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Rasoul D, Zhang J, Farnell E, Tsangarides AA, Chong SC, Fernando R, Zhou C, Ihsan M, Ahmed S, Lwin TS, Bateman J, Hill RA, Lip GY, Sankaranarayanan R. Continuous infusion versus bolus injection of loop diuretics for acute heart failure. Cochrane Database Syst Rev 2024; 5:CD014811. [PMID: 38775253 PMCID: PMC11110107 DOI: 10.1002/14651858.cd014811.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Acute heart failure (AHF) is new onset of, or a sudden worsening of, chronic heart failure characterised by congestion in about 95% of cases or end-organ hypoperfusion in 5% of cases. Treatment often requires urgent escalation of diuretic therapy, mainly through hospitalisation. This Cochrane review evaluated the efficacy of intravenous loop diuretics strategies in treating AHF in individuals with New York Heart Association (NYHA) classification III or IV and fluid overload. OBJECTIVES To assess the effects of intravenous continuous infusion versus bolus injection of loop diuretics for the initial treatment of acute heart failure in adults. SEARCH METHODS We identified trials through systematic searches of bibliographic databases and in clinical trials registers including CENTRAL, MEDLINE, Embase, CPCI-S on the Web of Science, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry platform (ICTRP), and the European Union Trials register. We conducted reference checking and citation searching, and contacted study authors to identify additional studies. The latest search was performed on 29 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) involving adults with AHF, NYHA classification III or IV, regardless of aetiology or ejection fraction, where trials compared intravenous continuous infusion of loop diuretics with intermittent bolus injection in AHF. We excluded trials with chronic stable heart failure, cardiogenic shock, renal artery stenosis, or end-stage renal disease. Additionally, we excluded studies combining loop diuretics with hypertonic saline, inotropes, vasoactive medications, or renal replacement therapy and trials where diuretic dosing was protocol-driven to achieve a target urine output, due to confounding factors. DATA COLLECTION AND ANALYSIS Two review authors independently screened papers for inclusion and reviewed full-texts. Outcomes included weight loss, all-cause mortality, length of hospital stay, readmission following discharge, and occurrence of acute kidney injury. We performed risk of bias assessment and meta-analysis where data permitted and assessed certainty of the evidence. MAIN RESULTS The review included seven RCTs, spanning 32 hospitals in seven countries in North America, Europe, and Asia. Data collection ranged from eight months to six years. Following exclusion of participants in subgroups with confounding treatments and different clinical settings, 681 participants were eligible for review. These additional study characteristics, coupled with our strict inclusion and exclusion criteria, improve the applicability of the body of the evidence as they reflect real-world clinical practice. Meta-analysis was feasible for net weight loss, all-cause mortality, length of hospital stay, readmission, and acute kidney injury. Literature review and narrative analysis explored daily fluid balance; cardiovascular mortality; B-type natriuretic peptide (BNP) change; N-terminal-proBNP change; and adverse incidents such as ototoxicity, hypotension, and electrolyte imbalances. Risk of bias assessment revealed two studies with low overall risk, four with some concerns, and one with high risk. All sensitivity analyses excluded trials at high risk of bias. Only narrative analysis was conducted for 'daily fluid balance' due to diverse data presentation methods across two studies (169 participants, the evidence was very uncertain about the effect). Results of narrative analysis varied. For instance, one study reported higher daily fluid balance within the first 24 hours in the continuous infusion group compared to the bolus injection group, whereas there was no difference in fluid balance beyond this time point. Continuous intravenous infusion of loop diuretics may result in mean net weight loss of 0.86 kg more than bolus injection of loop diuretics, but the evidence is very uncertain (mean difference (MD) 0.86 kg, 95% confidence interval (CI) 0.44 to 1.28; 5 trials, 497 participants; P < 0.001, I2 = 21%; very low-certainty evidence). Importantly, sensitivity analysis excluding trials with high risk of bias showed there was insufficient evidence for a difference in bodyweight loss between groups (MD 0.70 kg, 95% CI -0.06 to 1.46; 3 trials, 378 participants; P = 0.07, I2 = 0%). There may be little to no difference in all-cause mortality between continuous infusion and bolus injection (risk ratio (RR) 1.53, 95% CI 0.81 to 2.90; 5 trials, 530 participants; P = 0.19, I2 = 4%; low-certainty evidence). Despite sensitivity analysis, the direction of the evidence remained unchanged. No trials measured cardiovascular mortality. There may be little to no difference in the length of hospital stay between continuous infusion and bolus injection of loop diuretics, but the evidence is very uncertain (MD -1.10 days, 95% CI -4.84 to 2.64; 4 trials, 211 participants; P = 0.57, I2 = 88%; very low-certainty evidence). Sensitivity analysis improved heterogeneity; however, the direction of the evidence remained unchanged. There may be little to no difference in the readmission to hospital between continuous infusion and bolus injection of loop diuretics (RR 0.85, 95% CI 0.63 to 1.16; 3 trials, 400 participants; P = 0.31, I2 = 0%; low-certainty evidence). Sensitivity analysis continued to show insufficient evidence for a difference in the readmission to hospital between groups. There may be little to no difference in the occurrence of acute kidney injury as an adverse event between continuous infusion and bolus injection of intravenous loop diuretics (RR 1.02, 95% CI 0.70 to 1.49; 3 trials, 491 participants; P = 0.92, I2 = 0%; low-certainty evidence). Sensitivity analysis continued to show that continuous infusion may make little to no difference on the occurrence of acute kidney injury as an adverse events compared to the bolus injection of intravenous loop diuretics. AUTHORS' CONCLUSIONS Analysis of available data comparing two delivery methods of diuretics in acute heart failure found that the current data are insufficient to show superiority of one strategy intervention over the other. Our findings were based on trials meeting stringent inclusion and exclusion criteria to ensure validity. Despite previous reviews suggesting advantages of continuous infusion over bolus injections, our review found insufficient evidence to support or refute this. However, our review, which excluded trials with clinical confounders and RCTs with high risk of bias, offers the most robust conclusion to date.
