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Talha KM, Hammonds K, Alhamdow A, Bennett MM, Bomar JVA, Ettlinger JA, Martinez-Traba M, Hartgers-Gubbels ES, Priest EL, Shaver CN, Afzal A, Widmer RJ, Gottlieb RL, Mack MJ, Butler J. Health Care Resource Utilization Following Acute Myocardial Infarction: Findings from the RECORD-MI Registry. Am J Cardiol 2024; 232:1-7. [PMID: 39251079 DOI: 10.1016/j.amjcard.2024.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/11/2024]
Abstract
The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated. Of 6,804 patients admitted because of MI, 6,556 were discharged alive. The median age was 69 years, 60% were men, and 77% had non-ST-elevation MI; 17% (1,090) had multivessel disease. The number of patients with first all-cause readmissions within 30 days, 3 months, and 12 months of discharge were 844 (13%), 1,372 (21%), and 2,306 (35%), respectively, with a higher readmission rate in patients with non-ST-elevation MI, previous heart failure (HF), new-onset HF, and left ventricular ejection fraction ≤40%. ED visits at 12 months for any cause were 2,401 (37%), of which 1,321 (55%) were for any CV cause, with a higher incidence in patients with previous HF. Of the 6,556 patients, 4,102 (63%) had at least 1 primary care visit in the past year, 5,009 (76%) had CV specialty visits, and 3,860 (59%) had non-CV visits, with a similar distribution across subgroups. Patients hospitalized with an MI had a high risk of subsequent hospital readmissions and ED and outpatient visits, especially those with a previous HF diagnosis and those discharged with an MI and HF diagnosis.
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Affiliation(s)
- Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Ayman Alhamdow
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | | | | | | | | | | | | | - Aasim Afzal
- Heart Recovery Center, Baylor Scott and White The Heart Hospital Plano, Plano, Texas
| | - Robert J Widmer
- Department of Cardiology, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Robert L Gottlieb
- Baylor Scott & White Research Institute, Dallas, Texas; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Department of Medicine, Texas A&M Health Science Center, Dallas, Texas; Department of Medicine, Burnett School of Medicine, Texas Christian University, Fort Worth, Texas; Baylor Scott & White The Heart Hospital Plano, Plano, Texas
| | - Michael J Mack
- Baylor Scott & White Research Institute, Dallas, Texas; Baylor Scott & White The Heart Hospital Plano, Plano, Texas
| | - Javed Butler
- Baylor Scott & White Research Institute, Dallas, Texas; Department of Medicine, University of Mississippi, Jackson, Mississippi.
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Tang J, Wang P, Liu C, Peng J, Liu Y, Ma Q. Pharmacotherapy in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis. Chin Med J (Engl) 2024:00029330-990000000-01087. [PMID: 38811344 DOI: 10.1097/cm9.0000000000003118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Angiotensin receptor neprilysin inhibitors (ARNIs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) are the cornerstones in treating heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) are included in HFrEF treatment guidelines. However, the effect of SGLT-2i and the five drugs on HFrEF have not yet been systematically evaluated. METHODS PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) from inception dates to September 23, 2022. Additional trials from previous relevant reviews and references were also included. The primary outcomes were changes in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter/dimension (LVEDD), left ventricular end-systolic diameter/dimension (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI). Secondary outcomes were New York Heart Association (NYHA) class, 6-min walking distance (6MWD), B-type natriuretic peptide (BNP) level, and N-terminal pro-BNP (NT-proBNP) level. The effect sizes were presented as the mean difference (MD) with 95% confidence interval (CI). RESULTS We included 68 RCTs involving 16,425 patients. Compared with placebo, ARNI + BB + MRA + SGLT-2i was the most effective combination to improve LVEF (15.63%, 95% CI: 9.91% to 21.68%). ARNI + BB + MRA + SGLT-2i (5.83%, 95% CI: 0.53% to 11.14%) and ARNI + BB + MRA (3.83%, 95% CI: 0.72% to 6.90%) were superior to the traditional golden triangle "ACEI + BB + MRA" in improving LVEF. ACEI + BB + MRA + SGLT-2i was better than ACEI + BB + MRA (-8.05 mL/m2, 95% CI: -14.88 to -1.23 mL/m2) and ACEI + BB + SGLT-2i (-18.94 mL/m2, 95% CI: -36.97 to -0.61 mL/m2) in improving LVEDVI. ACEI + BB + MRA + SGLT-2i (-3254.21 pg/mL, 95% CI: -6242.19 to -560.47 pg/mL) was superior to ARB + BB + MRA in reducing NT-proBNP. CONCLUSIONS Adding SGLT-2i to ARNI/ACEI + BB + MRA is beneficial for reversing cardiac remodeling. The new quadruple drug "ARNI + BB + MRA + SGLT-2i" is superior to the golden triangle "ACEI + BB + MRA" in improving LVEF. REGISTRATION PROSPERO; No. CRD42022354792.
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Affiliation(s)
- Jia Tang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Ping Wang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Chenxi Liu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Jia Peng
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Yubo Liu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Qilin Ma
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
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3
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Shore S, Li H, Zhang M, Whitney R, Gross AL, Bhatt AS, Nallamothu BK, Giordani B, Briceño EM, Sussman JB, Gutierrez J, Yaffe K, Griswold M, Johansen MC, Lopez OL, Gottesman RF, Sidney S, Heckbert SR, Rundek T, Hughes TM, Longstreth WT, Levine DA. Trajectory of Cognitive Function After Incident Heart Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.09.24302608. [PMID: 38370803 PMCID: PMC10871464 DOI: 10.1101/2024.02.09.24302608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition. Methods This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a t-score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. Results The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes. Conclusions In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.
