaneous coronary intervention were randomly assigned to a candesartan or zofenopril treatment. After randomization, echocardiographic indices of cardiac remodeling including left ventricular mass, left ventricular mass index, and relative wall thickness were evaluated before the start of treatment along with 1- and 6-month follow-ups. RESULTS According to our study, candesartan group showed significant reduction of estimated left ventricular mass and left ventricular mass index at 6-month follow-up visit compared to baseline values (199.53±38.51 g vs. 212.69±40.82 g; 99.05 g/m2 (90.00-116.5) vs. 106.0 g/m2 (96.0∼123.00), p<0.05, respectively). This trend was also observed in zofenopril group during the 6-month period (201.22±40.07 g vs. 207.52±41.61 g; 101.0 g/m2 (92.25-111.75.0) vs. 104.50 g/m2 (95.0∼116.75), p<0.05, respectively). Although both classes of drugs had favorable effects on post-myocardial infarction cardiac remodeling, the absolute benefit was more prominent in candesartan group as compared to zofenopril group (p<0.05). CONCLUSION Our results suggest that candesartan treatment following myocardial infarction may potentially be useful in terms of improving post-myocardial infarction cardiac remodeling.
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Affiliation(s)
- Hüseyin Tezcan
- Konya City Hospital, Department of Cardiology – Konya, Turkey.,Corresponding author:
| | - Abdullah Tunçez
- Selçuk Üniversitesi, Faculty of Medicine, Department of Cardiology – Konya, Turkey
| | - Kenan Demir
- Selçuk Üniversitesi, Faculty of Medicine, Department of Cardiology – Konya, Turkey
| | | | - Nazif Aygül
- Selçuk Üniversitesi, Faculty of Medicine, Department of Cardiology – Konya, Turkey
| | - Muhammed Ulvi Yalcin
- Selçuk Üniversitesi, Faculty of Medicine, Department of Cardiology – Konya, Turkey
| | | | - Canan Aydoğan
- Konya Numune Hastanesi, Department of Cardiology – Konya, Turkey
| | - Onur Can Polat
- Selçuk Üniversitesi, Faculty of Medicine, Department of Cardiology – Konya, Turkey
| | - Aslıhan Merve Toprak
- Selçuk Üniversitesi, Faculty of Medicine, Department of Cardiology – Konya, Turkey
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Shore S, O'Leary M, Kamdar N, Harrod M, Silveira MJ, Hummel SL, Nallamothu BK. Do Not Attempt Resuscitation Order Rates in Hospitalized Patients With Heart Failure, Acute Myocardial Infarction, Chronic Obstructive Pulmonary Disease, and Pneumonia. J Am Heart Assoc 2022; 11:e025730. [PMID: 36382963 PMCID: PMC9851455 DOI: 10.1161/jaha.122.025730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Descriptions of do not attempt resuscitation (DNAR) orders in heart failure (HF) are limited. We describe use of DNAR orders in HF hospitalizations relative to other common conditions, focusing on race. Methods and Results This was a retrospective study of all adult hospitalizations for HF, acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), and pneumonia from 2010 to 2016 using the California State Inpatient Dataset. Using a hierarchical multivariable logistic regression model with random effects for the hospital, we identified factors associated with DNAR orders for each condition. For racial variation, hospitals were divided into quintiles based on proportion of Black patients cared for. Our cohort comprised 399 816 HF, 190 802 AMI, 192 640 COPD, and 269 262 pneumonia hospitalizations. DNAR orders were most prevalent in HF (11.9%), followed by pneumonia (11.1%), COPD (7.9%), and AMI (7.1%). Prevalence of DNAR orders did not change from 2010 to 2016 for each condition. For all conditions, DNAR orders were more common in elderly people, women, and White people with significant site-level variation across 472 hospitals. For HF and COPD, hospitalizations at sites that cared for a higher proportion of Black patients were less likely associated with DNAR orders. For AMI and pneumonia, conditions such as dementia and malignancy were strongly associated with DNAR orders. Conclusions DNAR orders were present in 12% of HF hospitalizations, similar to pneumonia but higher than AMI and COPD. For HF, we noted significant variability across sites when stratified by proportion of Black patients cared for, suggesting geographic and racial differences in end-of-life care.
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Affiliation(s)
- Supriya Shore
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Michael O'Leary
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Neil Kamdar
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
| | - Maria J. Silveira
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Veterans Affairs Geriatric Research Education and Clinical CenterAnn ArborMI
| | - Scott L. Hummel
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI,Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
| | - Brahmajee K. Nallamothu
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI,Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
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Heart to Heart Nurses Podcast Series. J Cardiovasc Nurs 2022; 37:403-404. [DOI: 10.1097/jcn.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Cardiac remodelling is characterized by abnormal changes in the function and morphological properties such as diameter, mass, normal diameter of cavities, heart shape, fibrosis, thickening of vessels and heart layers, cardiomyopathy, infiltration of inflammatory cells, and some others. These damages are associated with damage to systolic and diastolic abnormalities, damage to ventricular function, and vascular remodelling, which may lead to heart failure and death. Exposure of the heart to radiation or anti-cancer drugs including chemotherapy drugs such as doxorubicin, receptor tyrosine kinase inhibitors (RTKIs) such as imatinib, and immune checkpoint inhibitors (ICIs) can induce several abnormal changes in the heart structure and function through the induction of inflammation and fibrosis, vascular remodelling, hypertrophy, and some others. This review aims to explain the basic mechanisms behind cardiac remodelling following cancer therapy by different anti-cancer modalities.
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10
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Integrating Heart Failure Palliative Care Delivery in an Uncertain Disease Trajectory. Heart Lung Circ 2022; 31:755-756. [PMID: 35589205 DOI: 10.1016/j.hlc.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cao Y, Dong Z, Yang D, Ma X, Wang X. LSD1 regulates the expressions of core cardiogenic transcription factors and cardiac genes in oxygen and glucose deprivation injured mice fibroblasts in vitro. Exp Cell Res 2022; 418:113228. [PMID: 35688282 DOI: 10.1016/j.yexcr.2022.113228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Cardiac reprogramming has emerged as a novel therapeutic approach to regenerating the damaged heart by directly converting endogenous cardiac fibroblasts (CFs) into induced cardiomyocytes (iCMs). Cardiac reprogramming requires the activation of the cardiogenic transcriptional program in concert with the repression of the fibroblastic transcriptional program. Lysine-specific demethylase 1 (LSD1) plays an instrumental role in many physiological processes such as cell growth, differentiation and metabolism. The epigenetic modifications of histones are essential for the accurate expression of genes in cardiomyocytes and the normal functioning of the heart. However, the effect of LSD1 in regulating the cardiogenic transcriptional program under myocardial ischemia/reperfusion (I/R) injury remains unclear. Thus, mice I/R injury was induced by 4 and 24 h reperfusion after 1-h occlusion of the left anterior descending coronary artery. The primary CFs and CMs were exposed under oxygen and glucose deprivation (OGD) to mimic I/R injury. The expression of LSD1 significantly decreased in I/R injured heart tissue and OGD-injured primary CFs and CM, and methylated histone presented a notable increase in OGD-injured primary CFs. Overexpression of LSD1 inhibited the injury of primary CFs induced by OGD, but showed limited inhibition on injured primary CMs. Under the OGD condition, LSD1 overexpression significantly increased cell viability, decreased cell apoptosis and reactive oxygen species (ROS) production of primary CFs. The expression of core cardiogenic transcription factors and cardiac genes were significantly decreased in OGD injured primary CFs, whereas LSD1 overexpression reversed the decrease of transcription factors and cardiac genes under the OGD condition. In conclusion, the overexpression of LSD1 has a protective role in I/R injury by inhibiting the histone methylation of primary CFs and regulates the expressions of core cardiogenic transcription factors and cardiac genes, which can prove to be a potential approach for direct cardiac reprogramming.
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Affiliation(s)
- Yiqiu Cao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China; Department of Cardiac Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, People's Republic of China; Department of Cardiovascular Surgery, People's Liberation Army General Hospital of Southern Theater Command, Guangzhou, 510170, People's Republic of China
| | - Zhu Dong
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China; Department of Cardiovascular Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People's Republic of China
| | - Dongpeng Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China; Department of Cardiovascular Surgery, Guangzhou Red Cross Hospital, Jinan University, 510235, People's Republic of China
| | - Ximiao Ma
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China; Department of Cardiothoracic Surgery, Haikou People's Hospital, Haikou, 570208, People's Republic of China
| | - Xiaowu Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China; Department of Cardiovascular Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People's Republic of China; Department of Cardiovascular Surgery, People's Liberation Army General Hospital of Southern Theater Command, Guangzhou, 510170, People's Republic of China.