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Affiliation(s)
- Debar Rasoul
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Juqian Zhang
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Ebony Farnell
- General Medicine, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - Andreas A Tsangarides
- Emergency Department, The University of New South Wales, The Prince of Wales Hospital, Sydney, Australia
| | - Shiau Chin Chong
- Pharmacy, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Ranga Fernando
- General Medicine, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Can Zhou
- Cardiology, King's College Hospital, London, UK
| | - Mahnoor Ihsan
- Acute Medicine, Mid-Cheshire Hospital NHS Foundation Trust, Crewe, UK
| | - Sarah Ahmed
- Nephrology, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Tin S Lwin
- Cardiology, Castle Hill Hospital, Hull, UK
| | | | - Ruaraidh A Hill
- Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Liverpool John Moores University, Liverpool, UK
- Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rajiv Sankaranarayanan
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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Harikrishnan S, Rath PC, Bang V, McDonagh T, Ogola E, Silva H, Rajbanshi BG, Pathirana A, Ng GA, Biga C, Lüscher TF, Daggubati R, Adivi S, Roy D, Banerjee PS, Das MK. Heart failure, the global pandemic: A call to action consensus statement from the global presidential conclave at the platinum jubilee conference of cardiological society of India 2023. Indian Heart J 2024:S0019-4832(24)00057-9. [PMID: 38609052 DOI: 10.1016/j.ihj.2024.04.004] [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: 02/28/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies.
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Affiliation(s)
| | - Prathap Chandra Rath
- Apollo Health City, Jubilee Hills, Hyderabad, President, Cardiological Society of India (CSI), India
| | - Vijay Bang
- Lilavati Hospital, Bandra West, Mumbai, Immediate Past-President, CSI, India
| | | | - Elijah Ogola
- University of Nairobi (Kenya), President Pan African Society of Cardiology, Kenya
| | - Hugo Silva
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Treasurer, Argentinian Cardiac Society, Argentina
| | - Bijoy G Rajbanshi
- Nepal Mediciti, Lalitpur, Past-President, Cardiac Society of Nepal, Nepal
| | - Anidu Pathirana
- National Hospital of SriLanka, Past-President SriLanka Heart Association, Sri Lanka
| | - G Andre Ng
- University of Leicester, President-Elect, British Cardiovascular Society, United Kingdom
| | - Cathleen Biga
- President and CEO of Cardiovascular Management of Illinois, Vice President, American College of Cardiology, USA
| | - Thomas F Lüscher
- Royal Brompton Hospital Imperial College London, London, President-Elect European Society of Cardiology, United Kingdom
| | - Ramesh Daggubati
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Shirley Adivi
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Debabrata Roy
- Rabindranath Tagore Institute of Cardiac Sciences, Kolkata, Hon. General Secretary, CSI, India
| | - P S Banerjee
- Manipal Hospital, Kolkata, Past-President, CSI, India
| | - M K Das
- B.M. Birla Heart Research Centre, Kolkata, Past-President CSI, India
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Satheesh G, Unnikrishnan MK, Jha V, Salam A. India's latest essential medicines list: gaps, strengths and opportunities in evidence-based decision-making. BMJ Evid Based Med 2023; 28:303-305. [PMID: 36725306 DOI: 10.1136/bmjebm-2022-112171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Affiliation(s)
| | - M K Unnikrishnan
- NGSM Institute of Pharmaceutical Sciences, Mangalore, Karnataka, India
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, Delhi, India
- School of Public Health, Imperial College, London, UK
| | - Abdul Salam
- The George Institute for Global Health, University of New South Wales, New Delhi, Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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4
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Masenga SK, Povia JP, Lwiindi PC, Kirabo A. Recent Advances in Microbiota-Associated Metabolites in Heart Failure. Biomedicines 2023; 11:2313. [PMID: 37626809 PMCID: PMC10452327 DOI: 10.3390/biomedicines11082313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Heart failure is a risk factor for adverse events such as sudden cardiac arrest, liver and kidney failure and death. The gut microbiota and its metabolites are directly linked to the pathogenesis of heart failure. As emerging studies have increased in the literature on the role of specific gut microbiota metabolites in heart failure development, this review highlights and summarizes the current evidence and underlying mechanisms associated with the pathogenesis of heart failure. We found that gut microbiota-derived metabolites such as short chain fatty acids, bile acids, branched-chain amino acids, tryptophan and indole derivatives as well as trimethylamine-derived metabolite, trimethylamine N-oxide, play critical roles in promoting heart failure through various mechanisms. Mainly, they modulate complex signaling pathways such as nuclear factor kappa-light-chain-enhancer of activated B cells, Bcl-2 interacting protein 3, NLR Family Pyrin Domain Containing inflammasome, and Protein kinase RNA-like endoplasmic reticulum kinase. We have also highlighted the beneficial role of other gut metabolites in heart failure and other cardiovascular and metabolic diseases.