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Affiliation(s)
| | - Hanyu Li
- University of Michigan, Ann Arbor, MI, USA
| | - Min Zhang
- University of Michigan, Ann Arbor, MI, USA
| | | | - Alden L. Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankeet S. Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | | | | | | | | | | | - Michael Griswold
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Stephen Sidney
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | - Tatjana Rundek
- University of Miami – Miller School of Medicine, Evelyn F. McKnight Brain Institute, FL, USA
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Rao VU, Bhat G, Bossone E. Interventional Approaches to Augment Pharmacotherapy in Heart Failure. Heart Fail Clin 2024; 20:xi-xii. [PMID: 37953026 DOI: 10.1016/j.hfc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Vijay U Rao
- Heart Failure, CardioOncology, Anticoagulation, Franciscan Health, 5330 East Stop 11 Road, Indianapolis, IN 46235, USA.
| | - Geetha Bhat
- Cardiac Transplantation, The Christ Hospital, 2139 Auburn Avenue, Cincinnati, OH 45219, USA.
| | - Eduardo Bossone
- Department of Public Health, Department of Translational Medical Sciences, University of Naples "Federico II", Ed. 18, I piano, Via Sergio Pansini 5, Naples 80131, Italy.
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Matsukawa R, Okahara A, Tokutome M, Itonaga J, Koga E, Hara A, Kisanuki H, Sada M, Okabe K, Kawai S, Ogawa K, Matsuura H, Mukai Y. A scoring evaluation for the practical introduction of guideline-directed medical therapy in heart failure patients. ESC Heart Fail 2023; 10:3352-3363. [PMID: 37671603 PMCID: PMC10682854 DOI: 10.1002/ehf2.14524] [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: 05/05/2023] [Revised: 07/19/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS The guideline-directed medical therapy (GDMT) has been recommended for heart failure (HF) with reduced ejection fraction (HFrEF) based on the accumulating clinical evidence. However, it is difficult to implement all the trial-proven medications for every patient in the real world. METHODS AND RESULTS A simple GDMT score was created, according to the combination of GDMT drugs (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors) administration and their dosage (0-9 points). Its impact on the prognosis of HF patients was investigated. Admitted HF patients [HFrEF and HF with mildly reduced ejection fraction (HFmrEF), n = 1054] were retrospectively analysed (excluding those with in-hospital death and dialysis). A simple GDMT score ≥5, but not the number of medications, was significantly associated with a reduction of all-cause death, HF readmission, and composite outcome (HF readmission and all-cause death) (P < 0.001). Subgroup analysis showed that almost all groups with a simple GDMT score of 5 or higher had a better prognosis. CONCLUSIONS The developed simple GDMT score was associated with prognosis in HFrEF and HFmrEF patients. Even if all four drugs cannot be introduced for some reason, a regimen with a simple GDMT score ≥5 may lead to a prognosis in HF patients.
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Affiliation(s)
- Ryuichi Matsukawa
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Arihide Okahara
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Masaki Tokutome
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Junpei Itonaga
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Eiichi Koga
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Ayano Hara
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Hiroshi Kisanuki
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Masashi Sada
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Kousuke Okabe
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Shunsuke Kawai
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Kiyohiro Ogawa
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Hirohide Matsuura
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Yasushi Mukai
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
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6
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Sherwood A, Blumenthal JA, Mentz RJ, Koch GG, Rogers JG, Chang PP, Chien C, Adams KF, Rose-Jones LJ, Jensen BC, Johnson KS, Hinderliter AL. Association of Depression Symptoms and Biomarkers of Risk on Clinical Outcomes in HFrEF. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.26.23296194. [PMID: 37808654 PMCID: PMC10557801 DOI: 10.1101/2023.09.26.23296194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Prior studies have demonstrated an association of depression with adverse clinical outcomes in patients with HFrEF, but the possible mechanisms responsible for the association are not unserstood. METHODS 142 men and women with HFrEF were enrolled through HF clinics and followed over time. At baseline and 6-months, depression was assessed by the Beck Depression Inventory (BDI-II) and disease activity by B-type natriuretic peptide (BNP). Proportional Hazards Regression Models assessed the contribution of depressive symptoms and HFrEF disease biomarkers on death or cardiovascular hospitalization. RESULTS Over a median follow-up period of 4 years, 42 patients (30%) died, and 84 (60%) had cardiovascular hospitalizations. A 10-point higher baseline BDI-II score was associated with a 35% higher hazard of death or cardiovascular hospitalization. Greater baseline BDI-II scores were associated with poorer HF self-care maintenance (R=-0.30, p<0.001) and fewer daily steps (R=-0.19, p=0.04), suggesting that depression may adversely affect important health behaviors. Increases in plasma BNP over 6 months were associated with worse outcomes. Changes in BDI-II score and plasma BNP over 6 months were positively correlated (R=0.25, p=0.004). CONCLUSIONS This study underscores the importance of elevated depression symptoms and their association with an increased likelihood of adverse clinical outcomes in patients with HFrEF. Health behaviors may play a greater role than direct biobehavioral pathways in the adverse effects of depression on the HF disease trajectory and resultant clinical outcomes.
