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Ashraf S, Khalaf AKS, Fatima L, Hashim HT, Irfan H, Ashfaq H, Khan MA, Zahid A, Akram U, Goyal A. Evaluating the role of ivabradine in acute decompensated heart failure: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102604. [PMID: 38729277 DOI: 10.1016/j.cpcardiol.2024.102604] [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: 04/19/2024] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) presents a significant global health challenge, with high morbidity, mortality, and healthcare costs. The current therapeutic options for ADHF are limited. Ivabradine, a selective inhibitor of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, has emerged as a potential therapy for ADHF by reducing the heart rate (HR) without negatively affecting myocardial contractility. However, the evidence regarding the efficacy and safety of ivabradine in patients with ADHF is limited and inconsistent. This meta-analysis aimed to evaluate the efficacy and safety of ivabradine for ADHF based on observational studies. METHODS A systematic literature search was conducted following PRISMA guidelines to identify relevant observational studies comparing ivabradine with placebo in adult patients with ADHF. Data were pooled using a random-effects model, and heterogeneity was assessed. The risk of bias was evaluated using the Newcastle-Ottawa Scale. RESULTS Four observational studies comprising a total of 12034 patients. Meta-analysis revealed that ivabradine significantly reduced all-cause mortality (RR: 0.66, 95 % CI: 0.49-0.89, p < 0.01) and resting HR (MD: -12.54, 95 % CI: -21.66-3.42, p < 0.01) compared to placebo. However, no significant differences were observed in cardiovascular mortality, hospital readmission for all causes, changes in LVEF, or changes in LVEDD. Sensitivity and publication bias assessments were conducted for each outcome. CONCLUSION Ivabradine may be beneficial for reducing mortality and HR in patients with ADHF. However, its impact on other clinical outcomes such as cardiovascular mortality, hospital readmission, and cardiac function remains inconclusive. Further research, particularly well-designed RCTs with larger sample sizes and longer follow-up durations, are warranted.
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Affiliation(s)
- Saad Ashraf
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Hashim Talib Hashim
- Department of Internal Medicine, University of Warith Al-Anbiyaa, College of Medicine, Karbala, Iraq
| | - Hamza Irfan
- Department of Internal Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Maryam Ahmed Khan
- Department of Internal Medicine, Fazaia Medical College, Islamabad, Pakistan
| | - Arhamah Zahid
- Department of Internal Medicine, Fazaia Medical College, Islamabad, Pakistan
| | - Umar Akram
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India.
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Zhou J, Xu Y, Zheng Z, Zhang S, Yang J, Zhang Y, Tang B, Han H, Zhang Q, Liu F, Ding W, Qian C, Su G, Liu X, Shen Y, Shi B, Kong X, Ge Z, Zhang P, Guo X, Zhang H, Sun Y, Dong Y, Fu G, Feng L, Ge J. Effectiveness and safety of ivabradine in Chinese patients with chronic heart failure: an observational study. ESC Heart Fail 2024; 11:846-858. [PMID: 38193606 PMCID: PMC10966258 DOI: 10.1002/ehf2.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 08/12/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024] Open
Abstract
AIMS A therapeutic strategy for chronic heart failure (HF) is to lower resting heart rate (HR). Ivabradine is a well-known HR-lowering agent, but limited prospective data exist regarding its use in Chinese patients. This study aimed to evaluate the effectiveness and safety of ivabradine in Chinese patients with chronic HF. METHODS AND RESULTS This multicentre, single-arm, prospective, observational study enrolled Chinese patients with chronic HF. The primary outcome was change from baseline in HR at 1 and 6 months, measured by pulse counting. Effectiveness was also evaluated using laboratory tests, the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary score (CSS) and overall summary score (OSS), and New York Heart Association (NYHA) class. Treatment-emergent adverse events (TEAEs) were assessed. A post hoc analysis examined the effectiveness and safety of ivabradine combined with an angiotensin receptor-neprilysin inhibitor (ARNI) or beta-blocker. A total of 1003 patients were enrolled [mean age 54.4 ± 15.0 years, 773 male (77.1%), mean baseline HR 88.5 ± 11.3 b.p.m., mean blood pressure 115.7/74.4 ± 17.2/12.3 mmHg, mean left ventricular ejection fraction 30.9 ± 7.6%, NYHA Classes III and IV in 48.8% and 22.0% of patients, respectively]. HR decreased by a mean of 12.9 and 16.1 b.p.m. after 1 and 6 months, respectively (both P < 0.001). At Month 6, improvements in the KCCQ CSS and OSS of ≥5 points were observed in 72.1% and 74.1% of patients, respectively (both P < 0.001). Left ventricular ejection fraction increased by 12.1 ± 11.6 (P < 0.001), and 66.7% of patients showed improvement in NYHA class (P < 0.001). At Month 6, the overall proportion of patients in NYHA Classes III and IV was reduced to 13.5% and 2.1%, respectively. Serum brain natriuretic peptide (BNP) and N-terminal pro-BNP changed by -331.9 ng/L (-1238.6, -134.0) and -1113.8 ng/L (-2202.0, -297.2), respectively (P < 0.001). HR reductions and improvements in NYHA and KCCQ scores with ivabradine were similar with and without use of ARNIs or beta-blockers. Of 498 TEAEs in 296 patients (29.5%), 73 TEAEs in 55 patients (5.5%) were considered related to ivabradine [most frequent sinus bradycardia (n = 7) and photopsia (n = 7)]. TEAEs were reported in a similar number of patients in ARNI and beta-blocker subgroups (21.9-35.6%). CONCLUSIONS Ivabradine treatment reduced HR and improved cardiac function and health-related quality of life in Chinese patients with chronic HF. Benefits were seen irrespective of whether or not patients were also taking ARNIs or beta-blockers. Treatment was well tolerated with a similar profile to previous ivabradine studies.