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Affiliation(s)
- Sepiso K. Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia; (J.P.P.); (P.C.L.)
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-6602, USA
| | - Joreen P. Povia
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia; (J.P.P.); (P.C.L.)
| | - Propheria C. Lwiindi
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia; (J.P.P.); (P.C.L.)
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-6602, USA
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5
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Deora S, Choudhary R, Kaushik A, Singh S, Singh B, Kumar B. Noninvasive assessment of pulmonary congestion in heart failure: Need of the hour. Indian Heart J 2023; 75:224-228. [PMID: 37207829 PMCID: PMC10421985 DOI: 10.1016/j.ihj.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
Early pulmonary congestion detection and surveillance in acute heart failure patients can prevent decompensation, minimize hospitalizations, and improve prognosis. In India, the warm and wet types of HF are still the most common types and residual congestion at discharge is still a significant concern. Thus, there is an urgent need for a reliable and sensitive means of identifying residual and subclinical congestion. Two such monitoring systems are available and approved by US FDA. These include CardioMEMS HF System (Abbott, Sylmar, California) and ReDS System (Sensible Medical Innovations, Ltd., Nanya, Israel). CardioMEMS is a wireless pressure-sensitive implantable device, while ReDS is a wearable noninvasive device for measurement of the lung fluid and hence direct detection of PC. This review discusses the role of noninvasive assessment in PC monitoring in patients with heart failure and its implications from an Indian perspective.
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Affiliation(s)
- Surender Deora
- All India Institute of Medical Sciences, Jodhpur, India.
| | | | - Atul Kaushik
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | - Barun Kumar
- All India Institute of Medical Sciences, Rishikesh, India
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6
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Dhurjati R, Sagar V, Kanukula R, Rehana N, Mohanan PP, Huffman MD, Bhaumik S, Salam A. Quality of the Indian clinical practice guidelines for the management of cardiovascular conditions. JRSM Open 2022; 13:20542704221127178. [PMID: 36506268 PMCID: PMC9730011 DOI: 10.1177/20542704221127178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To assess the quality of Indian clinical practice guidelines (CPG)s for the management of cardiovascular conditions, MEDLINE, Embase, Google Scholar and websites of relevant medical associations and government organisations were searched, from inception until August 2020, to identify Indian CPGs for the management of cardiovascular disease (CVD) conditions, produced in or between 2010 and 2019. Excluded were CPGs that were not specific to India, focused on alternative systems of medicine, of non-CVD conditions (even if they included a component of CVD), and those related to the electronic devices, cardiac biomarkers, or diagnostic procedures. Quality of the each included CPG was assessed using the AGREE II tool by four reviewers in duplicate, independently. Each AGREE II domain score and overall quality score was considered low (≤40%), moderate (40.1%-59.9%), and high (≥60%). Of the 23 CPGs included, six (26%) were reported to be adapted from other CPGs. Fourteen (61%) CPGs were produced by medical associations, six (26%) by individual authors and three (13%) by government agencies. Based on the AGREE II overall quality score, two (9%) CPGs were of high quality, four (17%) and seventeen (74%) CPGs were of moderate and low quality, respectively. Except for scope and purpose, and clarity of presentation all other domains were rated low. The quality of most Indian CPGs for managing CVD conditions assessed using the AGREE II tool was moderate-to-low. Combined efforts from different stakeholders are needed to develop, disseminate and implement high-quality CPGs while identifying and addressing barriers to their uptake to optimize patient care and improve outcomes.
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Affiliation(s)
| | - Vidya Sagar
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Raju Kanukula
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Nusrath Rehana
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Mark D. Huffman
- Washington University in St. Louis, St Louis, MO, USA,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Soumyadeep Bhaumik
- The George Institute for Global Health, New Delhi, Delhi, India,Meta-research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, Delhi, India
| | - Abdul Salam
- The George Institute for Global Health, New Delhi, Delhi, India,Manipal Academy of Higher Education, Manipal, Karnataka, India,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,Abdul Salam.