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Affiliation(s)
- Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | - Gary G. Koch
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Joseph G. Rogers
- Department of Medicine, Duke University Medical Center
- Department of Cardiology, The Texas Heart Institute
| | | | - Christopher Chien
- Department of Medicine, University of North Carolina at Chapel Hill
- UNC Rex Healthcare, Raleigh, NC, USA
| | | | | | - Brian C. Jensen
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Kristy S. Johnson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Melendo-Viu M, Dobarro D, Marchán López Á, Domínguez LM, Raposeiras-Roubín S, Abu-Assi E, Cardero-González C, Pérez-Expósito L, Cespón Fernández M, Parada Barcia JA, Barreiro Pérez M, García E, Íñiguez Romo A. Hypotension at heart failure discharge: Should it be a limiting factor for drug titration? Int J Cardiol 2023; 386:59-64. [PMID: 37169152 DOI: 10.1016/j.ijcard.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Medical treatment in Heart Failure (HF) with reduced ejection fraction (HFrEF; LVEF ≤40%) has shifted towards quadruple therapy. Maximum tolerated dose is the goal, yet no hypotension's cut-off point has been specified. In this work, we analyze the impact of intensive drug titration in clinical events, focusing on low blood pressure (BP) patients at hospital discharge. METHODS AND RESULTS Retrospective analysis of 713 patients with HFrEF discharged after an acute HF event (mean LVEF 30 ± 5%). Mean SBP was 112.4 ± 16.5 mmHg and 50.6% were discharged on triple therapy. We considered hypotension as a Systolic blood pressure (SBP) <100 mmHg (21.7% of patients, mean SBP was 112.4 ± 16.5 mmHg) and codified the intensity of drug therapy in 5 stages from untreated to very high therapy intensity. The impact of the intensity of treatment was analysed with a propensity score and increasing the intensity was associated in the whole cohort with a reduction of the composite outcome of all-cause mortality and HF readmission, (HR 0.69; CI95% 0.57-0.85, p < 0.001) and benefit in mortality was maintained for SBP < 100 mmHg (HR 0.42; CI95% 0.22-0.82; p = 0.011). Moreover, therapy intensity was clearly associated with lower risk of HF-hospitalization and death after the additional regression, considering SBP as a covariate, in the whole cohort (HR 0.70; CI95% 0.57-0.85; p < 0.001). CONCLUSIONS In this retrospective cohort analysis, patients with HFrEF and an acute-HF admission, intensive drug dose titration was related to better outcomes, even in patients with low blood pressure at hospital discharge. Therefore, hypotension is not a contraindication for NHB uptitration.
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Affiliation(s)
- Maria Melendo-Viu
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain; Faculty of Medicine, University Complutense of Madrid, Spain.
| | - David Dobarro
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
| | | | | | - Sergio Raposeiras-Roubín
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
| | - Emad Abu-Assi
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
| | | | | | | | | | | | - Enrique García
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Andrés Íñiguez Romo
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
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8
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Fremes SE, Marquis-Gravel G, Gaudino MFL, Jolicoeur EM, Bédard S, Masterson Creber R, Ruel M, Vervoort D, Wijeysundera HC, Farkouh ME, Rouleau JL. STICH3C: Rationale and Study Protocol. Circ Cardiovasc Interv 2023; 16:e012527. [PMID: 37582169 DOI: 10.1161/circinterventions.122.012527] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is the recommended mode of revascularization in patients with ischemic left ventricular dysfunction (iLVSD) and multivessel disease. However, contemporary percutaneous coronary intervention (PCI) outcomes have improved with the integration of novel technologies and refinement of revascularization strategies, and PCI is often used in clinical practice in this population. There is a lack of evidence from randomized trials comparing contemporary state-of-the-art PCI versus CABG for the treatment of iLVSD and multivessel disease. This was the impetus for the STICH3C trial (Canadian CABG or PCI in Patients With Ischemic Cardiomyopathy), described here. METHODS The STICH3C trial is a prospective, unblinded, international, multicenter trial with an expected sample size of 754 participants from ≈45 centers. Patients with multivessel/left main coronary artery disease and iLVSD with left ventricular ejection fraction ≤40% considered by the local Heart Team appropriate for and amenable to revascularization by both modes of revascularization will be randomized in a 1:1 ratio to state-of-the-art PCI or CABG. RESULTS The primary end point is the composite of death from any cause, stroke, spontaneous myocardial infarction, urgent repeat revascularization, or heart failure readmission, summarized as a time-to-event outcome. The key hierarchical end point is time to death and frequency of hospitalizations for heart failure. The key safety outcome is a composite of major adverse events. Disease-specific quality-of-life and health economics measures will be compared between groups. Participants will be followed for a median of 5 years, with a minimum follow-up of 4 years. CONCLUSIONS STICH3C will directly inform patients, clinicians, and international practice guidelines about the efficacy and safety of CABG versus PCI in patients with iLVSD. The results will provide novel and broad evidence, including clinical events, health status, and economic assessments, to guide care for patients with iLVSD and severe coronary artery disease. REGISTRATION URL: https://clinicaltrials.gov/; Unique identifier: NCT05427370.
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Affiliation(s)
- Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | | | - Mario F L Gaudino
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - E Marc Jolicoeur
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - Sylvain Bédard
- Centre d'excellence sur le partenariat avec les patients et le public, Montreal, Quebec, Canada (S.B.)
| | | | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (M.R.)
| | - Dominique Vervoort
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Michael E Farkouh
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Ontario, Canada (M.E.F.)
| | - Jean-Lucien Rouleau
- Montreal Heart Institute, University of Montreal, Quebec, Canada (G.M.-G., E.M.J., J.-L.R.)