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Affiliation(s)
- Jingmin Zhou
- Department of CardiologyZhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular DiseasesShanghaiChina
| | - Yamei Xu
- Department of CardiologyZhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular DiseasesShanghaiChina
| | | | | | | | | | - Baopeng Tang
- The First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | | | - Qing Zhang
- West China Hospital, Sichuan UniversityChengduChina
| | - Fan Liu
- The Second Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Wenhui Ding
- Peking University First HospitalBeijingChina
| | | | - Guohai Su
- Jinan Central Hospital Affiliated to Shandong UniversityJinanChina
| | - Xiaohui Liu
- Beijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | | | - Bei Shi
- Affiliated Hospital of Zunyi Medical CollegeZunyiChina
| | | | - Zhiming Ge
- Qilu Hospital of Shandong University (Qingdao)QingdaoChina
| | - Ping Zhang
- Beijing Tsinghua Changgung HospitalBeijingChina
| | - Xiaomei Guo
- Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hong Zhang
- First People's Hospital of Yunnan ProvinceKunmingChina
| | - Yuemin Sun
- Tianjin Medical University General HospitalTianjinChina
| | - Yugang Dong
- The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, Zhejiang University School of MedicineZhejiangChina
| | - Lei Feng
- Servier (Tianjin) Pharmaceutical Co., LtdBeijingChina
| | - Junbo Ge
- Department of CardiologyZhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular DiseasesShanghaiChina
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Yang J, Lv T, Zhou J, Lin H, Zhao B, Lou H, Liu H, Zhang T, Guo H, Chi J. The effect of ivabradine therapy on dilated cardiomyopathy patients with congestive heart failure: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1149351. [PMID: 37915740 PMCID: PMC10616249 DOI: 10.3389/fcvm.2023.1149351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Background Ivabradine improves cardiac function in patients with heart failure, but its effect on dilated cardiomyopathy (DCM) remains unclear. We performed a systematic review and meta-analysis to study the efficacy and potential mechanisms of ivabradine's effect on cardiac function and prognosis in patients with DCM. Methods We searched PubMed, Cochrane Library, Embase, Web of Science, and four registers through September 28, 2022. All controlled trials of ivabradine for the treatment of DCM with congestive heart failure were included. Articles were limited to English, with the full text and necessary data available. We performed random- or fixed effects meta-analyses for all included outcome measures and compared the effect sizes for outcomes in patients treated with and without ivabradine. The quality of the studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB2.0). Findings Five trials with 357 participants were included. The pooled risk ratio was 0.48 [95% confidence interval (CI) (0.18, 1.25)] for all-cause mortality and 0.38 [95% CI (0.12, 1.23)] for cardiac mortality. The pooled mean difference was -15.95 [95% CI (-19.97, -11.92)] for resting heart rate, 3.96 [95% CI (0.99, 6.93)] for systolic blood pressure, 2.93 [95% CI (2.09, 3.77)] for left ventricular ejection fraction, -5.90 [95% CI (-9.36, -2.44)] for left ventricular end-systolic diameter, -3.41 [95% CI (-5.24, -1.58)] for left ventricular end-diastolic diameter, -0.81 [95% CI (-1.00, -0.62)] for left ventricular end-systolic volume, -0.67 [95% CI (-0.86, -0.48)] for left ventricular end-diastolic volume, -11.01 [95% CI (-19.66, -2.35)] for Minnesota Living with Heart Failure score, and -0.52 [95% CI (-0.73, -0.31)] for New York Heart Association class. Interpretation Ivabradine reduces heart rate and ventricular volume, and improves cardiac function in patients with DCM, but showed no significant effect on the prognosis of patients.