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7
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Banerjee S, Halder SK, Kimani P, Tran P, Ali D, Roelas M, Weight N, Dungarwalla M, Banerjee P. Kolkata-Coventry comparative registry study of acute heart failure: an insight into the impact of public, private and universal health systems on patient outcomes in low-middle income cities (KOLCOV HF Study). Open Heart 2022; 9:openhrt-2022-001964. [PMID: 35641099 PMCID: PMC9157346 DOI: 10.1136/openhrt-2022-001964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Survival gaps in acute heart failure (AHF) continue to expand globally. Multinational heart failure (HF) registries have highlighted variations between countries. Whether discrepancies in HF practice and outcomes occur across different health systems (ie, private, public or universal healthcare) within a city or between countries remain unclear. Insight into organisational care is also scarce. With increasing public scrutiny of health inequalities, a study to address these limitations is timely. Method KOLCOV-HF study prospectively compared patients with AHF in public (Nil Ratan Sircar Hospital (NRS)) versus private (Apollo Gleneagles Hospital (AGH)) hospitals of Kolkata, India, and one with universal health coverage in a socioeconomically comparable city of Coventry, England (University Hospitals Coventry & Warwickshire (UHCW)). Data variables were adapted from UK’s National HF Audit programme, collected over 24 months. Predictors of in-hospital mortality and length of hospitalisation were assessed for each centre. Results Among 1652 patients, in-hospital mortality was highest in government-funded NRS (11.9%) while 3 miles north, AGH had significantly lower mortality (7.5%, p=0.034), similar to UHCW (8%). This could be attributed to distinct HF phenotypes and differences in clinical and organisational care. As expected, low blood pressure was associated with a significantly greater risk of death in patients served by public hospitals UHCW and NRS. Conclusion Marked differences in HF characteristics, management and outcomes exist intra-regionally, and between low–middle versus high-income countries across private, public and universal healthcare systems. Physicians and policymakers should take caution when applying country-level data locally when developing strategies to address local evidence-practice gaps in HF.
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Affiliation(s)
- Suvro Banerjee
- Department of Cardiology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Swapan Kumar Halder
- Department of Cardiology, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Peter Kimani
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Tran
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Centre for Sport, Exercise & Life Scienes, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Marina Roelas
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nicholas Weight
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Moez Dungarwalla
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK .,Centre for Sport, Exercise & Life Scienes, Faculty of Health & Life Sciences, Coventry University, Coventry, UK.,Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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8
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Moyehodie YA, Muluneh MW, Belay AT, Fenta SM. Time to Death and Its Determinant Factors Among Patients With Chronic Heart Failure in Northwest Ethiopia: A Retrospective Study at Selected Referral Hospitals. Front Cardiovasc Med 2022; 9:817074. [PMID: 35600464 PMCID: PMC9120604 DOI: 10.3389/fcvm.2022.817074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Heart failure (HF) is a major health problem that affects patients and healthcare systems worldwide. It is the leading cause of morbidity and death and negatively impacts the quality of life, healthcare costs, and longevity. However, the causes of death were not well defined. This study aimed to identify the determinants of death among patients with HF in the Amhara Region, Northwest Ethiopia. Methods A multicenter retrospective cohort study was conducted on 285 patients in the age group 15 years or older under follow-up from 1 January 2015 to 31 December 2019. Descriptive analyses were summarized using the Kaplan–Meier survival curve and the log-rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to 5 years after they were admitted to the HF department to follow up on their treatment. Results Out of 285 patients with HF, 93(32.6%) of the respondents were dying within 5 years of follow-up. Anemia was the common comorbid disease (30.5%), and valvular heart disease was the most common etiology (33.7%) of chronic heart failure in this study. This study showed a significant mortality difference between hospitals. HF patients with hypertension [adjusted hazard ratio (AHR): 3.5076, 95% confidence interval (CI): 1.43, 8.60], anemia (AHR: 2.85, 95% 1.61, 5.03), pneumonia (AHR: 2.02, 95% 1.20, 3.39), chronic kidney disease (2.23, CI: 1.31, 3.77), and diabetes mellitus (AHR: 2.42, 95% CI: 1.43, 4.09) were at a higher risk of death. Moreover, patients with symptoms listed in the New York Heart Association Class (III and IV), Ischemic Heart Disease and unknown etiologies, men (AHR: 2.76, 95%:1.59, 4.78), and those with a high pulse rate (AHR: 1.02, 95%:1.00, 1.04) were at a higher risk of death. Conclusion There was a mortality difference between hospitals. This study has revealed that HF patients with anemia, diabetes mellitus, pneumonia, hypertension, chronic kidney disease, HF etiologies, severe New York Heart Association Class (III and IV), men, and high pulse rate were the main factors associated with death. Health professionals could give more attention to patients whose pulse rate is high, men, and a patient who had comorbidities in the ward.