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9
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Renal denervation in management of heart failure with reduced ejection fraction: A systematic review and meta-analysis. J Cardiol 2023; 81:513-521. [PMID: 36758670 DOI: 10.1016/j.jjcc.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/13/2022] [Accepted: 01/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Some, but not all, recent studies have shown that renal denervation (RDN) can improve cardiac function and exercise tolerance in people who have heart failure with reduced ejection fraction (HFrEF). This study assessed the efficacy and safety of RDN as a treatment for HFrEF. METHODS The Medline, Cochrane Library, Embase, and PubMed databases were searched through to September 28, 2022 for clinical studies that evaluated the effect of RDN on HFrEF. The primary endpoints were changes in left ventricular ejection fraction (LVEF) and 6-min walk distance (6MWD). Secondary endpoints were changes in echocardiographic parameters, including left ventricular end-diastolic and end-systolic diameters, left atrial diameter, and interventricular septal thickness. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, New York Heart Association (NYHA) class, heart rate, and systolic and diastolic blood pressure were also evaluated. Major adverse events were defined as death and rehospitalization for heart failure during follow-up. The estimated glomerular filtration rate (eGFR) and serum creatinine level were extracted as measures of renal function. RESULTS Eleven trials comprising 313 patients were eligible for quantitative analysis. Pooled analyses showed a mean increase in LVEF of 4.25 % (95 % CI 1.77-6.72; p < 0.001, I2 = 69 %) and an increase in 6MWD (mean difference 50.28 m, 95 % CI 8.78-91.78; p = 0.02; I2 = 81 %) after RDN. Left ventricular end-diastolic and end-systolic diameters, left atrial diameter, and interventricular septal thickness also improved after RDN. NT-proBNP, NYHA class, and heart rate were significantly decreased after RDN. There were no significant changes in blood pressure after RDN. Mortality and HF-related hospitalization rates were relatively low. There was no significant change in eGFR or creatinine after RDN. CONCLUSIONS Our findings suggest that RDN can effectively increase LVEF and 6MWD in patients with HFrEF but require confirmation in studies with larger sample sizes and longer follow-up durations.
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10
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Tromp J, Voors AA. Heart failure medication: moving from evidence generation to implementation. Eur Heart J 2022; 43:2588-2590. [PMID: 35758247 DOI: 10.1093/eurheartj/ehac272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore & the National University Health System, Singapore.,Duke-NUS Medical School, Singapore.,University Medical Centre Groningen, Department of Cardiology, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, Department of Cardiology, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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11
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Kyriakopoulos CP, Kapelios CJ, Stauder EL, Taleb I, Hamouche R, Sideris K, Koliopoulou AG, Bonios MJ, Drakos SG. LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement. J Clin Med 2022; 11:3542. [PMID: 35743611 PMCID: PMC9225013 DOI: 10.3390/jcm11123542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. In the first part of this review, we discuss the historical background, current evidence on the incidence and assessment of LVAD-mediated cardiac recovery, and out-comes including quality of life after LVAD support withdrawal. In the second part, we discuss current and future opportunities to promote LVAD-mediated reverse remodeling and improve our pathophysiological understanding of HF and recovery for the benefit of the greater HF population.
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Affiliation(s)
- Christos P. Kyriakopoulos
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Chris J. Kapelios
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
| | - Elizabeth L. Stauder
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Iosif Taleb
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Rana Hamouche
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Konstantinos Sideris
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
| | - Antigone G. Koliopoulou
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Divisions of Cardiology & Cardiothoracic Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Michael J. Bonios
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Divisions of Cardiology & Cardiothoracic Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stavros G. Drakos
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
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12
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Ostrominski JW, Vaduganathan M. Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction. Clin Cardiol 2022; 45 Suppl 1:S40-S51. [PMID: 35789014 PMCID: PMC9254675 DOI: 10.1002/clc.23849] [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: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Heart failure (HF) is a chronic, progressive, and increasingly prevalent syndrome characterized by stepwise declines in health status and residual lifespan. Despite significant advancements in both pharmacologic and nonpharmacologic management approaches for chronic HF, the burden of HF hospitalization-whether attributable to new-onset (de novo) HF or worsening of established HF-remains high and contributes to excess HF-related morbidity, mortality, and healthcare expenditures. Owing to a paucity of evidence to guide tailored interventions in this heterogeneous group, management of acute HF events remains largely subject to clinician discretion, relying principally on alleviation of clinical congestion, as-needed correction of hemodynamic perturbations, and concomitant reversal of underlying trigger(s). Following acute stabilization, the subsequent phase of care primarily involves interventions known to improve long-term outcomes and rehospitalization risk, including initiation and optimization of disease-modifying pharmacotherapy, targeted use of adjunctive therapies, and attention to contributing comorbid conditions. However, even with current standards of care many patients experience recurrent HF hospitalization, or after admission incur worsening clinical trajectories. These patterns highlight a persistent unmet need for evidence-based approaches to inform in-hospital HF care and call for renewed focus on urgent implementation of interventions capable of ameliorating risk of worsening HF. In this review, we discuss key contemporary and emerging therapeutic strategies for patients hospitalized with de novo or worsening HF.