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Affiliation(s)
- Juntao Yang
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Tingting Lv
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Jiedong Zhou
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Hui Lin
- Ningbo Medical Center Lihuili Hospital (Lihuili Hospital Affiliated to Ningbo University), Ningbo, China
| | - Bingjie Zhao
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Haifei Lou
- Department of Cardiology, Shaoxing People’s Hospital, Shaoxing, China
| | - Hanxuan Liu
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Tao Zhang
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Hangyuan Guo
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Jufang Chi
- Department of Cardiology, Zhuji People’s Hospital, Zhuji, China
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Khan ZM, Briere JB, Olewinska E, Khrouf F, Nikodem M. Ivabradine in patients with heart failure: a systematic literature review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2262073. [PMID: 37808119 PMCID: PMC10552613 DOI: 10.1080/20016689.2023.2262073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
Background: Heart failure is a chronic disease linked with significant morbidity and mortality, and uncontrolled resting heart rate is a risk factor for adverse outcomes. This systematic literature review aimed to assess the efficacy, safety, and patient-reported outcomes (PROs) of ivabradine in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in randomized controlled trials (RCTs) and observational studies. Methods: We searched electronic databases from their inception to July 2021 to include studies that reported on efficacy, safety, or PROs of ivabradine in patients with HFrEF. Results: Of 1947 records screened, 51 RCTs and 6 observational studies were identified. Ivabradine on top of background therapy demonstrated a significant reduction in composite outcomes including hospitalization for HF or cardiovascular death. In addition, observational studies suggested that ivabradine was associated with a significant reduction in mortality. Across all studies, ivabradine use on top of background therapy was associated with greater reductions in heart rate, improved EF, and improved health-related quality of life (QoL) and comparable risk of total adverse events compared to those treated with background therapy alone. Conclusions: Ivabradine on top of background therapy is beneficial for heart rate, hospitalization risk for HF, mortality, EF, and patients' QoL. Moreover, these benefits were achieved with no significant increase in the overall risk of total adverse events.
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Affiliation(s)
| | | | | | - Fatma Khrouf
- Health Economics and Outcome Research, Putnam PHMR, Tunis, Tunisia
| | - Mateusz Nikodem
- Health Economics and Outcome Research, Putnam PHMR, Cracow, Poland
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Angélico-Gonçalves A, Leite AR, Neves JS, Saraiva F, Brochado L, Oliveira AC, Butler J, Packer M, Zannad F, Vasques-Nóvoa F, Leite-Moreira A, Ferreira JP. Changes in health-related quality of life and treatment effects in chronic heart failure: A meta-analysis. Int J Cardiol 2023:S0167-5273(23)00726-X. [PMID: 37211049 DOI: 10.1016/j.ijcard.2023.05.032] [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: 03/20/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with poor health status, and high morbi-mortality. However, it is not well established how health status changes correlate with treatment effects on clinical outcomes. Our aim was to study the association between treatment-induced changes in health-status, assessed by Kansas City Cardiomyopathy Questionnaire 23 (KCCQ-23) and clinical outcomes in chronic HF. METHODS Systematic search of phase III-IV pharmacological RCTs in chronic HF that assessed KCCQ-23 changes and clinical outcomes throughout follow-up. We studied the association between treatment induced changes in KCCQ-23 and treatment effects on clinical outcomes (HF hospitalization or cardiovascular death, HF hospitalization, cardiovascular death, and all-cause death) using weighted random-effects meta-regression. RESULTS Sixteen trials were included, enrolling a total of 65,664 participants. Treatment induced KCCQ-23 changes were moderately correlated with treatment effects on the combined outcome of HF hospitalization or cardiovascular mortality (regression coefficient (RC) = -0.047, 95%CI: -0.085 to -0.009; R2 = 49%), a correlation that was mainly driven by HF hospitalization (RC = -0.076, 95%CI: -0.124 to -0.029; R2 = 56%). Correlations of treatment induced KCCQ-23 changes with cardiovascular death (RC = -0.029, 95%CI: -0.073 to 0.015; R2 = 10%) and all-cause death (RC = -0.019, 95%CI: -0.057 to 0.019; R2 = 0%) were weak and non-significant. CONCLUSIONS Treatment-induced changes in KCCQ-23 were moderately correlated with treatment-effects on HF hospitalizations but were not correlated with the effects on cardiovascular and all-cause mortality. Treatment-induced changes in patient-centered outcomes (i.e., KCCQ-23) may reflect non-fatal symptomatic changes in the clinical course of HF leading to hospitalization.