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Warner V, Nguyen D, Bayles T, Hopper I. Management of heart failure in older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria Warner
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
| | - David Nguyen
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
| | - Timothy Bayles
- Health of Older Persons Department Alfred Health Melbourne Australia
| | - Ingrid Hopper
- Alfred Heart Centre Alfred Hospital Melbourne Australia
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
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13
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Dos Santos PB, Simões RP, Goulart CL, Arêas GPT, Marinho RS, Camargo PF, Roscani MG, Arbex RF, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Responses to incremental exercise and the impact of the coexistence of HF and COPD on exercise capacity: a follow-up study. Sci Rep 2022; 12:1592. [PMID: 35102201 PMCID: PMC8803920 DOI: 10.1038/s41598-022-05503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Our aim was to evaluate: (1) the prevalence of coexistence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the studied patients; (2) the impact of HF + COPD on exercise performance and contrasting exercise responses in patients with only a diagnosis of HF or COPD; and (3) the relationship between clinical characteristics and measures of cardiorespiratory fitness; (4) verify the occurrence of cardiopulmonary events in the follow-up period of up to 24 months years. The current study included 124 patients (HF: 46, COPD: 53 and HF + COPD: 25) that performed advanced pulmonary function tests, echocardiography, analysis of body composition by bioimpedance and symptom-limited incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Key CPET variables were calculated for all patients as previously described. The [Formula: see text]E/[Formula: see text]CO2 slope was obtained through linear regression analysis. Additionally, the linear relationship between oxygen uptake and the log transformation of [Formula: see text]E (OUES) was calculated using the following equation: [Formula: see text]O2 = a log [Formula: see text]E + b, with the constant 'a' referring to the rate of increase of [Formula: see text]O2. Circulatory power (CP) was obtained through the product of peak [Formula: see text]O2 and peak systolic blood pressure and Ventilatory Power (VP) was calculated by dividing peak systolic blood pressure by the [Formula: see text]E/[Formula: see text]CO2 slope. After the CPET, all patients were contacted by telephone every 6 months (6, 12, 18, 24) and questioned about exacerbations, hospitalizations for cardiopulmonary causes and death. We found a 20% prevalence of HF + COPD overlap in the studied patients. The COPD and HF + COPD groups were older (HF: 60 ± 8, COPD: 65 ± 7, HF + COPD: 68 ± 7). In relation to cardiac function, as expected, patients with COPD presented preserved ejection fraction (HF: 40 ± 7, COPD: 70 ± 8, HF + COPD: 38 ± 8) while in the HF and HF + COPD demonstrated similar levels of systolic dysfunction. The COPD and HF + COPD patients showed evidence of an obstructive ventilatory disorder confirmed by the value of %FEV1 (HF: 84 ± 20, COPD: 54 ± 21, HF + COPD: 65 ± 25). Patients with HF + COPD demonstrated a lower work rate (WR), peak oxygen uptake ([Formula: see text]O2), rate pressure product (RPP), CP and VP compared to those only diagnosed with HF and COPD. In addition, significant correlations were observed between lean mass and peak [Formula: see text]O2 (r: 0.56 p < 0.001), OUES (r: 0.42 p < 0.001), and O2 pulse (r: 0.58 p < 0.001), lung diffusing factor for carbon monoxide (DLCO) and WR (r: 0.51 p < 0.001), DLCO and VP (r: 0.40 p: 0.002), forced expiratory volume in first second (FEV1) and peak [Formula: see text]O2 (r: 0.52; p < 0.001), and FEV1 and WR (r: 0.62; p < 0.001). There were no significant differences in the occurrence of events and deaths contrasting both groups. The coexistence of HF + COPD induces greater impairment on exercise performance when compared to patients without overlapping diseases, however the overlap of the two diseases did not increase the probability of the occurrence of cardiopulmonary events and deaths when compared to groups with isolated diseases in the period studied. CPET provides important information to guide effective strategies for these patients with the goal of improving exercise performance and functional capacity. Moreover, given our findings related to pulmonary function, body composition and exercise responses, evidenced that the lean mass, FEV1 and DLCO influence important responses to exercise.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
- Sciences of Motricity Institute, Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, MG, Brazil
| | - Cássia L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | | | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Patrícia F Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Claudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil.
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Safiullina AA, Uskach TM, Dobrovolskaya. SV, Saidova MA, Zhirov IV, Tereshchenko SN. Myocardial remodeling in patients with chronic heart failure and implanted cardiac contractility modulators. TERAPEVT ARKH 2022; 93:1443-1450. [DOI: 10.26442/00403660.2021.12.201218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
Abstract
Aim. To study the effect of cardiac contractility modulation on reverse remodeling and myocardial function in patients with chronic heart failure (HF) according to echocardiography (EchoCG).
Materials and methods. In a group of 40 patients with a combination of chronic HF and atrial fibrillation (AF), the dynamics of standard EchoCG parameters and the effectiveness of myocardial work of the left ventricle (LV) against the background of 12-month therapy of cardiac contractility modulation (CCM) were analyzed.
Results. The results obtained indicate a statistically significant positive effect of CCM on LV remodeling parameters and the effectiveness of myocardial work according to EchoCG.
Conclusion. Transthoracic echocardiography is the main imaging method and provides great opportunities for evaluating the effectiveness of HF treatment, including non-drug methods such as CCM. Evaluation of LV myocardial function in patients with HF and implanted CCM devices is a promising scientific and practical research method.
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Templeton EM, Lassé M, Kleffmann T, Ellmers LJ, Palmer SC, Davidson T, Scott NJA, Pickering JW, Charles CJ, Endre ZH, Cameron VA, Richards AM, Rademaker MT, Pilbrow AP. Identifying Candidate Protein Markers of Acute Kidney Injury in Acute Decompensated Heart Failure. Int J Mol Sci 2022; 23:ijms23021009. [PMID: 35055195 PMCID: PMC8778509 DOI: 10.3390/ijms23021009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/15/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
One-quarter of patients with acute decompensated heart failure (ADHF) experience acute kidney injury (AKI)—an abrupt reduction or loss of kidney function associated with increased long-term mortality. There is a critical need to identify early and real-time markers of AKI in ADHF; however, to date, no protein biomarkers have exhibited sufficient diagnostic or prognostic performance for widespread clinical uptake. We aimed to identify novel protein biomarkers of AKI associated with ADHF by quantifying changes in protein abundance in the kidneys that occur during ADHF development and recovery in an ovine model. Relative quantitative protein profiling was performed using sequential window acquisition of all theoretical fragment ion spectra–mass spectrometry (SWATH–MS) in kidney cortices from control sheep (n = 5), sheep with established rapid-pacing-induced ADHF (n = 8), and sheep after ~4 weeks recovery from ADHF (n = 7). Of the 790 proteins quantified, we identified 17 candidate kidney injury markers in ADHF, 1 potential kidney marker of ADHF recovery, and 2 potential markers of long-term renal impairment (differential abundance between groups of 1.2–2.6-fold, adjusted p < 0.05). Among these 20 candidate protein markers of kidney injury were 6 candidates supported by existing evidence and 14 novel candidates not previously implicated in AKI. Proteins of differential abundance were enriched in pro-inflammatory signalling pathways: glycoprotein VI (activated during ADHF development; adjusted p < 0.01) and acute phase response (repressed during recovery from ADHF; adjusted p < 0.01). New biomarkers for the early detection of AKI in ADHF may help us to evaluate effective treatment strategies to prevent mortality and improve outcomes for patients.
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Affiliation(s)
- Evelyn M. Templeton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
- Correspondence: ; Tel.: +64-03-364-12-53
| | - Moritz Lassé
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Torsten Kleffmann
- Research Infrastructure Centre, Division of Health Sciences, University of Otago, Dunedin 9016, New Zealand;
| | - Leigh J. Ellmers
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Suetonia C. Palmer
- Department of Medicine, University of Otago, Christchurch 8014, New Zealand;
| | - Trent Davidson
- Department of Anatomical Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia;
| | - Nicola J. A. Scott
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - John W. Pickering
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Christopher J. Charles
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Zoltan H. Endre
- Department of Nephrology, Prince of Wales Hospital, Sydney, NSW 2031, Australia;
| | - Vicky A. Cameron
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - A. Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
- Cardiovascular Research Institute, Department of Cardiology, National University of Singapore, Singapore 119077, Singapore
| | - Miriam T. Rademaker
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Anna P. Pilbrow
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
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Singh VP, Pinnamaneni JP, Pugazenthi A, Sanagasetti D, Mathison M, Martin JF, Yang J, Rosengart TK. Hippo Pathway Effector Tead1 Induces Cardiac Fibroblast to Cardiomyocyte Reprogramming. J Am Heart Assoc 2021; 10:e022659. [PMID: 34889103 PMCID: PMC9075224 DOI: 10.1161/jaha.121.022659] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The conversion of fibroblasts into induced cardiomyocytes may regenerate myocardial tissue from cardiac scar through in situ cell transdifferentiation. The efficiency transdifferentiation is low, especially for human cells. We explored the leveraging of Hippo pathway intermediates to enhance induced cardiomyocyte generation. Methods and Results We screened Hippo effectors Yap (yes‐associated protein), Taz (transcriptional activator binding domain), and Tead1 (TEA domain transcription factor 1; Td) for their reprogramming efficacy with cardio‐differentiating factors Gata4, Mef2C, and Tbx5 (GMT). Td induced nearly 3‐fold increased expression of cardiomyocyte marker cTnT (cardiac troponin T) by mouse embryonic and adult rat fibroblasts versus GMT administration alone (P<0.0001), while Yap and Taz failed to enhance cTnT expression. Serial substitution demonstrated that Td replacement of TBX5 induced the greatest cTnT expression enhancement and sarcomere organization in rat fibroblasts treated with all GMT substitutions (GMTd versus GMT: 17±1.2% versus 5.4±0.3%, P<0.0001). Cell contractility (beating) was seen in 6% of GMTd‐treated cells by 4 weeks after treatment, whereas no beating GMT‐treated cells were observed. Human cardiac fibroblasts likewise demonstrated increased cTnT expression with GMTd versus GMT treatment (7.5±0.3% versus 3.0±0.3%, P<0.01). Mechanistically, GMTd administration increased expression of the trimethylated lysine 4 of histone 3 (H3K4me3) mark at the promoter regions of cardio‐differentiation genes and mitochondrial biogenesis regulator genes in rat and human fibroblast, compared with GMT. Conclusions These data suggest that the Hippo pathway intermediate Tead1 is an important regulator of cardiac reprogramming that increases the efficiency of maturate induced cardiomyocytes generation and may be a vital component of human cardiodifferentiation strategies.