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Affiliation(s)
- John W. Ostrominski
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical SchoolBostonMAUSA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical SchoolBostonMAUSA
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13
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D'Amario D, Rodolico D, Rosano GM, Dahlström U, Crea F, Lund LH, Savarese G. Association between dosing and combination use of medications and outcomes in heart failure with reduced ejection fraction: data from the Swedish Heart Failure Registry. Eur J Heart Fail 2022; 24:871-884. [PMID: 35257446 PMCID: PMC9315143 DOI: 10.1002/ejhf.2477] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS To assess the association between combination, dose and use of current guideline-recommended target doses (TD) of renin-angiotensin system inhibitors (RASi), angiotensin receptor-neprilysin inhibitors (ARNi) and β-blockers, and outcomes in a large and unselected contemporary cohort of patients with heart failure (HF) and reduced ejection fraction. METHODS AND RESULTS Overall, 17 809 outpatients registered in the Swedish Heart Failure Registry (SwedeHF) from May 2000 to December 2018, with ejection fraction <40% and duration of HF ≥90 days were selected. Primary outcome was a composite of time to cardiovascular death and first HF hospitalization. Compared with no use of RASi or ARNi, the adjusted hazard ratio (HR) (95% confidence interval [CI]) was 0.83 (0.76-0.91) with <50% of TD, 0.78 (0.71-0.86) with 50%-99%, and 0.73 (0.67-0.80) with ≥100% of TD. Compared with no use of β-blockers, the adjusted HR (95% CI) was 0.86 (0.76-0.91), 0.81 (0.74-0.89) and 0.74 (0.68-0.82) with <50%, 50%-99% and ≥100% of TD, respectively. Patients receiving both an angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB)/ARNi and a β-blocker at 50%-99% of TD had a lower adjusted risk of the primary outcome compared with patients only receiving one drug, i.e. ACEi/ARB/ARNi or β-blocker, even if this was at ≥100% of TD. CONCLUSION Heart failure with reduced ejection fraction patients using higher doses of RASi or ARNi and β-blockers had lower risk of cardiovascular death or HF hospitalization. Use of two drug classes at 50%-99% of TD dose was associated with lower risk than one drug class at 100% of TD.
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Affiliation(s)
- Domenico D'Amario
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
- Department of Cardiovascular SciencesFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | - Daniele Rodolico
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | | | - Ulf Dahlström
- Department of Cardiology and the Department of Health, Medicine and Caring SciencesLinkoping UniversityLinkopingSweden
| | - Filippo Crea
- Department of Cardiovascular SciencesFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | - Lars H. Lund
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
- Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
- Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
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14
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Potere N, Del Buono MG, Vecchié A, Porreca E, Abbate A, Dentali F, Bonaventura A. Diabetes mellitus and heart failure: an update on pathophysiology and therapy. Minerva Cardiol Angiol 2022; 70:344-356. [PMID: 35212512 DOI: 10.23736/s2724-5683.22.05967-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetes mellitus (DM) is frequent among heart failure (HF) patients with a further projected increase in prevalence in next years. DM promotes the development of both HF with reduced (HFrEF) and preserved ejection fraction (HFpEF) through different mechanisms. As the general prevalence of both DM and HF is growing worldwide, it is important to define the pathophysiologic mechanisms driving the development of HF in DM patients. These include changes in the cardiac metabolism, mitochondrial dysfunction, impairment in insulin signaling, maladaptive inflammation, coronary microvascular dysfunction, endoplasmic reticulum stress, autophagy suppression, and structural changes, among the main ones. In recent years, novel glucose-lowering treatments, especially sodium-glucose cotransporter 2 inhibitors (SGLT-2is), have shown a strikingly positive impact on the natural history of HF. This has led to a progressive change in choosing SGLT-2is in DM patients at high risk for CV disease, supported by recent guidelines. The knowledge about novel pathophysiological mechanisms linking DM and HF may open the way to the development of new targeted therapies in the future. In this review, we will summarize general aspects dealing with incidence, prevalence, and pathophysiology of DM in HF patients. As well, we discuss the therapeutic targets to reduce the disease burden and the current evidence of glucose-lowering drugs in patients with DM and HF.
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Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences and Department of Innovative Technologies in Medicine and Dentistry, G. D'Annunzio University, Chieti, Italy
| | - Marco G Del Buono
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandra Vecchié
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Ettore Porreca
- Department of Medicine and Ageing Sciences and Department of Innovative Technologies in Medicine and Dentistry, G. D'Annunzio University, Chieti, Italy
| | - Antonio Abbate
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Aldo Bonaventura
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy -
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15
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Villa C, Auerbach SR, Bansal N, Birnbaum BF, Conway J, Esteso P, Gambetta K, Hall EK, Kaufman BD, Kirmani S, Lal AK, Martinez HR, Nandi D, O’Connor MJ, Parent JJ, Raucci FJ, Shih R, Shugh S, Soslow JH, Tunuguntla H, Wittlieb-Weber CA, Kinnett K, Cripe L. Current Practices in Treating Cardiomyopathy and Heart Failure in Duchenne Muscular Dystrophy (DMD): Understanding Care Practices in Order to Optimize DMD Heart Failure Through ACTION. Pediatr Cardiol 2022; 43:977-985. [PMID: 35024902 PMCID: PMC8756173 DOI: 10.1007/s00246-021-02807-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/17/2021] [Indexed: 02/06/2023]
Abstract
Cardiac disease has emerged as a leading cause of mortality in Duchenne muscular dystrophy in the current era. This survey sought to identify the diagnostic and therapeutic approach to DMD among pediatric cardiologists in Advanced Cardiac Therapies Improving Outcomes Network. Pediatric cardiology providers within ACTION (a multi-center pediatric heart failure learning network) were surveyed regarding their approaches to cardiac care in DMD. Thirty-one providers from 23 centers responded. Cardiac MRI and Holter monitoring are routinely obtained, but the frequency of use and indications for ordering these tests varied widely. Angiotensin converting enzyme inhibitor and aldosterone antagonist are generally initiated prior to onset of systolic dysfunction, while the indications for initiating beta-blocker therapy vary more widely. Seventeen (55%) providers report their center has placed an implantable cardioverter defibrillator in at least 1 DMD patient, while 11 providers (35%) would not place an ICD for primary prevention in a DMD patient. Twenty-three providers (74%) would consider placement of a ventricular assist device (VAD) as destination therapy (n = 23, 74%) and three providers (10%) would consider a VAD only as bridge to transplant. Five providers (16%) would not consider VAD at their institution. Cardiac diagnostic and therapeutic approaches vary among ACTION centers, with notable variation present regarding the use of advanced therapies (ICD and VAD). The network is currently working to harmonize medical practices and optimize clinical care in an era of rapidly evolving outcomes and cardiac/skeletal muscle therapies.