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Affiliation(s)
- António Angélico-Gonçalves
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Rita Leite
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Endocrinology and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - João Sérgio Neves
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Endocrinology and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Liliana Brochado
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Cristina Oliveira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, United States of America; Department of Medicine, University of Mississippi, Jackson, MS, United States of America
| | - Milton Packer
- Baylor University Medical Center, Dallas, TX, United States of America; Imperial College, London, United Kingdom
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques, - Plurithématique 14-33 and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Francisco Vasques-Nóvoa
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Pedro Ferreira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Savarese G, Lindenfeld J, Stolfo D, Adams K, Ahmad T, Desai NR, Ammirati E, Gottlieb SS, Psotka MA, Rosano GMC, Allen LA. Use of patient-reported outcomes in heart failure: from clinical trials to routine practice. Eur J Heart Fail 2023; 25:139-151. [PMID: 36644876 DOI: 10.1002/ejhf.2778] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/06/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023] Open
Abstract
Heart failure (HF) is a complex syndrome that affects mortality/morbidity and acts at different levels in the patient's life, resulting in a drastic impairment in multiple aspects of daily activities (e.g. physical, mental/emotional, and social) and leading to a reduction in quality of life. The definition of disease status and symptom severity has been traditionally based on the physician assessment, while the patient's experience of disease has been long overlooked. The active participation of patients in their own care is necessary to better understand the perception of disease and the multiple aspects of life affected, and to improve adherence to treatments. Patient-reported outcomes (PROs) aim to switch traditional care to a more patient-centred approach. Although PROs demonstrated precision in the evaluation of disease status and have a good association with prognosis in several randomized controlled trials, their implementation into clinical practice is limited. This review discusses the modalities of use of PROs in HF, summarizes the most largely adopted PROs in HF care, and provides an overview on the application of PROs in trials and the potential for their transition to clinical practice. By discussing the advantages and the disadvantages of their use, the reasons limiting their application in daily clinical routine, and the strategies that may promote their implementation, this review aims to foster the systematic integration of the patient's standpoint in HF care.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joann Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Davide Stolfo
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Kirkwood Adams
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tariq Ahmad
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Nihar R Desai
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine and Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | | | - Giuseppe M C Rosano
- Centre for Clinical & Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Evertz R, Gödde K, Diehl C, Valentova M, Garfias‐Veitl T, Braulke F, Wulf GG, Overbeck TR, Bleckmann A, König AO, Weinländer P, Potthoff S, Hadzibegovic S, Lena A, Keller U, Landmesser U, Schuster A, Anker MS, Hasenfuß G, von Haehling S. Cardiovascular and metabolic determinants of quality of life in patients with cancer. ESC Heart Fail 2022; 10:167-176. [PMID: 36178215 PMCID: PMC9871717 DOI: 10.1002/ehf2.14175] [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: 05/16/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Maintaining quality of life (QoL) in patients with cancer has gathered significant interest, but little is known about its major determinants. We sought to identify determinants of QoL in patients undergoing cancer treatment as well as in treatment-naïve patients about to commence such therapy. METHODS AND RESULTS QoL was assessed in 283 patients with cancer using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 questionnaire. All patients underwent a battery of tests including physical examination, resting electrocardiogram, hand grip strength, and biochemistry assessment. Using multivariable logistic regression, we found that age [odds ratio (OR) 0.954, 95% confidence interval (CI) 0.916-0.994], resting heart rate (OR 1.036, 95% CI 1.004-1.068), hand grip strength (OR 0.932, 95% CI 0.878-0.990), and the presence of cachexia (OR 4.334, 95% CI 1.767-10.631) and dyspnoea (OR 3.725, 95% CI 1.540-9.010; all P < 0.05) remained independently predictive of reduced QoL. CONCLUSIONS Therefore, it may be reasonable to address circumstances that are affecting muscle mass, body weight, and heart rate to maintaining QoL; however, prospective studies to test these endpoints are required.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Katharina Gödde
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Christine Diehl
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,Department of PaediatricsUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Miroslava Valentova
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Tania Garfias‐Veitl
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Friederike Braulke
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,Comprehensive Cancer Center G‐CCCUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Gerald G. Wulf
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Tobias R. Overbeck
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Annalen Bleckmann
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,Department of Medicine, Hematology, Oncology, and PneumologyUniversity Hospital MünsterMünsterGermany,West German Cancer CenterUniversity Hospital MünsterMünsterGermany
| | - Alexander O. König
- Department of GastroenterologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Pia Weinländer
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité University Medicine BerlinBerlinGermany
| | - Sophia Potthoff
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité University Medicine BerlinBerlinGermany
| | - Sara Hadzibegovic
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
| | - Alessia Lena
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité University Medicine BerlinBerlinGermany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer ImmunologyCharité – Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinGermany,Max‐Delbrück‐Center for Molecular MedicineBerlinGermany,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Ulf Landmesser
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Berlin Institute of Health (BIH)BerlinGermany
| | - Andreas Schuster
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Markus S. Anker
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
| | - Gerd Hasenfuß
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
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Bhalla S, AlQabandi Y, Nandula SA, Boddepalli CS, Gutlapalli SD, Lavu VK, Abdelwahab Mohamed Abdelwahab R, Huang R, Potla S, Hamid P. Potential Benefits of Sodium-Glucose Transporter-2 Inhibitors in the Symptomatic and Functional Status of Patients With Heart Failure: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e29579. [DOI: 10.7759/cureus.29579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
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9
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Szklarz M, Gontarz-Nowak K, Matuszewski W, Bandurska-Stankiewicz E. Can Iron Play a Crucial Role in Maintaining Cardiovascular Health in the 21st Century? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11990. [PMID: 36231287 PMCID: PMC9565681 DOI: 10.3390/ijerph191911990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
In the 21st century the heart is facing more and more challenges so it should be brave and iron to meet these challenges. We are living in the era of the COVID-19 pandemic, population aging, prevalent obesity, diabetes and autoimmune diseases, environmental pollution, mass migrations and new potential pandemic threats. In our article we showed sophisticated and complex regulations of iron metabolism. We discussed the impact of iron metabolism on heart diseases, treatment of heart failure, diabetes and obesity. We faced the problems of constant stress, climate change, environmental pollution, migrations and epidemics and showed that iron is really essential for heart metabolism in the 21st century.