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Affiliation(s)
- Vivek P Singh
- Department of Surgery Baylor College of Medicine Houston TX
| | | | | | | | | | - James F Martin
- Department of Molecular Physiology and Biophysics Baylor College of Medicine Houston TX
| | - Jianchang Yang
- Department of Surgery Baylor College of Medicine Houston TX
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Curtis BR, Rollman BL, Belnap BH, Jeong K, Yu L, Harinstein ME, Kavalieratos D. Perceptions of Need for Palliative Care in Recently Hospitalized Patients With Systolic Heart Failure. J Pain Symptom Manage 2021; 62:1252-1261. [PMID: 34119619 PMCID: PMC8908441 DOI: 10.1016/j.jpainsymman.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT The symptom burden associated with heart failure (HF) remains high despite improvements in therapy and calls for the integration of palliative care into traditional HF care. Little is also known about how patients with HF perceive palliative care and patient-level characteristics associated with the need for palliative care, which could influence the utilization of palliative care in HF management. OBJECTIVES To identify characteristics of HF patients associated with perceived need for palliative care. METHODS We analyzed data from the Hopeful Heart Trial, which studied the efficacy of a collaborative care intervention for treating both systolic HF and depression. Palliative care preferences were collected during routine study follow-up. We assessed the association of perceived need for palliative care during study follow-up and baseline data on sociodemographics, clinical measures, and patient-centered outcomes. We then used descriptive statistics and logistic regression to analyze our data. RESULTS Participants were on average 64 years old, male, and reported severe HF symptoms and poor to below average quality of life (. Most had unfavorable impressions of palliative care, but many still perceived a need for palliative care. Factors associated with perceived need for palliative care included depression, non-white race, more severe HF symptoms, and lower mental & physical health-related quality of life. CONCLUSION HF patients' beliefs about palliative care may affect utilization of palliative care. Specific characteristics can help identify patients with HF who may benefit from palliative care involvement. Education targeted towards patients with selected attributes may help incorporate palliative care into HF management.
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Affiliation(s)
- Brett R Curtis
- School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania
| | - Bruce L Rollman
- School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania; Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania
| | - Bea Herbeck Belnap
- Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania
| | - Kwonho Jeong
- Center for Research on Health Care Data Center, University of Pittsburgh (K.J.), Pittsburgh, Pennsylvania
| | - Lan Yu
- Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center (M.E.H.), Pittsburgh, Pennsylvania
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University (D.K.), Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University (D.K.), Atlanta, Georgia.
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Chera HH, Al-Sadawi M, Michelakis N, Spinelli M. Optimizer Smart System for the treatment of chronic heart failure: Overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:505-512. [PMID: 34323128 DOI: 10.1080/17434440.2021.1923478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Heart failure (HF) is a major cause of morbidity and mortality throughout the world. Despite the significant progress in the prevention and treatment of HF, mortality rates still remain high. Device therapy for HF includes cardiac resynchronization therapy (CRT) and the use of an implantable cardioverter-defibrillator (ICD). Recently, a new device therapy for the treatment of HF became available, called cardiac contractility modulation (CCM). CCM is a new device therapy for patients with HF who do not qualify for CRT. It is implanted in a minimally invasive manner to improve the patient's morbidity. Optimizer Smart System is a new device that delivers CCM therapy.Areas covered: We review the function of the Optimizer Smart System, the data from the recent clinical trials, and discuss its efficacy and future projections in the treatment for HF.Expert opinion: CCM therapy provided with the Optimizer® Smart System is safe, feasible, and applicable to a wide range of patients with HF. To demonstrate the effectiveness of the Optimizer Smart System's use merits further large multicenter randomized controlled trials.
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Liu L, Lima JAC, Post WS, Szklo M. Associations of time-varying obesity and metabolic syndrome with risk of incident heart failure and its subtypes: Findings from the Multi-Ethnic Study of Atherosclerosis. Int J Cardiol 2021; 338:127-135. [PMID: 34089770 DOI: 10.1016/j.ijcard.2021.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most previous studies have examined associations between metabolic disorders measured at a single point in time and risk of heart failure (HF). However, there are many situations where the values of exposures vary over time before HF occurs. We aimed to examine the associations of time-varying obesity and metabolic syndrome (MetSyn) measured at multiple points in time with HF. METHODS A total of 6750 participants in the Multi-Ethnic Study of Atherosclerosis from 2000 were included in the study. Follow-up was completed through December 2015. MetSyn was defined using the American Heart Association criteria. Incident HF was diagnosed by clinical criteria. Subtypes HF (reduced ejection fraction (HFrEF) and preserved (HFpEF) were classified by left ventricular EF. RESULTS A total of 331 HF cases were identified during 82,609 person-years of observation. The incidence (95%CI) of total HF was 4.0 (3.4-4.4) per 1000 person-years. Of the total HF cases, 45.6% were HFrEF (n = 151), 40.8% HFpEF (n = 135), and 13.6% were unclassified HF subtypes (n = 45). After adjusting for key covariates, time-varying obesity (BMI ≥ 30 kg/m2) and MetSyn were significantly associated with HF, with a stronger association for HFpEF than for HFrEF. The corresponding hazards ratios (HR, 95%CI) were 1.97 (1.43-2.72) and 1.86 (1.43-2.42) for HFpEF, and 1.46 (1.07-1.98), and 1.39 (1.06-1.82) for HFrEF respectively. Time-varying large waist circumference was significantly associated with for HFpEF, but not with HFrEF. CONCLUSION Time-varying obesity and MetSyn were significantly associated with HF risk, with a stronger association with HFpEF than with HFrEF. Continued effort to control these risk factors is recommended.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, United States of America.
| | - Joao A C Lima
- Division of Cardiology of the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Wendy S Post
- Division of Cardiology of the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
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Kuzheleva EA, Garganeeva AA, Aleksandrenko VA, Fedyunina VA, Ogurkova ON. Growth differentiation factor 15 associations with clinical features of chronic heart failure with midrange ejection fraction and preserved ejection fraction depending on the history of myocardial infarction. ACTA ACUST UNITED AC 2021; 61:59-64. [PMID: 34112076 DOI: 10.18087/cardio.2021.5.n1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/18/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
Aim To analyze associations between levels of the inflammatory marker, growth differentiation factor 15 (GDF-15), and echocardiographic indexes in CHF patients with mid-range and preserved left ventricular ejection fraction (LV EF) depending on the history of myocardial infarction (MI).Material and methods This study included 34 CHF patients with preserved and mid-range LV EF after MI (group 1, n=19) and without a history of MI (group 2, n=15). Serum concentration of GDF-15 was measured with enzyme immunoassay (BioVendor, Czech Republic). Statistical analysis was performed with STATISTICA 10.0.Results Patients of the study groups were age-matched [62 (58;67) and 64 (60;70) years, p=0.2] but differed in the gender; group 1 consisted of men only (100 %) whereas in group 2, the proportion of men was 53.3 % (p=0.001). Median concentration of GDF-15 was 2385 (2274; 2632.5) and 1997 (1534;2691) pg/ml in groups 1 and 2, respectively (p=0.09). Patients without MI showed a moderate negative correlation between LV EF and GDF-15 concentration (r= - 0.51, p=0.050) and a pronounced correlation between GDF-15 and LV stroke volume (r= -0.722, p=0.002). For patients after MI, a correlation between the level of GDF-15 and the degree of systolic dysfunction was not found (р>0.05).Conclusion Blood concentration of the inflammatory marker, GDF-15, correlates with LV EF and stroke volume in CHF patients with preserved or mid-range LV EF and without a history of MI while no such correlations were observed for patients with a history of MI.
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Affiliation(s)
- E A Kuzheleva
- Research Institute for Cardiology, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - A A Garganeeva
- Research Institute for Cardiology, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - V A Aleksandrenko
- Research Institute for Cardiology, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - V A Fedyunina
- Research Institute for Cardiology, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - O N Ogurkova
- Research Institute for Cardiology, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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Teimourizad A, Rezapour A, Sadeghian S, Tajdini M. Cost-effectiveness of cardiac resynchronization therapy plus an implantable cardioverter-defibrillator in patients with heart failure: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:31. [PMID: 34020661 PMCID: PMC8139093 DOI: 10.1186/s12962-021-00285-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is an unusual heart function that causes reduction in cardiac or pulmonary output. Cardiac resynchronization therapy (CRT) is a mechanical device that helps to recover ventricular dysfunction by pacing the ventricles. This study planned to systematically review cost-effectiveness of CRT combined with an implantable cardioverter-defibrillator (ICD) versus ICD in patients with HF. METHODS We used five databases (NHS Economic Evaluation Database, Cochrane Library, Medline, PubMed, and Scopus) to systematically reviewed studies published in the English language on the cost-effectiveness of CRT with defibrillator (CRT-D) Vs. ICD in patients with HF over 2000 to 2020. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to assess the quality of the selected studies. RESULTS Five studies reporting the cost-effectiveness of CRT-D vs ICD were finally identified. The results revealed that time horizon, direct medical costs, type of model, discount rate, and sensitivity analysis obviously mentioned in almost all studies. All studies used quality-adjusted life years (QALYs) as an effectiveness measurement. The highest and the lowest Incremental cost-effectiveness ratio (ICER) were reported in the USA ($138,649per QALY) and the UK ($41,787per QALY), respectively. CONCLUSION Result of the study showed that CRT-D compared to ICD alone was the most cost-effective treatment in patients with HF.