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Zhang J, Zhou C, Ihsan M, Tsangarides A, Ahmed S, Fernando R, Lwin TS, Surtee S, Farnell E, Chaudhary M, Lip GYH, Hill RA, Sankaranarayanan R. Continuous infusion versus bolus injection of loop diuretics for congestive heart failure. Hippokratia 2021. [DOI: 10.1002/14651858.cd014811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juqian Zhang
- Liverpool Centre for Cardiovascular Science; University of Liverpool; Liverpool UK
| | - Can Zhou
- Department of Cardiology; King’s College Hospital; London UK
| | - Mahnoor Ihsan
- Department of Acute Medicine; Mid-Cheshire Hospital NHS Foundation Trust; Crewe UK
| | - Andreas Tsangarides
- Emergency Department; The University of New South Wales, The Prince of Wales Hospital; Sydney Australia
| | - Sarah Ahmed
- Department of Anaesthesiology and Intensive Care Medicine; NHS; Cambridge UK
| | - Ranga Fernando
- Department of General Medicine; Salford Royal NHS FoundationTrust; Manchester UK
| | | | - Shazmeen Surtee
- Department of Cardiology; Wrightington, Wigan and Leigh NHS Foundation Trust; Wigan UK
| | - Ebony Farnell
- Department of Medical Education/Acute Medicine; Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust; Wigan UK
| | - Muhammad Chaudhary
- Department of General Practice; St Helens and Knowsley Teaching Hospitals NHS Trust; Manchester UK
| | - Gregory YH Lip
- Institute of Ageing and Chronic Disease; University of Liverpool; Liverpool UK
| | - Ruaraidh A Hill
- Liverpool Reviews and Implementation Group, Department of Health Data Science; University of Liverpool; Liverpool UK
| | - Rajiv Sankaranarayanan
- Department of Cardiology; Liverpool University Hospitals NHS Foundation Trust; Liverpool UK
- Liverpool Centre for Cardiovascular Science; Liverpool Heart and Chest Hospital; Liverpool UK
- University of Liverpool; Liverpool UK
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Sun YV, Liu C, Staimez L, Ali MK, Chang H, Kondal D, Patel S, Jones D, Mohan V, Tandon N, Prabhakaran D, Quyyumi AA, Narayan KMV, Agrawal A. Cardiovascular disease risk and pathophysiology in South Asians: can longitudinal multi-omics shed light? Wellcome Open Res 2021; 5:255. [PMID: 34136649 PMCID: PMC8176264 DOI: 10.12688/wellcomeopenres.16336.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in South Asia, with rapidly increasing prevalence of hypertension, type 2 diabetes (T2DM) and hyperlipidemia over the last two decades. Atherosclerotic CVD (ASCVD) affects South Asians earlier in life and at lower body weights, which is not fully explained by differential burden of conventional risk factors. Heart failure (HF) is a complex clinical syndrome of heterogeneous structural phenotypes including two major clinical subtypes, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). The prevalence of HF in South Asians is also rising with other metabolic diseases, and HFpEF develops at younger age and leaner body mass index in South Asians than in Whites. Recent genome-wide association studies, epigenome-wide association studies and metabolomic studies of ASCVD and HF have identified genes, metabolites and pathways associated with CVD traits. However, these findings were mostly driven by samples of European ancestry, which may not accurately represent the CVD risk at the molecular level, and the unique risk profile of CVD in South Asians. Such bias, while formulating hypothesis-driven research studies, risks missing important causal or predictive factors unique to South Asians. Importantly, a longitudinal design of multi-omic markers can capture the life-course risk and natural history related to CVD, and partially disentangle putative causal relationship between risk factors, multi-omic markers and subclinical and clinical ASCVD and HF. In conclusion, combining high-resolution untargeted metabolomics with epigenomics of rigorous, longitudinal design will provide comprehensive unbiased molecular characterization of subclinical and clinical CVD among South Asians. A thorough understanding of CVD-associated metabolomic profiles, together with advances in epigenomics and genomics, will lead to more accurate estimates of CVD progression and stimulate new strategies for improving cardiovascular health.
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Affiliation(s)
- Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.,Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Lisa Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.,Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | | | - Shivani Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Dean Jones
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, 30322, USA
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Anurag Agrawal
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, New Delhi, India
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11
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Jariwala P, Punjani A, Boorugu H, Madhawar DB. A clinical experience of Indian patients with heart failure with reduced left ventricular ejection fraction using an angiotensin receptor-neprilysin inhibitor [ARNI] on an outpatient basis. Indian Heart J 2021; 73:211-213. [PMID: 33865520 PMCID: PMC8065353 DOI: 10.1016/j.ihj.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/08/2020] [Accepted: 01/02/2021] [Indexed: 12/03/2022] Open
Abstract
The goal of this study is to portray an initial experience with the efficacy, safety, and, acceptance of ARNI in ambulatory cardiology practices in India. The research is a retrospective review of single-centre data who began therapy with ARNI in HFrEF between 2019 and 2020. The analysis included data for 454 symptomatic patients, aged 57 ± 20.8 years in NYHA class II-III. During follow-up, patients experienced significant improvement in HF symptoms determined by using Kansas City Cardiomyopathy Questionnaire (KCCQ) and a considerable reduction in NT-proBNP levels. ARNI is associated with substantial clinical benefit in an outpatient setting in HFrEF.