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Affiliation(s)
- Chet Villa
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA.
| | - Scott R. Auerbach
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, Division of Cardiology, University of Colorado, Denver Anschutz Medical Campus, Children’s Hospital Colorado Aurora, Aurora, CO USA
| | - Neha Bansal
- grid.251993.50000000121791997Division of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Brian F. Birnbaum
- grid.239559.10000 0004 0415 5050Children’s Mercy Hospital and Clinics, Kansas City, MO USA
| | - Jennifer Conway
- grid.416656.60000 0004 0633 3703Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
| | - Paul Esteso
- grid.2515.30000 0004 0378 8438Boston Children’s Hospital, Boston, MA USA
| | - Katheryn Gambetta
- grid.413808.60000 0004 0388 2248Ann and Robert H Lurie Children’s Hospital, Chicago, IL USA
| | - E. Kevin Hall
- grid.417307.6Yale New Haven Children’s Hospital, Yale University School of Medicine, New Haven, CT USA
| | - Beth D. Kaufman
- grid.168010.e0000000419368956Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA USA
| | - Sonya Kirmani
- grid.414182.a0000 0004 0496 1167Duke Children’s Pediatric and Congenital Heart Center, Duke Children’s Hospital, Durham, NC USA
| | - Ashwin K. Lal
- grid.223827.e0000 0001 2193 0096Division of Pediatric Cardiology, Primary Children’s Hospital, University of Utah, Salt Lake City, UT USA
| | - Hugo R. Martinez
- grid.267301.10000 0004 0386 9246The Heart Institute at Le Bonheur Children’s Hospital and The University of Tennessee Health Science Center, Memphis, TN USA
| | - Deipanjan Nandi
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
| | - Matthew J. O’Connor
- grid.25879.310000 0004 1936 8972Division of Cardiology, Department of Pediatrics, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - John J. Parent
- grid.257413.60000 0001 2287 3919Riley Hospital for Children, Indiana University, Indianapolis, IN USA
| | - Frank J. Raucci
- grid.224260.00000 0004 0458 8737Children’s Hospital of Richmond, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Renata Shih
- grid.15276.370000 0004 1936 8091Congenital Heart Center, University of Florida, Gainesville, FL USA
| | - Svetlana Shugh
- grid.428608.00000 0004 0444 4338Heart Institute, Joe DiMaggio Children’s Hospital, Hollywood, FL USA
| | - Jonathan H. Soslow
- grid.416074.00000 0004 0433 6783Department of Pediatrics, Thomas P. Graham Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN USA
| | - Hari Tunuguntla
- grid.39382.330000 0001 2160 926XDepartment of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Carol A. Wittlieb-Weber
- grid.25879.310000 0004 1936 8972Division of Cardiology, Department of Pediatrics, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Kathi Kinnett
- grid.437213.00000 0004 5907 1479Parent Project Muscular Dystrophy, Hackensack, NJ USA
| | - Linda Cripe
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
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16
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Rubio R, Palacios B, Varela L, Fernández R, Camargo Correa S, Estupiñan MF, Calvo E, José N, Ruiz Muñoz M, Yun S, Jiménez-Marrero S, Alcoberro L, Garay A, Moliner P, Sánchez-Fernández L, Soria Gómez MT, Hidalgo E, Enjuanes C, Calero-Molina E, Rueda Y, San Saturnino M, Garcimartín P, López-Ibor JV, Segovia-Cubero J, Comin-Colet J. Quality of life and disease experience in patients with heart failure with reduced ejection fraction in Spain: a mixed-methods study. BMJ Open 2021; 11:e053216. [PMID: 34862295 PMCID: PMC8647550 DOI: 10.1136/bmjopen-2021-053216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients' experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers. DESIGN Observational, descriptive, multicentre, cross-sectional, mixed-methods study. SETTING Secondary care, patient's homes. PARTICIPANTS Twenty patients with HFrEF (New York Heart Association (NYHA) classification I-III) aged 38-85 years. MEASURES PROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation. RESULTS A total of 20 patients with HFrEF participated in the study. The patients' mean (SD) age was 72.5 (11.4) years, 65% were male and were classified inNYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients' quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed. CONCLUSIONS PROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient's status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.