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Affiliation(s)
- Abedin Teimourizad
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Gok Metin Z, Gulbahar M. The Prevalence of Complementary and Integrative Health Approach Use and Quality of Life Among Patients With Heart Failure: A Cross-sectional, Descriptive, and Comparative Study. Holist Nurs Pract 2021; 35:123-132. [PMID: 33853096 DOI: 10.1097/hnp.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the prevalence of complementary and integrative health approach (CIHA) use in patients with heart failure (HF) and compare quality of life (QoL) between CIHA users and nonusers. This was a cross-sectional, descriptive, and comparative study including 130 patients with HF in Turkey. The data were collected using the sociodemographic and CIHA information form and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The mean age was 64.51 ± 10.40 years. Furthermore, 26.1% of the participants had used at least one form of CIHA in the previous year. The most used CIHA was herbal therapies (94.2%). The total scores of the KCCQ were 47.70 ± 9.50 in the study, and a statistically significant difference was found in the total scores of the KCCQ between CIHA users and nonusers. The findings of this study revealed that more than a quartile of patients with HF used at least one form of CIHA. Further prospective studies are warranted to follow up with patients having HF who use any form of CIHA for a longer period and determine other parameters that directly influence QoL.
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Affiliation(s)
- Zehra Gok Metin
- Internal Medicine Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
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24
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Liu JL, Zhang XF, Liu Z, Li JM, Wen ZJ, Zhang M, Lin QH, Kou QY. The role of recombinant human brain natriuretic peptide on the cardiac output of patients with acute decompensated heart failure using Guyton venous return curve: A STROBE-compliant retrospective study. Medicine (Baltimore) 2021; 100:e25492. [PMID: 33907098 PMCID: PMC8084054 DOI: 10.1097/md.0000000000025492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT rbBNP has positive cardiac effects in patients with acute decompensated heart failure, but its effects on the systemic venous circulation are not known.A single-center retrospective, self-controlled study was conducted on 14 patients undergone recombinant human brain natriuretic peptide (rhBNP) treatment between January 1, 2015 to December 31, 2018.The cardiac output (CO) significantly increased from 3.75 ± 1.14 L min-1 to 4.24 ± 0.97 L min-1 30 minutes after rbBNP infusion, and to 4.20 ± 1.19 L min-1 3 hours later. The systemic vascular resistance significantly decreased from 18.85 ± 7.66 mm Hg min L-1 to 14.62 ± 6.13 mm Hg min L-1 30 minutes. The resistance to venous return (VR) significantly decreased from 5.93 ± 4.97 mm Hg min L-1 to 4.46 ± 1.53 mmHg min L-1 3 hours later. The mean systemic filling pressure significantly decreased from 32.71 ± 20.00 mm Hg to 28.254 ± 6.09 mm Hg 3 hours later.The role of rhBNP on CO was to reduce the peripheral circulation resistance at 30 minutes after rhBNP infusion and to reduce the resistance to VR at 3 hours later.This trial is registered at ChiCTR: ID ChiCTR1900024562.
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Affiliation(s)
- Jian ling Liu
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Xiao fei Zhang
- Department of Intensive Care Unit, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhi Liu
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Jie min Li
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Zhen jie Wen
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Ming Zhang
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Qin han Lin
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Qiu ye Kou
- Department of Intensive Care Unit, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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25
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Gupta M, Bell A, Padarath M, Ngui D, Ezekowitz J. Physician Perspectives on the Diagnosis and Management of Heart Failure With Preserved Ejection Fraction. CJC Open 2021; 3:361-366. [PMID: 33778453 PMCID: PMC7985003 DOI: 10.1016/j.cjco.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Heart failure (HF) with preserved ejection fraction (HFpEF) carries high morbidity and mortality. Compared with HF with reduced ejection fraction (HFrEF), HFpEF is difficult to diagnose, and lacks evidence-based treatments. In this survey we assessed perceptions of cardiologists, internists, and primary care physicians (PCPs) regarding HFpEF diagnosis and management. Methods In total, 159 cardiologists, 89 internists, and 200 PCPs from across Canada completed an online survey, with response rates of 14%-17%. Results The perceived prevalence of HFpEF vs HFrEF was similar across physician types (58% HFrEF, 42% HFpEF). Thirty-seven percent of PCPs did not differentiate HF on the basis of ejection fraction. All physician types ranked symptom and mortality reduction as treatment priorities. Ninety-two percent of specialists believed that HFpEF is best comanaged by PCPs and specialists, whereas one-fifth of PCPs suggested PCP management alone. Compared with specialists, PCPs were more likely to underestimate HFpEF mortality and less aware of sex differences in the prevalence of HFpEF vs HFrEF (all P < 0.001). Fewer PCPs use natriuretic peptides for diagnosis (P < 0.001). All physician types listed cost and availability as barriers to natriuretic peptide use. Ninety-one percent of PCPs incorrectly identified various therapies as effective for improving HFpEF outcomes. Most of all physicians expressed a strong desire to increase knowledge of diagnostic and treatment algorithms for HFpEF. Conclusions There are substantial knowledge gaps in the diagnosis and management of HFpEF, particularly among PCPs. Because of the prevalence of HFpEF in primary care, strategies are required to reduce these gaps.
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Affiliation(s)
- Milan Gupta
- McMaster University, Department of Medicine, Hamilton, Ontario, Canada.,Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Alan Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel Ngui
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Ezekowitz
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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26
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Horlock D, Kaye DM, Winbanks CE, Gao XM, Kiriazis H, Donner DG, Gregorevic P, McMullen JR, Bernardo BC. Old Drug, New Trick: Tilorone, a Broad-Spectrum Antiviral Drug as a Potential Anti-Fibrotic Therapeutic for the Diseased Heart. Pharmaceuticals (Basel) 2021; 14:ph14030263. [PMID: 33804032 PMCID: PMC7998193 DOI: 10.3390/ph14030263] [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: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiac fibrosis is associated with most forms of cardiovascular disease. No reliable therapies targeting cardiac fibrosis are available, thus identifying novel drugs that can resolve or prevent fibrosis is needed. Tilorone, an antiviral agent, can prevent fibrosis in a mouse model of lung disease. We investigated the anti-fibrotic effects of tilorone in human cardiac fibroblasts in vitro by performing a radioisotopic assay for [3H]-proline incorporation as a proxy for collagen synthesis. Exploratory studies in human cardiac fibroblasts treated with tilorone (10 µM) showed a significant reduction in transforming growth factor-β induced collagen synthesis compared to untreated fibroblasts. To determine if this finding could be recapitulated in vivo, mice with established pathological remodelling due to four weeks of transverse aortic constriction (TAC) were administered tilorone (50 mg/kg, i.p) or saline every third day for eight weeks. Treatment with tilorone was associated with attenuation of fibrosis (assessed by Masson's trichrome stain), a favourable cardiac gene expression profile and no further deterioration of cardiac systolic function determined by echocardiography compared to saline treated TAC mice. These data demonstrate that tilorone has anti-fibrotic actions in human cardiac fibroblasts and the adult mouse heart, and represents a potential novel therapy to treat fibrosis associated with heart failure.
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Affiliation(s)
- Duncan Horlock
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
| | - David M. Kaye
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
- Department of Medicine, Monash University, Clayton, VIC 3800, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC 3010, Australia
| | - Catherine E. Winbanks
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
| | - Xiao-Ming Gao
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Disease in Central Asia, Clinical Medical Research Institute of Xinjiang Medical University, Urumqi 830054, China
| | - Helen Kiriazis
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
- Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC 3010, Australia
| | - Daniel G. Donner
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
- Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC 3010, Australia
| | - Paul Gregorevic
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
- Centre for Muscle Research, Department of Physiology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Julie R. McMullen
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
- Department of Medicine, Monash University, Clayton, VIC 3800, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC 3010, Australia
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC 3800, Australia
- Department of Physiology, Monash University, Clayton, VIC 3800, Australia
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Bianca C. Bernardo
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (D.H.); (D.M.K.); (C.E.W.); (X.-M.G.); (H.K.); (D.G.D.); (P.G.); (J.R.M.)
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC 3800, Australia
- Department of Paediatrics, University of Melbourne, VIC 3010, Australia
- Correspondence: ; Tel.: +61-(0)3-8532-1167; Fax: +61-(0)3-8532-1100
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Mareev VY, Garganeeva AA, Ageev FT, Arutunov GP, Begrambekova YL, Belenkov YN, Vasyuk YA, Galyavich AS, Gilarevsky SR, Glezer MG, Drapkina OM, Duplyakov DV, Kobalava ZD, Koziolova NA, Kuzheleva EA, Mareev YV, Ovchinnikov AG, Orlova YA, Perepech NB, Sitnikova MY, Skvortsov AA, Skibitskiy VV, Chesnikova AI. [The use of diuretics in chronic heart failure. Position paper of the Russian Heart Failure Society]. ACTA ACUST UNITED AC 2021; 60:13-47. [PMID: 33522467 DOI: 10.18087/cardio.2020.12.n1427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
The document focuses on key issues of diuretic therapy in CHF from the standpoint of current views on the pathogenesis of edema syndrome, its diagnosis, and characteristics of using diuretics in various clinical situations.