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Affiliation(s)
- Pankaj Jariwala
- Consultant Cardiologist and Heart Failure Specialist, Department of Cardiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India.
| | - Arshad Punjani
- Consultant Physician, Department of Internal Medicine, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India
| | - Harikishan Boorugu
- Consultant Physician, Department of Internal Medicine, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India
| | - Dilip Babu Madhawar
- Consultant Nephrologist and Transplant Physician, Department of Nephrology and Transplant Medicine, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India
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12
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Sun YV, Liu C, Staimez L, Ali MK, Chang H, Kondal D, Patel S, Jones D, Mohan V, Tandon N, Prabhakaran D, Quyyumi AA, Narayan KMV, Agrawal A. Cardiovascular disease risk and pathophysiology in South Asians: can longitudinal multi-omics shed light? Wellcome Open Res 2020; 5:255. [DOI: 10.12688/wellcomeopenres.16336.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in South Asia, with rapidly increasing prevalence of hypertension, type 2 diabetes and hyperlipidemia over the last two decades. Atherosclerotic CVD (ASCVD) affects South Asians earlier in life and at lower body weights, which is not fully explained by differential burden of conventional risk factors. Heart failure (HF) is a complex clinical syndrome of heterogeneous structural phenotypes including two major clinical subtypes, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). The prevalence of HF in South Asians is also rising with other metabolic diseases, and HFpEF develops at younger age and leaner body mass index in South Asians than in Whites. Recent genome-wide association studies, epigenome-wide association studies and metabolomic studies of ASCVD and HF have identified genes, metabolites and pathways associated with CVD traits. However, these findings were mostly driven by samples of European ancestry, which may not accurately represent the CVD risk at the molecular level, and the unique risk profile of CVD in South Asians. Such bias, while formulating hypothesis-driven research studies, risks missing important causal or predictive factors unique to South Asians. Importantly, a longitudinal design of multi-omic markers can capture the life-course risk and natural history related to CVD, and partially disentangle putative causal relationship between risk factors, multi-omic markers and subclinical and clinical ASCVD and HF. In conclusion, combining high-resolution untargeted metabolomics with epigenomics of rigorous, longitudinal design will provide comprehensive unbiased molecular characterization of subclinical and clinical CVD among South Asians. A thorough understanding of CVD-associated metabolomic profiles, together with advances in epigenomics and genomics, will lead to more accurate estimates of CVD progression and stimulate new strategies for improving cardiovascular health.
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13
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Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CSP, Harikrishnan S, Shah SJ, Kandula NR, Jose PO, Narayan KMV, Agyemang C, Misra A, Jenum AK, Bilal U, Nasir K, Cainzos-Achirica M. The Upcoming Epidemic of Heart Failure in South Asia. Circ Heart Fail 2020; 13:e007218. [PMID: 32962410 DOI: 10.1161/circheartfailure.120.007218] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world's highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.
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Affiliation(s)
- Pablo Martinez-Amezcua
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD
| | - Waqas Haque
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD.,Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (R.K.).,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (R.K.)
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom (N.S.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (C.S.P.L.).,Duke-National University of Singapore (C.S.P.L.).,University Medical Centre, Groningen, the Netherlands (C.S.P.L.)
| | - Sivadasanpillai Harikrishnan
- Heart Failure Association of India (S.H.).,National Center of Research and Excellence in Heart Failure, ICMR (S.H.).,Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum (S.H.)
| | - Sanjiv J Shah
- Bluhm Cardiovascular Institute and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Namratha R Kandula
- Northwestern University, Feinberg School of Medicine, Chicago, IL (N.R.K.)
| | - Powell O Jose
- Sutter Davis Hospital, Sutter Medical Center, Sacramento, CA (P.O.J.)
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University and Emory University School of Medicine, Atlanta, GA (K.M.V.N.)
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands (C.A.)
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India (A.M.).,National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India (A.M.).,Diabetes Foundation India, New Delhi, India (A.M.)
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, University of Oslo, Institute of Health and Society, Norway (A.K.J.)
| | - Usama Bilal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA (U.B.)