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10
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Zamora E, González B, Lupón J, Borrellas A, Domingo M, Santiago‐Vacas E, Cediel G, Codina P, Rivas C, Pulido A, Crespo E, Velayos P, Diaz V, Bayes‐Genis A. Quality of life in patients with heart failure and improved ejection fraction: one-year changes and prognosis. ESC Heart Fail 2022; 9:3804-3813. [PMID: 35916351 PMCID: PMC9773756 DOI: 10.1002/ehf2.14098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/16/2022] [Accepted: 07/20/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The criteria for patients with heart failure (HF) and improved ejection fraction (HFimpEF) are a baseline left ventricular ejection fraction (LVEF) ≤40%, a ≥10-point increase from baseline LVEF, and a second LVEF measurement >40%. We aimed to (i) assess patients with HF and reduced LVEF (HFrEF) at baseline and compare quality of life (QoL) changes between those that fulfilled and those that did not fulfil the HFimpEF criteria 1 year later and (ii) assess the prognostic role of QoL in patients with HFimpEF. METHODS We reviewed data from a prospective registry of real-world outpatients with HF that were assessed for LVEF and QoL at a first visit to the HF clinic and 1 year later. QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). The primary prognostic endpoint was the composite of all-cause death or HF hospitalization. RESULTS Baseline and 1-year LVEF and MLWFQ scores were available for 1040 patients with an initial LVEF ≤40% (mean age, 65.2 ± 11.7 years; 75.9% men). The main aetiology was ischaemic heart disease (52.9%), and patients were mostly in New York heart Association Classes II (71.1%) and III (21.6%). At baseline, the mean LVEF was 28.5% ± 7.3, and the mean MLWHFQ score was 30.2 ± 19.5. After 1 year, the mean LVEF increased to 38.0% ± 12.2, and the MLWHFQ scores improved to 17.4 ± 16.0. In 361 patients that fulfilled the HFimpEF criteria (34.7%), significant improvements were observed in both LVEF (from 28.7% ± 6.6 to 50.9% ± 7.6, P < 0.001) and QoL (from 32.9 ± 20.6 to 16.9 ± 16.0, P < 0.001). Patients that did not fulfil the HFimpEF criteria also showed significant improvements in LVEF (from 28.4% ± 7.6 to 31.1% ± 7.9, P < 0.001) and QoL (from 28.7 ± 18.8 to 17.6 ± 15.9, P < 0.001). However, the QoL improvement was significantly higher in the HFimpEF group (-16.0 ± 23.8 vs. -11.1 ± 20.3, P = 0.001), despite the worse mean baseline MLWHFQ score, compared with the non-HFimpEF group (P = 0.001). The 1-year QoL was similar between groups (P = 0.50). The 1-year MLWHFQ score was independently associated with outcomes; the hazard ratio for the composite endpoint was 1.02 (95% CI: 1.01-1.03, P = 0.006). In contrast, the QoL improvement (with a cut-off ≥5 points) was not independently associated with the composite outcome. CONCLUSIONS Patients with HFrEF showed improved QoL after 1 year, regardless of whether they met the HFimpEF criteria. The similar 1-year QoL perception between groups suggested that factors other than LVEF influenced QoL perception. The 1-year QoL was superior to the QoL change from baseline for predicting prognosis in patients with HFimpEF.