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Affiliation(s)
| | - Beatriz Palacios
- Medical Department, AstraZeneca Farmacéutica Spain SA, Madrid, Spain
| | - Luis Varela
- Medical Department, AstraZeneca Farmacéutica Spain SA, Madrid, Spain
| | - Raquel Fernández
- Medical Department, AstraZeneca Farmacéutica Spain SA, Madrid, Spain
| | | | | | - Elena Calvo
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Nuria José
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Marta Ruiz Muñoz
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Sergi Yun
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Santiago Jiménez-Marrero
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Lidia Alcoberro
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Alberto Garay
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Department of Cardio-Oncology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Pedro Moliner
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Department of Cardio-Oncology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Lydia Sánchez-Fernández
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Department of Cardio-Oncology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | | | - Encarna Hidalgo
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Cristina Enjuanes
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Esther Calero-Molina
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | | | | | - Paloma Garcimartín
- Outpatients Clinics, Hospital del Mar, Barcelona, Spain
- Department of Biomedical Research in Heart Diseases, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Jorge V López-Ibor
- Department of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Javier Segovia-Cubero
- Department of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
- CIBER of Cardiovascular Diseases, Carlos III Health Institute, Madrid, Spain
| | - Josep Comin-Colet
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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17
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Caseley P, Houchens N, Gupta A. Quality and Safety in the Literature: January 2022. BMJ Qual Saf 2021; 31:64-69. [PMID: 34815352 DOI: 10.1136/bmjqs-2021-014410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Paul Caseley
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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18
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Abstract
Advanced heart failure (HF) is characterized by a progressive worsening of symptoms disabling for daily life, refractory to all therapies, and with high mortality. These patients may be candidates for life-prolonging therapies, such as heart transplantation (HT) or long-term (LT) mechanical circulatory support (MCS) or must just require palliative therapies. The 1-year survival after HT and/or LT-MCS is approaching 80% to 90%, being patient selection and timely referral to advanced HF centers critical for optimal outcomes. There is no single symptom, sign, or test that can identify these patients and different classifications are complementary and helpful for clinical decision-making.
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19
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Piña IL, Allen LA, Desai NR. Policy and Payment Challenges in the Postpandemic Treatment of Heart Failure: Value-Based Care and Telehealth. J Card Fail 2021; 28:835-844. [PMID: 34520854 PMCID: PMC8434774 DOI: 10.1016/j.cardfail.2021.08.019] [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: 04/27/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022]
Abstract
Increasing patient and therapeutic complexity have created both challenges and opportunities for heart failure care. Within this background, the coronavirus disease-2019 pandemic has disrupted care as usual, accelerating the need for transition from volume-based to value-based care, and demanding a rapid expansion of telehealth and remote care for heart failure. Patients, clinicians, health systems, and payors have by necessity become more invested in these issues. Herein we review recent changes in health care policy related to the movement from volume to value-based payment and from in-person to remote care delivery.
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Affiliation(s)
- Ileana L Piña
- Central Michigan University, Mount Pleasant, Michigan.
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nihar R Desai
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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Oppedisano F, Mollace R, Tavernese A, Gliozzi M, Musolino V, Macrì R, Carresi C, Maiuolo J, Serra M, Cardamone A, Volterrani M, Mollace V. PUFA Supplementation and Heart Failure: Effects on Fibrosis and Cardiac Remodeling. Nutrients 2021; 13:nu13092965. [PMID: 34578843 PMCID: PMC8471017 DOI: 10.3390/nu13092965] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) characterized by cardiac remodeling is a condition in which inflammation and fibrosis play a key role. Dietary supplementation with n-3 polyunsaturated fatty acids (PUFAs) seems to produce good results. In fact, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anti-inflammatory and antioxidant properties and different cardioprotective mechanisms. In particular, following their interaction with the nuclear factor erythropoietin 2 related factor 2 (NRF2), the free fatty acid receptor 4 (Ffar4) receptor, or the G-protein coupled receptor 120 (GPR120) fibroblast receptors, they inhibit cardiac fibrosis and protect the heart from HF onset. Furthermore, n-3 PUFAs increase the left ventricular ejection fraction (LVEF), reduce global longitudinal deformation, E/e ratio (early ventricular filling and early mitral annulus velocity), soluble interleukin-1 receptor-like 1 (sST2) and high-sensitive C Reactive protein (hsCRP) levels, and increase flow-mediated dilation. Moreover, lower levels of brain natriuretic peptide (BNP) and serum norepinephrine (sNE) are reported and have a positive effect on cardiac hemodynamics. In addition, they reduce cardiac remodeling and inflammation by protecting patients from HF onset after myocardial infarction (MI). The positive effects of PUFA supplementation are associated with treatment duration and a daily dosage of 1–2 g. Therefore, both the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) define dietary supplementation with n-3 PUFAs as an effective therapy for reducing the risk of hospitalization and death in HF patients. In this review, we seek to highlight the most recent studies related to the effect of PUFA supplementation in HF. For that purpose, a PubMed literature survey was conducted with a focus on various in vitro and in vivo studies and clinical trials from 2015 to 2021.
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Affiliation(s)
- Francesca Oppedisano
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
- Correspondence: (F.O.); (V.M.)
| | - Rocco Mollace
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Division of Cardiology, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy
- Department of Cardiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy;
| | - Annamaria Tavernese
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
| | - Micaela Gliozzi
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
| | - Vincenzo Musolino
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
| | - Roberta Macrì
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
| | - Cristina Carresi
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
| | - Jessica Maiuolo
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
| | - Maria Serra
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
| | - Antonio Cardamone
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
| | | | - Vincenzo Mollace
- Department of Health Sciences, Institute of Research for Food Safety & Health (IRC-FSH), University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (A.T.); (M.G.); (V.M.); (R.M.); (C.C.); (J.M.); (M.S.); (A.C.)