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
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14
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Kaul U, Das MK, Agarwal R, Bali H, Bingi R, Chandra S, Chopra VK, Dalal J, Jadhav U, Jariwala P, Jena A, Gupta R, Kerkar P, Guha S, Kumar D, Mashru M, Mehta A, Mohan JC, Nair T, Prabhakar D, Ray R, Rajani R, Sathe S, Sinha N, Vijayaraghavan G. Consensus and development of document for management of stabilized acute decompensated heart failure with reduced ejection fraction in India. Indian Heart J 2020; 72:477-481. [PMID: 33357634 PMCID: PMC7772598 DOI: 10.1016/j.ihj.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/08/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
Aim Ensuring adherence to guideline-directed medical therapy (GDMT) is an effective strategy to reduce mortality and readmission rates for heart failure (HF). Use of a checklist is one of the best tools to ensure GDMT. The aim was to develop a consensus document with a robust checklist for stabilized acute decompensated HF patients with reduced ejection fraction. While there are multiple checklists available, an India-specific checklist that is easy to fill and validated by regional and national subject matter experts (SMEs) is required. Methodology A total of 25 Cardiology SMEs who consented to participate from India discussed data from literature, current evidence, international guidelines and practical experiences in two national and four regional meetings. Results Recommendations included HF management, treatment optimization, and patient education. The checklist should be filled at four time points- (a) transition from intensive care unit to ward, (b) at discharge, (c) 1st follow-up and (d) subsequent follow-up. The checklist is the responsibility of the consultant or the treating physician which can be delegated to a junior resident or a trained HF nurse. Conclusion This checklist will ensure GDMT, simplify transition of care and can be used by all doctors across India. Institutions, associations, and societies should recommend this checklist for adaptability in public and private hospital. Hospital administrations should roll out policy for adoption of checklist by ensuring patient files have the checklist at the time of discharge and encourage practice of filling it diligently during follow-up visits.
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Affiliation(s)
- U Kaul
- Dept of Cardiology, Batra Hospital and Research Centre, 1, Mehrauli Badarpur Rd, Tughlakabad Institutional Area, New Delhi, India.
| | - M K Das
- Dept of Cardiology, CMRI Hospitals, 7/2 Diamond Harbour Road, Kolkata, West Bengal, India
| | - R Agarwal
- Dept of Cardiology, Jaswant Rai Speciality Hospital, Opp Sports Stadium, Civil Line Mawana Road Meerut, Uttar Pradesh, India
| | - H Bali
- Paras Hospital, Plot No. 2, HSIIDC Tech Park, Near NADA Sahib Gurudwara, Panchkula, Haryana, India
| | - R Bingi
- Vasavi Hospital, 15, 1st Stage, Opp. to 15E Bus Stop, 70th Cross Rd, Kumaraswamy Layout, Bengaluru, Karnataka, India
| | - S Chandra
- Dept of Cardiology, Virinchi Hospital, Virinchi Circle, Rd Number 1, Shyam Rao Nagar, Banjara Hills, Hyderabad, Telangana, India
| | - V K Chopra
- Max Superspeciality Hospital, 1, 2, Press Enclave Marg, Saket Institutional Area, Saket, New Delhi, India
| | - J Dalal
- Dept of Cardiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, Maharashtra, India
| | - U Jadhav
- MGM Hospital, Plot No.35, Atmashanti Society, Sector 3, Vashi, Navi Mumbai, Maharashtra, India
| | - P Jariwala
- Yashoda Hospital, Raj Bhavan Rd, Matha Nagar, Somajiguda, Hyderabad, Telangana, India
| | - A Jena
- Kalinga Institute of Medical Sciences, Kushabhadra Campus, KIIT Campus, 5, KIIT Road, Patia, Bhubaneswar, Odisha, India
| | - R Gupta
- Preventive Cardiology, RUHS Hospital, Kumbha Marg, Sector 11 Rd, Pratap Nagar, Jaipur, Rajasthan, India
| | - P Kerkar
- KEM Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India; Asian Heart Institute, Bandra Kurla Complex, G/N, Bandra (E), Mumbai, Maharashtra, India
| | - S Guha
- Dept of Cardiology, Calcutta Medical College, 88, College St, Calcutta Medical College, College Square, Kolkata, West Bengal, India
| | - D Kumar
- MEDICA Superspeciality Hospital, 127, Eastern Metropolitan Bypass, Nitai Nagar, Mukundapur, Kolkata, West Bengal, India
| | - M Mashru
- Dept of Cardiology, Sir H N Reliance Foundation Hospital and Research Centre, Prarthana Samaj, Raja Rammohan Roy Rd, Charni Road East, Khetwadi, Girgaon, Mumbai, Maharashtra, India
| | - A Mehta
- Sir Ganga Ram Hospital and Research Centre, Sarhadi Gandhi Marg, Old Rajinder Nagar, Rajinder Nagar, New Delhi, Delhi, India
| | - J C Mohan
- Dept of Cardiology, Jaipur Golden Hospital, 2, Naharpur Village Rd, Institutional Area, Sector 3, Rohini, Delhi, India
| | - T Nair
- Dept of Cardiology, PRS Hospital, NH 47, Killipalam, Thiruvananthapuram, Kerala, India
| | - D Prabhakar
- Apollo First Med Hospital, Poonamallee High Rd, New Bupathy Nagar, Kilpauk, Chennai, Tamil Nadu, India
| | - R Ray
- AMRI Hospital, Block-A, Scheme-L11 P-4&5, Gariahat Rd, Dhakuria, Kolkata, West Bengal, India