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Affiliation(s)
- V Yu Mareev
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - A A Garganeeva
- "Research Institute for Cardiology", Siberian State Medical University, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - F T Ageev
- Scientific Medical Research Center of Cardiology, Russia
| | - G P Arutunov
- Russian National Research Medical University named after Pirogov, Moscow
| | - Yu L Begrambekova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - Yu N Belenkov
- Sechenov Moscow State Medical University, Moscow, Russia
| | - Yu A Vasyuk
- Moscow State Medical and Dental University named after Evdokimov, Moscow, Russia
| | | | - S R Gilarevsky
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - M G Glezer
- Sechenov Moscow State Medical University, Moscow, Russia
| | - O M Drapkina
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia
| | - D V Duplyakov
- Samara Regional Clinical Cardiological Dispensary, Russia
| | - Zh D Kobalava
- Russian State University of Peoples' Friendship, Moscow, Russia
| | - N A Koziolova
- Federal State Budgetary Institution of Healthcare of Higher Education "Perm State Medical University named after Academician E.A. Wagner ", Russia
| | - E A Kuzheleva
- "Research Institute for Cardiology", Siberian State Medical University, Tomsk National Research Medical Center, Russian Academy of Sciences, Russia
| | - Yu V Mareev
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia Robertson Centre for Biostatistics, Glasgow, Great Britain
| | | | - Ya A Orlova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | | | - M Yu Sitnikova
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - A A Skvortsov
- Scientific Medical Research Center of Cardiology, Russia
| | - V V Skibitskiy
- Kuban State Medical University" of the Ministry of Health of the Russian Federation, Russia
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28
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Liu J, Xu Z, Yang S, Du K, Zhang Y, Tan N, Sun X, Zhao H, Wang W. Efficacy and safety of Qishen granules for chronic heart failure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23901. [PMID: 33350788 PMCID: PMC7769332 DOI: 10.1097/md.0000000000023901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Qishen granules (QSG) is a famous traditional Chinese Medicine (TCM) formula used to treat chronic heart failure (CHF). The objective of this protocol is to clarify the efficacy and safety of QSG for treating CHF. METHODS Six databases will be electronically searched up to November 1, 2020 for randomized controlled trials (RCTs) in English and Chinese languages. Two independent reviewers will complete tasks of literature retrieval and data extraction. After that, the Cochrane Collaboration risk of bias tool will be utilized to assess methodological quality. The primary outcomes are left ventricular ejection fraction, left ventricular fractional shortening, and N-terminal B-type natriuretic peptide. The secondary outcomes consist of composite cardiac events, adverse effects, and quality of life. Meta-analysis will be performed using the Revman version 5.3. RESULTS This study will provide a high-quality synthesis of current evidence of QSG for CHF from primary and secondary outcomes. CONCLUSION This study will provide evidence for the effectiveness and safety of QSG in the treatment of CHF. PROSPERO REGISTRATION NUMBER CRD42020150442.
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Affiliation(s)
- Junjie Liu
- Nanjing Pukou Hospital of Traditional Chinese Medicine, Nanjing
| | - Zixuan Xu
- Nanjing Pukou Hospital of Traditional Chinese Medicine, Nanjing
| | - Shuangjie Yang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine
| | - Kangjia Du
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine
| | - Yili Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine
| | - Nannan Tan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine
| | - Xiaoli Sun
- School of Biomedicine, Beijing City University, Beijing, China
| | - Huihui Zhao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine
| | - Wei Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine
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Wan H, Huang T, Zhang H, Wu Q. Effects of Ivabradine on Cardiac Remodeling in Patients With Stable Symptomatic Heart Failure: A Systematic Review and Meta-analysis. Clin Ther 2020; 42:2289-2297.e0. [PMID: 33160681 DOI: 10.1016/j.clinthera.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/30/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Ivabradine reduces heart rate (HR) in patients with heart failure (HF). However, its effect on cardiac remodeling is not obvious. The goal of this study was to explore the extra effect of ivabradine on cardiac remodeling in patients with HF. METHODS We searched PubMed from database inception to January 31, 2020, Cochrane and Embase from database inception to February 2, 2020, and Web of Science and ClinicalTrials.gov from database inception to February 3, 2020, for randomized controlled trials on ivabradine treatments in patients with stable symptomatic HF, left ventricular ejection fraction (LVEF) < 45%, and resting HR ≥ 60 beats/min in sinus rhythm. We pooled the mean differences (MDs) or standardized mean differences and their 95% CIs. An inverse variance was used to combine data. Fixed- or random-effects models were used to outline the outcomes based on heterogeneity levels. We assessed the heterogeneity among studies according to the I2 statistic. A sensitivity analysis for select results was performed to assess the robustness of the outcomes. FINDINGS Of 2277 trials, 9 trials fulfilled the inclusion criteria. A total of 1523 patients were enrolled in 9 studies. There were 796 participants in the ivabradine group and 727 participants in the control group. The duration of follow-up ranged from 6 weeks to 19.6 months. The mean (SD) age of the participants was 59.7 (11.2) years, and 1187 participants (77.9%) were men. Therapy with ivabradine was related to reversing cardiac remodeling with a significant increase in LVEF (MD = 3.04%; 95% CI, 2.07%-4.00%; p < 0.001), decrease in the left ventricular end-systolic volume index (LVESVI) (MD = -7.30 mL/m2; 95% CI, -12.94 to -1.66 mL/m2; p = 0.01), and reduction in the left ventricular end-diastolic volume index (LVEDVI) (MD = -7.27 mL/m2; 95% CI, -14.04 to -0.50 mL/m2; p = 0.04). In the subgroup of enrolled patients with a resting HR of ≥70 beats/min, greater progress in LVEF was detected in the ivabradine group (MD = 3.60%; 95% CI, 2.40%-4.81%; p < 0.001), and a higher improvement in LVESVI was identified in the ivabradine group (MD = -11.06 mL/m2; 95% CI, -21.15 to -0.98 mL/m2; p = 0.03). IMPLICATIONS In patients with stable symptomatic HF, LVEF <45%, and resting HR ≥ 60 beats/min in sinus rhythm, ivabradine use was associated with reversing cardiac remodeling with a significant increase in LVEF, a decrease in LVESVI, and a reduction in LVEDVI.
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Affiliation(s)
- Hongbing Wan
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Tieqiu Huang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongzhou Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qinghua Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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30
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Soofi MA, Jafery Z, AlSamadi F. Impact of a Social Support Program Supervised by a Multidisciplinary Team on Psychosocial Distress and Knowledge About Heart Failure Among Heart Failure Patients. J Saudi Heart Assoc 2020; 32:456-463. [PMID: 33299791 PMCID: PMC7721446 DOI: 10.37616/2212-5043.1046] [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: 05/02/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022] Open
Abstract
Background Heart failure drains significant financial resources with morbidity and mortality higher than cancer. Social support is defined as the care provided by the family members, friends and health care workers to the patients. Absence of social support and poor perceived social support will create stress, anxiety, depression and anger which further deteriorate the underlying disease and worsen quality of life. Discussion in group creates better understanding of the disease which helps the patients improving their skills in managing their condition. Objective To evaluate the impact of multidisciplinary team supervised social support program on components of psychosocial distress and knowledge about heart failure among heart failure patients. Methods Adult patients with heart failure attending King Fahad Medical City as inpatient or outpatient were enrolled in this prospective cohort study. Patients were given questionnaire to assess their perception of social support they have at their disposal, quality of life, knowledge regarding heart failure and self-care behavior. They then had interactive education in groups supervised by multidisciplinary team members about the pathogenesis of their disease with management strategies, dietary restriction, importance of exercise and healthy life style pattern. Patients shared their experiences in the group and had opportunity to learn from each other. Patients were assessed regarding their perceived social support, quality of life, knowledge regarding heart failure and self-care behavior immediately after the session and at 1 month interval. Results There were total 500 patients participated in the study. Among the study participants 62% were male and majority was living with the family. Components of psychosocial distress were present in up to 40% of study participants and only 36% considered knowledgeable regarding heart failure. After the interactive social support group meeting components of psychosocial distress were significantly reduced with significant improvement in knowledge about heart failure. At 1 month follow up participants reported persistent improvement in quality of life, improvement in self-care behavior, perceived social support and wanted to continue in social group program. Conclusion Social support program supervised by multidisciplinary team providing education and social support improved knowledge, self-care behavior, perceived social support and quality of life among heart failure patients.
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Affiliation(s)
| | - Zainab Jafery
- Adult Cardiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal AlSamadi
- Adult Cardiology, King Fahad Medical City, Riyadh, Saudi Arabia
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31
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Zhou R, Wang L, Zhao G, Chen D, Song X, Momtazi-Borojeni AA, Yuan H. Circulating exosomal microRNAs as emerging non-invasive clinical biomarkers in heart failure: Mega bio-roles of a nano bio-particle. IUBMB Life 2020; 72:2546-2562. [PMID: 33053610 DOI: 10.1002/iub.2396] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/22/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022]
Abstract
Exosomes are nano-sized extracellular vesicles containing a cell-specific biologically active cargo of proteins and genetic materials. Exosomes are constitutively released from almost all cell-types and affect neighboring or distant cells through a complex intercellular exchange of the genetic information and/or regulation of certain gene expressions that change the function and behavior of recipient cells. Those released into body fluids are the major mediators of intercellular communications. The success of the biological functions of exosomes is highly mediated by the effective transfer of microRNAs (miRs). Exosomes secreted by a damaged or diseased heart can exhibit alterations in the miRs' profile that may reflect the cellular origin and (patho)physiological state, as a "signature" or "fingerprint" of the donor cell. It has been shown that the transportation of cardiac-specific miRs in exosomes can be rapidly detected and measured, holding great potential as biomarkers in heart diseases. Currently, the search for new biomarkers of heart diseases remains a large and increasing enterprise. Notably, circulating exosomal miRs (Exo-miRs) have successfully gained huge interests for their diagnostic and prognostic potentials. The present review highlights circulating Exo-miRs explored for diagnosis/prognosis and outcome prediction in patients with heart failure (HF). To this end, we explain the feasibility of exosomes as clinical biomarkers, discuss the priority of circulating Exo-miRs over non-exosomal ones as a biomarker, and then outline reported circulating Exo-miRs having the biomarker function in HF patients, together with their mechanism of action. In conclusion, circulating Exo-miRs represent emerging diagnostic (Exo-miR-92b-5p, Exo-miR-146a, Exo-miR-181c, and Exo-miR-495) and prognostic (Exo-miR-192, Exo-miR-194, Exo-miR-34a, Exo-miR-425, Exo-miR-744) biomarkers for HF.