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Affiliation(s)
- Elisabet Zamora
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Beatriz González
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Josep Lupón
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Andrea Borrellas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Mar Domingo
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Evelyn Santiago‐Vacas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Germán Cediel
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Pau Codina
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain
| | - Carmen Rivas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Ana Pulido
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Eva Crespo
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Patricia Velayos
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Violeta Diaz
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Antoni Bayes‐Genis
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
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11
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Maagaard M, Nielsen EE, Sethi NJ, Liang N, Yang SH, Gluud C, Jakobsen JC. Ivabradine added to usual care in patients with heart failure: a systematic review with meta-analysis and trial sequential analysis. BMJ Evid Based Med 2022; 27:224-234. [PMID: 34789473 PMCID: PMC9340018 DOI: 10.1136/bmjebm-2021-111724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the beneficial and harmful effects of adding ivabradine to usual care in participants with heart failure. DESIGN A systematic review with meta-analysis and trial sequential analysis. ELIGIBILITY CRITERIA Randomised clinical trials comparing ivabradine and usual care with usual care (with or without) placebo in participants with heart failure. INFORMATION SOURCES Medline, Embase, CENTRAL, LILACS, CNKI, VIP and other databases and trial registries up until 31 May 2021. DATA EXTRACTION Primary outcomes were all-cause mortality, serious adverse events and quality of life. Secondary outcomes were cardiovascular mortality, myocardial infarction and non-serious adverse events. We performed meta-analysis of all outcomes. We used trial sequential analysis to control risks of random errors, the Cochrane risk of bias tool to assess the risks of systematic errors and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of the evidence. RESULTS We included 109 randomised clinical trials with 26 567 participants. Two trials were at low risk of bias, although both trials were sponsored by the company that developed ivabradine. All other trials were at high risk of bias. Meta-analyses and trial sequential analyses showed that we could reject that ivabradine versus control reduced all-cause mortality (risk ratio (RR)=0.94; 95% CI 0.88 to 1.01; p=0.09; high certainty of evidence). Meta-analysis and trial sequential analysis showed that ivabradine seemed to reduce the risk of serious adverse events (RR=0.90; 95% CI 0.87 to 0.94; p<0.00001; number needed to treat (NNT)=26.2; low certainty of evidence). This was primarily due to a decrease in the risk of 'cardiac failure' (RR=0.83; 95% CI 0.71 to 0.97; p=0.02; NNT=43.9), 'hospitalisations' (RR=0.89; 95% CI 0.85 to 0.94; p<0.0001; NNT=36.4) and 'ventricular tachycardia' (RR=0.59; 95% CI 0.43 to 0.82; p=0.001; NNT=212.8). However, the trials did not describe how these outcomes were defined and assessed during follow-up. Meta-analyses showed that ivabradine increased the risk of atrial fibrillation (RR=1.19; 95% CI 1.04 to 1.35; p=0.008; number needed to harm (NNH)=116.3) and bradycardia (RR=3.95; 95% CI 1.88 to 8.29; p=0.0003; NNH=303). Ivabradine seemed to increase quality of life on the Kansas City Cardiomyopathy Questionnaire (KCCQ) (mean difference (MD)=2.92; 95% CI 1.34 to 4.50; p=0.0003; low certainty of evidence), but the effect size was small and possibly without relevance to patients, and on the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) (MD=-5.28; 95% CI -6.60 to -3.96; p<0.00001; very low certainty of evidence), but the effects were uncertain. Meta-analysis showed no evidence of a difference between ivabradine and control when assessing cardiovascular mortality and myocardial infarction. Ivabradine seemed to increase the risk of non-serious adverse events. CONCLUSION AND RELEVANCE High certainty evidence shows that ivabradine does not seem to affect the risks of all-cause mortality and cardiovascular mortality. The effects on quality of life were small and possibly without relevance to patients on the KCCQ and were very uncertain for the MLWHFQ. The effects on serious adverse events, myocardial infarction and hospitalisation are uncertain. Ivabradine seems to increase the risk of atrial fibrillation, bradycardia and non-serious adverse events.PROSPERO registration number: CRD42018112082.
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Affiliation(s)
- Mathias Maagaard
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil Eik Nielsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Internal Medicine, Holbaek Sygehus, Holbaek, Denmark
| | - Naqash Javaid Sethi
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ning Liang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Si-Hong Yang
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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12
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Quality of Life in Older Patients after a Heart Failure Hospitalization: Results from the SENECOR Study. J Clin Med 2022; 11:jcm11113035. [PMID: 35683423 PMCID: PMC9181457 DOI: 10.3390/jcm11113035] [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] [Received: 04/25/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Information about health-related quality of life (HRQoL) in heart failure (HF) in older adults is scarce. Methods: We aimed to describe the HRQoL of the SENECOR study cohort, a single-center, randomized trial comparing the effects of multidisciplinary intervention by a geriatrician and a cardiologist (intervention group) to that of a cardiologist alone (control group) in older patients with a recent HF hospitalization. Results: HRQoL was assessed by the short version of the disease-specific Kansas Cardiomyopathy Questionnaire (KCCQ-12) in 141 patients at baseline and was impaired (KCCQ-12 < 75) in almost half of the cohort. Women comprised 50% of the population, the mean age was 82.2 years, and two-thirds of patients had preserved ejection fraction. Comorbidities were highly prevalent. Patients with impaired HRQoL had a worse NYHA functional class, a lower NT-proBNP, a lower Barthel index, and a higher Clinical Frailty Scale. One-year all-cause mortality was 22.7%, significantly lower in the group with good-to-excellent HRQoL (14.5% vs. 30.6%; hazard ratio 0.28; 95% confidence interval 0.10−0.78; p = 0.014). In the group with better HRQoL, all-cause hospitalization was lower, and there was a trend towards lower HF hospitalization. Conclusions: The KCCQ-12 questionnaire can provide inexpensive prognostic information even in older patients with HF. (Funded by grant Primitivo de la Vega, Fundación MAPFRE. ClinicalTrials number, NCT03555318).