- Nutramed S.c.a.r.l., Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy
- Department of Cardiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy;
- Correspondence: (F.O.); (V.M.)
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Abstract
Endotyping is an emerging concept in which diseases are classified into distinct subtypes based on underlying molecular mechanisms. Heart failure (HF) is a complex clinical syndrome that encompasses multiple endotypes with differential risks of adverse events, and varying responses to treatment. Identifying these distinct endotypes requires molecular-level investigation involving multi-"omics" approaches, including genomics, transcriptomics, proteomics, and metabolomics. The derivation of these HF endotypes has important implications in promoting individualized treatment and facilitating more targeted selection of patients for clinical trials, as well as in potentially revealing new pathways of disease that may serve as therapeutic targets. One challenge in the integrated analysis of high-throughput omics and detailed clinical data is that it requires the ability to handle "big data", a task for which machine learning is well suited. In particular, unsupervised machine learning has the ability to uncover novel endotypes of disease in an unbiased approach. In this review, we will discuss recent efforts to identify HF endotypes and cover approaches involving proteomics, transcriptomics, and genomics, with a focus on machine-learning methods.
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Affiliation(s)
- Lusha W Liang
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center
| | - Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center
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Bhatt AS, Solomon SD, Vaduganathan M. Prioritizing Dissemination and Implementation Science in Cardiometabolic Medicine: CONNECTing the Dots. JAMA 2021; 326:311-313. [PMID: 34313706 DOI: 10.1001/jama.2021.9847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ankeet S Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, Massachusetts
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Fine NM, Walsh MN. Juggling While Dancing: The Complex Medical Management of Heart Failure With Reduced Ejection Fraction. JACC Case Rep 2021; 3:1077-1080. [PMID: 34317688 PMCID: PMC8311356 DOI: 10.1016/j.jaccas.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Despite multiple attempts to develop a unifying hypothesis that explains the pathophysiology of heart failure with a reduced ejection fraction (HFrEF), no single conceptual model has withstood the test of time. In the present review, we discuss how the results of recent successful phase III clinical development programs in HFrEF are built upon existing conceptual models for drug development. We will also discuss where recent successes in clinical trials do not fit existing models to identify areas where further refinement of current paradigms may be needed. To provide the necessary structure for this review, we will begin with a brief overview of the pathophysiology of HFrEF, followed by an overview of the current conceptual models for HFrEF, and end with an analysis of the scientific rationale and clinical development programs for 4 new therapeutic classes of drugs that have improved clinical outcomes in HFrEF. The 4 new therapeutic classes discussed are ARNIs, SGLT2 (sodium-glucose cotransporter 2) inhibitors, soluble guanylate cyclase stimulators, and myosin activators. With the exception of SGLT2 inhibitors, each of these therapeutic advances was informed by the insights provided by existing conceptual models of heart failure. Although the quest to determine the mechanism of action of SGLT2 inhibitors is ongoing, this therapeutic class of drugs may represent the most important advance in cardiovascular therapeutics of recent decades and may lead to rethinking or expanding our current conceptual models for HFrEF.
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Affiliation(s)
- Douglas L. Mann
- Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO 63108
| | - G. Michael Felker
- Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO 63108
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Mo Y, Chu M, Hu W, Wang H. Association between the nurse-led program with mental health status, quality of life, and heart failure rehospitalization in chronic heart failure patients. Medicine (Baltimore) 2021; 100:e25052. [PMID: 33725890 PMCID: PMC7969300 DOI: 10.1097/md.0000000000025052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/03/2021] [Accepted: 02/13/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The nurse-led program is associated with a short-term improvement of mental health status (MHS) and quality of life (QOL) in patients with chronic heart failure (CHF). Nonetheless, the long-term effect of this program is undetermined. The aims of the current study were to evaluate the 1-year effects of the nurse-led program on MHS, QOL, and heart failure (HF) rehospitalization among patients with CHF.CHF patients in the control group received standard care, and patients in the treatment group received standard care plus telehealth intervention including inquiring patients' medical condition, providing feedbacks, counseling and providing positive and emotional talk with the patients. At the third, sixth, and twelfth month's follow-up, patients were called by registered nurses to assess the Mental Health Inventory-5 (MHI-5) and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. HF rehospitalization was also assessed.A total of 300 patients were included and 46% (n = 138) of the patients were in the treatment group. There were no significant between-group differences in the MHI-5 and KCCQ scores at baseline. In the control group, the MHI-5 score was gradually decreased with follow-up and the score was significantly lower than that in the treatment group since the third month's follow-up (63.5 ± 10.6 vs 73.6 ± 10.3). Compared with the treatment group, KCCQ score was lower in the control group from the third month's follow-up (64.3 ± 10.6 vs 73.5 ± 12.3) until the end of the twelfth months' follow-up (45.3 ± 11.2 vs 60.8 ± 11.1). During 12 months' follow-up, the proportion of patients who experienced HF rehospitalization was lower in the treatment group (19.6% vs 24.1%). After adjusting for covariates, the utilization of the nurse-led program, and increase of MHI-5 and KCCQ scores were associated with reduced risk of HF rehospitalization.The nurse-led program is beneficial for the improvement of MHS and QOL for CHF patients, which might contribute to the reduction of HF rehospitalization.
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Affiliation(s)
- Yuzhu Mo
- Department of Nursing, Hainan Western Central Hospital, Hainan
| | - Mingzi Chu
- Department of Nursing, the Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Wenxiong Hu
- Department of Nursing, Hainan Western Central Hospital, Hainan
| | - Haiyan Wang
- Department of Nursing, the Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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