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Affiliation(s)
- Runfa Zhou
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Leiyan Wang
- Clinical Skill Training Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Gang Zhao
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dan Chen
- Department of Cardiology Electrocardiogram Room, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoning Song
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Amir A Momtazi-Borojeni
- Department of Medical Biotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Haitao Yuan
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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32
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Edelson JB, Genuardi MV, Santangeli P, Birati EY. Cardiac Contractility Monitoring: an Important Therapy in the Treatment of Advanced Heart Failure. Curr Cardiol Rep 2020; 22:81. [DOI: 10.1007/s11886-020-01330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33
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Liu R, Jagannathan R, Sun L, Li F, Yang P, Lee J, Negi V, Perez-Garcia EM, Shiva S, Yechoor VK, Moulik M. Tead1 is essential for mitochondrial function in cardiomyocytes. Am J Physiol Heart Circ Physiol 2020; 319:H89-H99. [PMID: 32502376 DOI: 10.1152/ajpheart.00732.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mitochondrial dysfunction occurs in most forms of heart failure. We have previously reported that Tead1, the transcriptional effector of Hippo pathway, is critical for maintaining adult cardiomyocyte function, and its deletion in adult heart results in lethal acute dilated cardiomyopathy. Growing lines of evidence indicate that Hippo pathway plays a role in regulating mitochondrial function, although its role in cardiomyocytes is unknown. Here, we show that Tead1 plays a critical role in regulating mitochondrial OXPHOS in cardiomyocytes. Assessment of mitochondrial bioenergetics in isolated mitochondria from adult hearts showed that loss of Tead1 led to a significant decrease in respiratory rates, with both palmitoylcarnitine and pyruvate/malate substrates, and was associated with reduced electron transport chain complex I activity and expression. Transcriptomic analysis from Tead1-knockout myocardium revealed genes encoding oxidative phosphorylation, TCA cycle, and fatty acid oxidation proteins as the top differentially enriched gene sets. Ex vivo loss of function of Tead1 in primary cardiomyocytes also showed diminished aerobic respiration and maximal mitochondrial oxygen consumption capacity, demonstrating that Tead1 regulation of OXPHOS in cardiomyocytes is cell autonomous. Taken together, our data demonstrate that Tead1 is a crucial transcriptional node that is a cell-autonomous regulator, a large network of mitochondrial function and biogenesis related genes essential for maintaining mitochondrial function and adult cardiomyocyte homeostasis.NEW & NOTEWORTHY Mitochondrial dysfunction constitutes an important aspect of heart failure etiopathogenesis and progression. However, the molecular mechanisms are still largely unknown. Growing lines of evidence indicate that Hippo-Tead pathway plays a role in cellular bioenergetics. This study reveals the novel role of Tead1, the downstream transcriptional effector of Hippo pathway, as a novel regulator of mitochondrial oxidative phosphorylation and in vivo cardiomyocyte energy metabolism, thus providing a potential therapeutic target for modulating mitochondrial function and enhancing cytoprotection of cardiomyocytes.
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Affiliation(s)
- Ruya Liu
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajaganapathi Jagannathan
- Division of Cardiology, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart, Lung, and Vascular Medicine Institute, Pittsburgh, Pennsylvania
| | - Lingfei Sun
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Feng Li
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ping Yang
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeongkyung Lee
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vinny Negi
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eliana M Perez-Garcia
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sruti Shiva
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart, Lung, and Vascular Medicine Institute, Pittsburgh, Pennsylvania
| | - Vijay K Yechoor
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mousumi Moulik
- Division of Cardiology, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart, Lung, and Vascular Medicine Institute, Pittsburgh, Pennsylvania
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Ghasemi M, Arab M, Mangolian Shahrbabaki P. Relationship Between Caregiver Burden and Family Functioning in Family Caregivers of Older Adults With Heart Failure. J Gerontol Nurs 2020; 46:25-33. [PMID: 32453437 DOI: 10.3928/00989134-20200511-04] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/16/2020] [Indexed: 11/20/2022]
Abstract
Caregivers of individuals with heart failure are at high risk for diminished quality of life because of the energy involved in providing necessary care. Caring for someone with chronic heart failure can affect caregivers' physical, psychological, and social health, collectively referred to as the burden of care, and may also affect family functioning. The current cross-sectional study aimed to investigate the relationship between caregiver burden and family functioning in caregivers of older adults with heart failure in southeastern Iran using the Zarit Burden Inventory and the Family Assessment Device based on the McMaster Model of Family Functioning. The Pearson correlation coefficient, independent t test, and analysis of variance were used to determine relationships among variables. Results showed a significant correlation between burden of care and total score of family functioning. Therefore, it is necessary to take measures to reduce burden of care for caregivers through education and support programs and to improve their family functioning and quality of life. [Journal of Gerontological Nursing, 46(6), 25-33.].
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Healthcare Providers' Perceived Communication Barriers to Offering Palliative Care to Patients With Heart Failure: An Integrative Review. J Cardiovasc Nurs 2020; 34:E9-E18. [PMID: 30543546 DOI: 10.1097/jcn.0000000000000556] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Heart failure is a chronic complex syndrome that is common and burdensome. International clinical practice guidelines recommend that healthcare providers communicate palliative care options with patients with heart failure. OBJECTIVES The aim of this study was to conduct an integrative review to evaluate how healthcare providers perceived communication barriers to offering information to individuals in the palliative phase of heart failure. METHODS Four databases and the gray literature were searched from January 1987 to February 2017. Inclusion and exclusion criteria were applied. Studies were graded for strength and quality using a critical appraisal tool, and key themes were extracted and synthesized. RESULTS Ten articles met the full inclusion criteria. Most studies were qualitative or nonexperimental studies of good quality. Authors of several studies found that healthcare providers lacked basic knowledge about palliative care or did not possess sufficient knowledge to effectively provide care. Poor knowledge of palliative care created a barrier between the provider and the patient. Inadequate education or inexperience in palliative care led to the resistance of health providers to implementing a palliative approach. CONCLUSIONS The results of this review emphasize a lack of knowledge as a barrier to delivering palliative care. Healthcare providers caring for individuals with heart failure need palliative care knowledge, skills, and competencies to ensure that this vulnerable population receives holistic patient-centered care.
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Roch C, Palzer J, Zetzl T, Störk S, Frantz S, van Oorschot B. Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure. Eur J Cardiovasc Nurs 2020; 19:702-710. [PMID: 32370552 DOI: 10.1177/1474515120919386] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM The aim of this study was to evaluate the suitability and comprehensibility of the integrated palliative care outcome scale for the evaluation of palliative care needs in patients with heart failure. METHODS AND RESULTS This cross-sectional study investigated 100 heart failure patients (40 women, 60 men; median age 79 years) within the first few days of their hospitalisation by applying the integrated palliative care outcome scale (3-day recall period) and two additional self-developed questions about the suitability and comprehensibility of the integrated palliative care outcome scale. Clinically relevant somatic and psycho-emotional symptoms were reported very frequently (approximately 75% each), followed by communicational needs or practical issues. Ninety-five per cent of patients thought the integrated palliative care outcome scale very easy to understand, and 91% judged the integrated palliative care outcome scale suitable to assess palliative care needs. CONCLUSION The integrated palliative care outcome scale was well accepted by hospitalised patients with heart failure and identified a high burden of both physical and psycho-emotional symptoms. Screening for palliative care has to consider patients and their relatives alike, and should be part of a comprehensive care concept jointly integrated into clinical routine by primary and specialised palliative care teams.
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Affiliation(s)
- Carmen Roch
- Interdisciplinary Center for Palliative Medicine, University Hospital Würzburg, Germany
| | - Johanna Palzer
- Interdisciplinary Center for Palliative Medicine, University Hospital Würzburg, Germany
| | - Teresa Zetzl
- Interdisciplinary Center for Palliative Medicine, University Hospital Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, University Hospital Würzburg, Germany
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Martelli A, Testai L, Colletti A, Cicero AFG. Coenzyme Q 10: Clinical Applications in Cardiovascular Diseases. Antioxidants (Basel) 2020; 9:antiox9040341. [PMID: 32331285 PMCID: PMC7222396 DOI: 10.3390/antiox9040341] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
Coenzyme Q10 (CoQ10) is a ubiquitous factor present in cell membranes and mitochondria, both in its reduced (ubiquinol) and oxidized (ubiquinone) forms. Its levels are high in organs with high metabolism such as the heart, kidneys, and liver because it acts as an energy transfer molecule but could be reduced by aging, genetic factors, drugs (e.g., statins), cardiovascular (CV) diseases, degenerative muscle disorders, and neurodegenerative diseases. As CoQ10 is endowed with significant antioxidant and anti-inflammatory features, useful to prevent free radical-induced damage and inflammatory signaling pathway activation, its depletion results in exacerbation of inflammatory processes. Therefore, exogenous CoQ10 supplementation might be useful as an adjuvant in the treatment of cardiovascular diseases such as heart failure, atrial fibrillation, and myocardial infarction and in associated risk factors such as hypertension, insulin resistance, dyslipidemias, and obesity. This review aims to summarize the current evidences on the use of CoQ10 supplementation as a therapeutic approach in cardiovascular diseases through the analysis of its clinical impact on patients' health and quality of life. A substantial reduction of inflammatory and oxidative stress markers has been observed in several randomized clinical trials (RCTs) focused on several of the abovementioned diseases, even if more RCTs, involving a larger number of patients, will be necessary to strengthen these interesting findings.