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13
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Johansson I, Balasubramanian K, Bangdiwala S, Mielniczuk L, Hage C, Sharma SK, Branch K, Zhu J, Kragholm K, Sliwa K, Alla F, Yonga G, Roy A, Orlandini A, Grinvalds A, McCready T, Pogosova N, Störk S, McMurray JJ, Conen D, Yusuf S. Factors associated with health‐related quality of life in heart failure in 23,000 patients from 40 countries: Results of the
G‐CHF
Research Program. Eur J Heart Fail 2022; 24:1478-1490. [DOI: 10.1002/ejhf.2535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Isabelle Johansson
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | | | - Shrikant Bangdiwala
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | - Lisa Mielniczuk
- Division of Cardiology University of Ottawa Heart Institute, Ottawa Ontario
| | - Camilla Hage
- Karolinska University Hospital Heart, Vascular and Neuro Theme Heart Failure Section
- Karolinska Institutet Department of Medicine Cardiology Unit
| | | | - Kelly Branch
- Division of Cardiology University of Washington School of Medicine Seattle
| | - Jun Zhu
- 3 Fuwai Hospital, CAMS & PUMC China
| | | | - Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences University of Cape Town
| | - Francois Alla
- Bordeaux Population Health Research Center. Inserm Université de Bordeaux Bordeaux France
- Prevention department, CHU, Bordeaux, France. Bordeaux Population Health Research Center. Inserm Université de Bordeaux Bordeaux France
| | | | - Ambuj Roy
- Department of Cardiology All India Institute of Medical Sciences, New Delhi Delhi India
| | | | - Alex Grinvalds
- Population Health Research Institute McMaster University Hamilton Canada
| | - Tara McCready
- Population Health Research Institute McMaster University Hamilton Canada
| | - Nana Pogosova
- National Medical Research Center of Cardiology Moscow Russia
| | - Stefan Störk
- Comprehensive Heart Failure Center University and University Hospital Würzburg Würzburg Germany
| | | | - David Conen
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | - Salim Yusuf
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
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14
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Butler J, Khan MS, Friede T, Jankowska EA, Fabien V, Goehring UM, Dorigotti F, Metra M, Piña IL, Coats AJS, Rosano G, Comin-Colet J, Van Veldhuisen DJ, Filippatos GS, Anker SD, Ponikowski P. Health status improvement with ferric carboxymaltose in heart failure with reduced ejection fraction and iron deficiency. Eur J Heart Fail 2022; 24:821-832. [PMID: 35279929 PMCID: PMC9313582 DOI: 10.1002/ejhf.2478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022] Open
Abstract
AIM Intravenous ferric carboxymaltose (FCM) has been shown to improve overall quality of life in iron-deficient heart failure with reduced ejection fraction (HFrEF) patients at a trial population level. This FAIR-HF and CONFIRM-HF pooled analysis explored the likelihood of individual improvement or deterioration in Kansas City Cardiomyopathy Questionnaire (KCCQ) domains with FCM versus placebo and evaluated the stability of this response over time. METHODS AND RESULTS Changes versus baseline in KCCQ overall summary score (OSS), clinical summary score (CSS) and total symptom score (TSS) were assessed at weeks 12 and 24 in FCM and placebo groups. Mean between-group differences were estimated and individual responder analyses and analyses of response stability were performed. Overall, 760 (FCM, n = 454) patients were studied. At week 12, the mean improvement in KCCQ OSS was 10.6 points with FCM versus 4.8 points with placebo (least-square mean difference [95% confidence interval, CI] 4.36 [2.14; 6.59] points). A higher proportion of patients on FCM versus placebo experienced a KCCQ OSS improvement of ≥5 (58.3% vs. 43.5%; odds ratio [95% CI] 1.81 [1.30; 2.51]), ≥10 (42.4% vs. 29.3%; 1.73 [1.23; 2.43]) or ≥15 (32.1% vs. 22.6%; 1.46 [1.02; 2.11]) points. Differences were similar at week 24 and for CSS and TSS domains. Of FCM patients with a ≥5-, ≥10- or ≥15-point improvement in KCCQ OSS at week 12, >75% sustained this improvement at week 24. CONCLUSION Treatment of iron-deficient HFrEF patients with intravenous FCM conveyed clinically relevant improvements in health status at an individual-patient level; benefits were sustained over time in most patients.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | | | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | | | | | | | - Marco Metra
- Department of Cardiology, University and Civil Hospital, Brescia, Italy
| | - Ileana L Piña
- Central Michigan University, Mount Pleasant, MI, USA
| | | | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital, Barcelona, Spain.,IDIBELL (Institute of Biomedical Investigation of Bellvitge), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Dirk J Van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerasimos S Filippatos