| | - R Rajani
- P D Hinduja Hospital & Medical Research Centre, SVS Rd, Mahim West, Shivaji Park, Mumbai, Maharashtra, India
| | - S Sathe
- Deenanath Mangeshkar Hospital and Research Centre, Deenanath Mangeshkar Hospital Road, Near Mhatre Bridge, Erandwane, Pune, Maharashtra, India
| | - N Sinha
- Sahara India Medical Institute, Sahara India Medical Institute, Sahara Hospital Rd, Viraj Khand - 1, Viraj Khand, Gomti Nagar, Lucknow, Uttar Pradesh, India
| | - G Vijayaraghavan
- Kerala Institute of Medical Sciences, 1, Vinod Nagar Rd, Anayara, Thiruvananthapuram, Kerala, India
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15
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Liu T, Quasinowski B, Soares A. The Emulation and Adaptation of a Global Model of Clinical Practice Guidelines on Chronic Heart Failure in BRICS Countries: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1735. [PMID: 32155868 PMCID: PMC7084235 DOI: 10.3390/ijerph17051735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/11/2022]
Abstract
Whilst knowledge about diseases is universal, access to health care is not equally distributed. During the last decade, the countries of BRICS (Brazil, Russia, India, China, South Africa) have become important actors on the global health scene, pushing for universal, affordable, and more equal access to health care. Although non-communicable diseases place a significant burden on all populations and health systems, low- and middle-income countries (LMIC), such as BRICS, have been affected particularly hard. Approximately 80 percent of worldwide deaths from non-communicable diseases occur in LMIC. We examined if guidelines concerning chronic heart failure from BRICS countries are influenced by global scripts and if these guidelines have converged or diverged in an inter-state context. Our analysis shows that guidelines on heart failure published in BRICS predominantly rely on models initially formulated by European or American cardiological organisations. Guidelines from BRICS deviate from these models to some extent, in particular with regard to specific epidemiological conditions. Except for the Indian guideline, they do not, however, extensively engage with BRICS-specific aspects of costs, access to and affordability of health care services. We interpret these results through the lens of sociological theories on globalisation. Consistent with neoinstitutionalism, recommendations for clinical practice guidelines have spread in BRICS countries in a rather isomorphic fashion. Notwithstanding, some local medical traditions have also been included into these guidelines through localised adaptation and variation.
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Affiliation(s)
- Tao Liu
- School of Public Affairs, Zhejiang University, Hangzhou 310058, China
- Institute for Sociology, University of Duisburg-Essen, 47057 Duisburg, Germany;
- Institute of East Asian Studies, University of Duisburg-Essen, 47057 Duisburg, Germany
| | - Benjamin Quasinowski
- Institute for Sociology, University of Duisburg-Essen, 47057 Duisburg, Germany;
- Institute of East Asian Studies, University of Duisburg-Essen, 47057 Duisburg, Germany
| | - André Soares
- Institute for Sociology, University of Duisburg-Essen, 47057 Duisburg, Germany;
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16
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Dewan P, Docherty KF, McMurray JJV. Sacubitril/Valsartan in Asian Patients with Heart Failure with Reduced Ejection Fraction. Korean Circ J 2019; 49:469-484. [PMID: 31172710 PMCID: PMC6554586 DOI: 10.4070/kcj.2019.0136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/19/2019] [Indexed: 12/11/2022] Open
Abstract
The Prospective comparison of Angiotensin Receptor-neprilysin inhibitor (ARNI) with Angiotensin converting enzyme inhibitor (ACEI) to Determine Impact on Global Mortality and morbidity in Heart Failure (HF) trial (PARADIGM-HF) showed that adding a neprilysin inhibitor (sacubitril) to a renin-angiotensin system blocker (and other standard therapy) reduced morbidity and mortality in ambulatory patients with chronic HF with reduced ejection fraction (HFrEF). In PARADIGM-HF, valsartan combined with sacubitril (a so-called ARNI) was superior to the current gold standard of an ACEI, specifically enalapril, reducing the risk of the primary composite outcome of cardiovascular (CV) death or first HF hospitalization by 20% and all-cause death by 16%. Following the results of PARADIGM-HF, sacubitril/valsartan was approved by American and European regulatory authorities for the treatment of HFrEF. The burden of HF in Asia is substantial, both due to the huge population of the region and as a result of increasing CV risk factors and disease. Both the prevalence and mortality associated with HF are high in Asia. In the following review, we discuss the development of sacubitril/valsartan, the prototype ARNI, and the available evidence for its efficacy and safety in Asian patients with HFrEF.
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Affiliation(s)
- Pooja Dewan
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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