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Affiliation(s)
- Alma Martelli
- Department of Pharmacy, University of Pisa, 56120 Pisa, Italy; (A.M.); (L.T.)
- Interdepartmental Research Centre “Nutraceuticals and Food for Health (NUTRAFOOD)”, University of Pisa, 56120 Pisa, Italy
- Interdepartmental Research Centre of Ageing, Biology and Pathology, University of Pisa, 56120 Pisa, Italy
| | - Lara Testai
- Department of Pharmacy, University of Pisa, 56120 Pisa, Italy; (A.M.); (L.T.)
- Interdepartmental Research Centre “Nutraceuticals and Food for Health (NUTRAFOOD)”, University of Pisa, 56120 Pisa, Italy
- Interdepartmental Research Centre of Ageing, Biology and Pathology, University of Pisa, 56120 Pisa, Italy
| | - Alessandro Colletti
- Department of Science and Drug Technology, University of Turin, 10125 Turin, Italy;
- Italian Nutraceutical Society (SINut), Via Guelfa 9, 40138 Bologna, Italy
| | - Arrigo F. G. Cicero
- Italian Nutraceutical Society (SINut), Via Guelfa 9, 40138 Bologna, Italy
- Medical and Surgical Sciences Department, University of Bologna, 40126 Bologna, Italy
- Correspondence: ; Tel.: +39-512142224
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Liu J, Yang S, Wang W, Zhang Y, Wang Q, Sun X, Tan N, Du K, Wang Y, Zhao H. Use of Qishen granule for the treatment of heart failure: A systematic review and meta-analysis of animal studies. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2020. [DOI: 10.1016/j.jtcms.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nutraceutical support in heart failure: a position paper of the International Lipid Expert Panel (ILEP). Nutr Res Rev 2020; 33:155-179. [PMID: 32172721 DOI: 10.1017/s0954422420000049] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) is a complex clinical syndrome that represents a major cause of morbidity and mortality in Western countries. Several nutraceuticals have shown interesting clinical results in HF prevention as well as in the treatment of the early stages of the disease, alone or in combination with pharmacological therapy. The aim of the present expert opinion position paper is to summarise the available clinical evidence on the role of phytochemicals in HF prevention and/or treatment that might be considered in those patients not treated optimally as well as in those with low therapy adherence. The level of evidence and the strength of recommendation of particular HF treatment options were weighed up and graded according to predefined scales. A systematic search strategy was developed to identify trials in PubMed (January 1970 to June 2019). The terms 'nutraceuticals', 'dietary supplements', 'herbal drug' and 'heart failure' or 'left verntricular dysfunction' were used in the literature search. The experts discussed and agreed on the recommendation levels. Available clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, l-carnitine, d-ribose, carnosine, vitamin D, probiotics, n-3 PUFA and beet nitrates) might be associated with improvements in self-perceived quality of life and/or functional parameters such as left ventricular ejection fraction, stroke volume and cardiac output in HF patients, with minimal or no side effects. Those benefits tended to be greater in earlier HF stages. Available clinical evidence supports the usefulness of supplementation with some nutraceuticals to improve HF management in addition to evidence-based pharmacological therapy.
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Gao K, Zhang J, Gao P, Wang Q, Liu Y, Liu J, Zhang Y, Li Y, Chang H, Ren P, Liu J, Wang Y, Wang W. Qishen granules exerts cardioprotective effects on rats with heart failure via regulating fatty acid and glucose metabolism. Chin Med 2020; 15:21. [PMID: 32158496 PMCID: PMC7055086 DOI: 10.1186/s13020-020-0299-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/05/2020] [Indexed: 12/29/2022] Open
Abstract
Background Qishen granules (QSG) has been applied to treat heart failure (HF) for decades. Our previous transcriptomics study has suggested that Qishen granules (QSG) could regulate the pathways of cardiac energy metabolism in HF, but the specific regulatory mechanism has not yet been clarified. This study was to investigate the potential mechanism of QSG in regulating myocardial fatty acid (FA) and glucose metabolism in a rat model of HF. Methods The model of HF was induced by left anterior descending coronary artery ligation. Cardiac structure and function were assessed by cine magnetic resonance imaging (MRI) and echocardiography. Level of glucose metabolism was non-invasively evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT). Blood lipid levels were determined by enzymatic analysis. The mitochondrial ultrastructure was observed with a transmission electron microscope. The critical proteins related to FA metabolism, glucose metabolism and mitochondrial function were measured by western blotting. The ANOVA followed by a Fisher’s LSD test was used for within-group comparisons. Results QSG ameliorated cardiac functions and attenuated myocardial remodeling in HF model. The levels of serum TC, TG and LDL-C were significantly reduced by QSG. The proteins mediating FA uptake, transportation into mitochondria and β-oxidation (FAT/CD36, CPT1A, ACADL, ACADM, ACAA2 and SCP2) as well as the upstreaming transcriptional regulators of FA metabolism (PPARα, RXRα, RXRβ and RXRγ) were up-regulated by QSG. As to glucose metabolism, QSG inhibited glycolytic activity by decreasing LDHA, while stimulated glucose oxidation by decreasing PDK4. Furthermore, QSG could facilitate tricarboxylic acid cycle, promote the transportation of ATP from mitochondria to cytoplasm and restore the mitochondrial function by increasing SUCLA2, CKMT2 and PGC-1α and decreasing UCP2 simultaneously. Conclusion QSG improved myocardial energy metabolism through increasing FA metabolism,inhibiting uncoupling of glycolysis from glucose oxidation.
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Affiliation(s)
- Kuo Gao
- 1Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078 China
| | - Jian Zhang
- 2School of Life Science, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Pengrong Gao
- 2School of Life Science, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Qiyan Wang
- 2School of Life Science, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Ying Liu
- 2School of Life Science, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Junjie Liu
- 3School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Yili Zhang
- 3School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Yan Li
- 1Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078 China
| | - Hong Chang
- 4Traditional Chinese Medicine College, North China University of Science and Technology, Tangshan, 063210 Hebei China
| | - Ping Ren
- 5School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Jinmin Liu
- 1Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078 China
| | - Yong Wang
- 3School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Wei Wang
- 3School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
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Templeton EM, Cameron VA, Pickering JW, Richards AM, Pilbrow AP. Emerging microRNA biomarkers for acute kidney injury in acute decompensated heart failure. Heart Fail Rev 2020; 26:1203-1217. [PMID: 32062825 DOI: 10.1007/s10741-020-09928-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute decompensated heart failure (ADHF) is associated with a high incidence of acute kidney injury (AKI), an abrupt loss of kidney function associated with a near doubling of mortality at 1 year. In addition to the direct threat acute HF itself poses to kidney function, the beneficial effects of commonly prescribed HF treatments must be weighed against their potentially adverse effects on glomerular perfusion. Consequently, there is an urgent need to identify early markers for AKI in ADHF to facilitate timely implementation of supportive measures to minimize kidney damage and improve outcomes. The recent recognition of the diagnostic potential of circulating microRNAs presents the potential to address this gap if microRNAs specific for AKI can be identified in serial plasma, serum and/or urine samples from well-phenotyped cohorts of ADHF patients, including a proportion with AKI. This review summarizes emerging circulating diagnostic and prognostic microRNA biomarkers (serum, plasma or urine) in HF and AKI.
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Affiliation(s)
- Evelyn M Templeton
- Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Vicky A Cameron
- Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - John W Pickering
- Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Anna P Pilbrow
- Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand. .,Christchurch Heart Institute, University of Otago-Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
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Avula S, LaFata M, Nabhan M, Allana A, Toprani B, Scheidel C, Suneja A. Heart failure mortality prediction using PRISM score and development of a classification and regression tree model to refer patients for palliative care consultation. IJC HEART & VASCULATURE 2020; 26:100440. [PMID: 31886404 PMCID: PMC6921143 DOI: 10.1016/j.ijcha.2019.100440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION We sought to assess one-year mortality in heart failure (HF) patients by using (Placement Resource Indicator for Systems Management) PRISM, a disease nonspecific risk stratification score, and use it along with modified Seattle Heart Failure Model (SHFM) to guide patient selection for palliative care consultation. METHODS A retrospective study design was used to examine 1-year mortality in 689 HF patients admitted from 2012 to 2014. One-year mortality was calculated using Pmort30/PRISM and modified SHFM scores, and the predicted scores were validated using the area under the ROC curve. CART was used to develop an algorithm to classify patients based on their mortality risk. RESULTS The discriminatory ability of PRISM categorical score (AUC = 0.701) was not significantly different than the discriminatory ability of modified SHFM (AUC = 0.686) (DeLong's test p = 0.56) but improved significantly with the combination of PRISM (categorical) score + modified SHFM (AUC = 0.740) (p = 0.002). The predictive capability of the CART tree model after cross-validation was 72.2% (AUC 0.631). CONCLUSION Our study suggests PRISM score performed as well as modified SHFM for one-year mortality prediction. Moreover, the addition of modified SHFM to PRISM score increases discriminatory ability in predicting 1-year mortality in heart failure patients compared to either of the two models alone. Together, when combined in a CART model, they can be used to identify the population subset with the highest mortality risk and hence guide goals of care discussion.
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Affiliation(s)
- Sindhu Avula
- Mercy St. Vincent Medical Center, Toledo, OH, United States
| | - Michael LaFata
- St Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Mohammed Nabhan
- St Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, United States
| | | | - Bhavana Toprani
- St Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, United States
| | | | - Anupam Suneja
- St Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, United States
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Ooi JYY, Bernardo BC. Translational Potential of Non-coding RNAs for Cardiovascular Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1229:343-354. [PMID: 32285423 DOI: 10.1007/978-981-15-1671-9_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jenny Y Y Ooi
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Bianca C Bernardo
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
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Liu L, Klein L, Eaton C, Panjrath G, Martin LW, Chae CU, Greenland P, Lloyd-Jones DM, Wactawski-Wende J, Manson JE. Menopausal Hormone Therapy and Risks of First Hospitalized Heart Failure and its Subtypes During the Intervention and Extended Postintervention Follow-up of the Women's Health Initiative Randomized Trials. J Card Fail 2020; 26:2-12. [DOI: 10.1016/j.cardfail.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/24/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
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Boisvert S, Francoeur J, Gallani MC. Cross-Cultural Adaptation and Reliability of the French–Canadian Version of the European Heart Failure Self-Care Behaviour Scale-9. J Nurs Meas 2019; 27:458-477. [DOI: 10.1891/1061-3749.27.3.458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and PurposeThe purposes of this methodological study were to adapt the European Heart Failure Self-care Behaviour Scale-9 to the French–Canadian population and to evaluate its reliability.MethodsThe adaptation process consisted of translation, back-translation, evaluation by an expert committee, and pretesting. Reliability was evaluated with stability criteria (test–retest) and internal consistency.ResultsPretesting led to testing of two response formats: 5-point Likert scale and the frequency scale. Both demonstrated good levels of agreement between the test–retest, although the values were higher with the frequency format. The Cronbach's alpha coefficients ranged from 0.71 to 0.78 (Likert scale) and 0.70 to 0.83 (frequency scale).ConclusionThe French–Canadian version of the EHFScB-9, in both formats, demonstrated good evidence of reliability.
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Myers J, Christle JW, Tun A, Yilmaz B, Moneghetti KJ, Yuen E, Soofi M, Ashley E. Cardiopulmonary Exercise Testing, Impedance Cardiography, and Reclassification of Risk in Patients Referred for Heart Failure Evaluation. J Card Fail 2019; 25:961-968. [DOI: 10.1016/j.cardfail.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/28/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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Shariatpanahi S, Ashghali Farahani M, Rafii F, Rassouli M, Kavousi A. Designing and Testing a Treatment Adherence Model Based on the Roy Adaptation Model in Patients With Heart Failure: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e13317. [PMID: 31350842 PMCID: PMC6688435 DOI: 10.2196/13317] [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: 01/05/2019] [Revised: 04/07/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adherence to treatment is an important factor to decrease repeated and costly hospitalization owing to heart failure (HF). The explanation and prediction of medication adherence and other lifestyle recommendations in chronic diseases, including HF, are complex. Theories lead to a better understanding of complex situations as well as the process of changing behavior and explain the reasons for the existence of a problem. OBJECTIVE The aim of this study is to report a protocol for a mixed methods study setting out to investigate the empirical validity of the Roy Adaptation Model as a conceptual framework for explaining and predicting adherence to treatment in patients with HF in Iran. METHODS This mixed methods study consists of an exploratory sequential design to be conducted in 2 phases. The first phase involves identifying the factors associated with treatment adherence in patients with HF through content analysis of the literature and elucidating the perception of participants in the context of Iranian health care where the model of adherence to treatment is designed based on the Roy Adaptation Model. The second phase addresses the interrelationships among variables in the model through a descriptive study using structural equation modeling. Finally, following the summarization and separate interpretation of the qualitative findings and quantitative results, a decision is made about the extent to and ways in which the results of the quantitative stage can be generalized or tested for the qualitative findings. RESULTS Content analysis of the literature in part 1 of the first phase was completed in 2017. Collection and analysis of qualitative data in part 2 of the first phase will be completed soon. The results are expected to be submitted for publication in 2019. Then, the second phase-the quantitative study-will be conducted. CONCLUSIONS The results of this study will provide valuable information about the empirical validity of the Roy Adaptation Model as a conceptual framework for explaining and predicting adherence to treatment in patients with HF, which, to date, have received little attention. The results can be used as a guide for nursing practice and care provision to patients with HF and also to design and implement effective interventions to improve treatment adherence in these patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13317.
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Affiliation(s)
- Shabnam Shariatpanahi
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Forough Rafii
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amir Kavousi
- Workplace Health Promotion Research Center and Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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Abstract
The prevalence of chronic heart failure is increasing in the United States due to the increase in the number of older adults and because many people are surviving acute cardiac events and living longer with chronic heart disease. In end-stage heart failure, heart transplant was once the gold standard of treatment and patients had to wait for a matching heart donor. In the past, the left ventricular assist device (LVAD) was a mechanical circulatory support treatment used temporarily for those awaiting heart transplant. However, the LVAD is increasingly becoming the chosen treatment of patients in lieu of heart transplant. Home healthcare nurses and clinicians need to be familiar with LVADs in order to care for patients in end-stage heart failure who are using these devices. This article explains the mechanism, potential complications, and nursing implications of caring for the patient who is using an LVAD.
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Schneider JE, Stojanovic I. Economic evaluation of cardiac magnetic resonance with fast-SENC in the diagnosis and management of early heart failure. HEALTH ECONOMICS REVIEW 2019; 9:13. [PMID: 31123926 PMCID: PMC6734300 DOI: 10.1186/s13561-019-0229-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 04/01/2019] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Heart failure (HF) is a major public health concern, prevalent in millions of people worldwide. The most widely-used HF diagnostic method, echocardiography, incurs a decreased diagnostic accuracy for heart failure disease progression when patients are asymptomatic compared to those who are symptomatic. The purpose of this study is to conduct a cost-effectiveness analysis of heart failure diagnosis comparing echocardiography to a novel myocardial strain assessment (Fast-SENC), which utilizes cardiac-tagged magnetic resonance imaging. METHODS We develop two models, one from the perspective of payers and one from the perspective of purchasers (hospitals). The payer model is a cost-effectiveness model composed of a 1-year short-term model and a lifetime horizon model. The hospital/purchaser model is a cost impact model where expected costs are calculated by multiplying cost estimates of each subcomponent by the accompanying probability. RESULTS The payer model shows lower healthcare costs for Fast-SENC in comparison to ECHO ($24,647 vs. $39,097) and a lifetime savings of 37% when utilizing Fast-SENC. Similarly, the hospital model revealed that the total cost per HF patient visit is $184 for ECHO and $209 for Fast-SENC, which results in hospital contribution margins of $81 and $115, respectively. CONCLUSIONS Fast-SENC is associated with higher quality-adjusted life years and lower accumulated expected healthcare costs than echocardiogram patients. Fast-SENC also shows a significant short-term and lifetime cost-savings difference and a higher hospital contribution margin when compared to echocardiography. These results suggest that early discovery of heart failure with methods like Fast-SENC can be cost-effective when followed by the appropriate treatment.
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Affiliation(s)
- John E. Schneider
- Avalon Health Economics, 26 Washington Street, 3rd Floor, Morristown, NJ 07960 USA
| | - Ivana Stojanovic
- Avalon Health Economics, 26 Washington Street, 3rd Floor, Morristown, NJ 07960 USA
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Atrial Fibrillation, Ventricular Arrhythmia, and Left Ventricular Remodeling in the ICU – First Results of the Single- Center RHYTHM-ACC Registry. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2018-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
The aim of this study was to investigate the association between left ventricular remodeling, atrial fibrillation (AF), and the severity of ventricular tachycardia (VT) in patients with ventricular rhythm disturbances admitted in a level 3 facility of acute cardiac care. Material and Methods: The RHYTHM-ACC registry was a single-center observational study, including 150 consecutive patients with sustained or non-sustained ventricular tachycardia (sVT and nsVT, respectively) admitted in an intensive cardiac care unit (ICCU), separated in: group 1 - 29 patients (21.01%) with dilated cardiomyopathy (DCM), and group 2 - 109 patients (78.99%) with normal ventricular performance. We investigated the difference between clinical characteristics of patients with sVT versus those with nsVT in each study group, and the association between AF and different forms of ventricular arrhythmia in 38 (25.33%) patients with AF and 112 (74.66%) patients in sinus rhythm. Results: There were no significant differences between the study groups with respect to type of ventricular arrhythmia: sVT (46.87% vs. 36.44%, p = 0.2), nsVT (43.75% vs. 55.93%, p = 0.2), or ventricular fibrillation (VF) (9.37% vs. 7.62%, p = 0.7). However, patients with DCM presented a significantly higher incidence of AF (43.75% vs. 20.33%, p = 0.01) and bundle branch block (37.5% vs. 11.86%, p = 0.0007). VF occurred more frequently in patients with AF compared to those in sinus rhythm (18.42% vs. 4.46%, p = 0.006). Multivariate analysis identified the co-existence of AF (OR = 4.8, p = 0.01) and the presence of a bundle branch block (BBB) (OR = 3.9, p = 0.03) as the most powerful predictors for the degeneration of VT into VF in patients admitted with sVT or nsVT in an ICCU unit. Conclusions: In patients with any type of VT admitted in an ICCU, the presence of ventricular remodeling is associated with a higher incidence of AF and conduction abnormalities, but not with a more severe pattern of ventricular arrhythmia. At the same time, AF and BBB seem to represent the most powerful predictors for degeneration of VT into VF, independent of the type of VT.
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