- National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Center for Cardiovascular Research) Berlin partner site, Charité Universitätsmedizin Berlin, Berlin, Germany
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15
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Real-World Effectiveness of Ivabradine in Chinese Patients with Chronic Heart Failure: Interim Analysis of the POSITIVE Study. Am J Cardiovasc Drugs 2022; 22:345-354. [PMID: 34878632 PMCID: PMC9061670 DOI: 10.1007/s40256-021-00500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/23/2022]
Abstract
Background Ivabradine improves cardiac function and clinical outcomes in chronic heart failure (HF) by reducing heart rate (HR), but there is a lack of real-world data on its effectiveness and safety in Chinese patients. Methods We designed a prospective, multicenter, observational study of Chinese adults with HF and left ventricular systolic dysfunction, resting HR ≥ 75 beats per minute (bpm), and an indication for ivabradine treatment. An interim analysis was performed using a cut-off date of 31 October 2019. The primary outcome was change in HR at 6 months after the initiation of ivabradine. Secondary endpoints included change in New York Heart Association (NYHA) functional class; quality of life (QoL), measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ); and adverse events (AEs). Results Overall, 655 subjects were included in the interim analysis. Mean reduction in HR from baseline was 13.2 (95% confidence interval [CI] 11.2–15.2) bpm at Month 1, and 14.5 (95% CI 11.8–17.2) bpm at Month 6 (p < 0.001 for both changes). NYHA functional class and KCCQ scores improved significantly over time (p < 0.001 for all comparisons with baseline), indicating amelioration of symptoms and better QoL, respectively. Forty-four subjects (6.7%) reported a total of 60 ivabradine-related AEs, most frequently phosphenes and bradycardia (both n = 6, 0.9%). Conclusion Treatment with ivabradine for 6 months effectively reduced HR and improved functional class and QoL in Chinese patients with chronic HF. Treatment was well tolerated. Clinical Trial Registration ISRCTN11703380; registered on 8 November 2016.
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16
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Faragli A, Tano GD, Carlini CD, Nassiacos D, Gori M, Confortola G, Lo Muzio FP, Rapis K, Abawi D, Post H, Kelle S, Pieske B, Alogna A, Campana C. In-hospital Heart Rate Reduction With Beta Blockers and Ivabradine Early After Recovery in Patients With Acute Decompensated Heart Failure Reduces Short-Term Mortality and Rehospitalization. Front Cardiovasc Med 2021; 8:665202. [PMID: 34395550 PMCID: PMC8363305 DOI: 10.3389/fcvm.2021.665202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: In the past years, heart rate (HR) has emerged as a highly relevant modifiable risk factor for heart failure (HF) patients. However, most of the clinical trials so far evaluated the role of HR in stable chronic HF cohorts. The aim of this multi-center, prospective observational study was to assess the association between HR and therapy with HR modulators (beta blockers, ivabradine, or a combination of ivabradine and beta blockers) at hospital discharge with patients' cardiovascular mortality and re-hospitalization at 6 months in acutely decompensated HF patients. Materials and Methods: We recruited 289 HF patients discharged alive after admission for HF decompensation from 10 centers in northern Italy over 9 months (from April 2017 to January 2018). The primary endpoint was the combination of cardiovascular mortality or re-hospitalizations for HF at 6 months. Results: At 6 months after discharge, 64 patients were readmitted (32%), and 39 patients died (16%). Multivariate analysis showed that HR at discharge ≥ 90 bpm (OR = 8.47; p = 0.016) independently predicted cardiovascular mortality, while therapy with beta blockers at discharge was found to reduce the risk of the composite endpoint. In patients receiving HR modulators the event rates for the composite endpoint, all-cause mortality, and cardiovascular mortality were lower than in patients not receiving HR modulators. Conclusions: Heart rate at discharge ≥90 bpm predicts cardiovascular mortality, while therapy with beta blockers is negatively associated with the composite endpoint of cardiovascular mortality and hospitalization at 6 months in acutely decompensated HF patients. Patients receiving a HR modulation therapy at hospital discharge showed the lowest rate of cardiovascular mortality and re-hospitalization.
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Affiliation(s)
- Alessandro Faragli
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Giuseppe Di Tano
- Department of Cardiology Ospedale Maggiore, ASST Cremona, Cremona, Italy
| | | | - Daniel Nassiacos
- Department of Cardiology, Ospedale di Circolo, ASST Valle Olona, Saronno VA, Italy
| | - Mauro Gori
- Department of Cardiology, ASST Ospedale Papa Giovanni XXXIII, Bergamo, Italy
| | - Giada Confortola
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Francesco Paolo Lo Muzio
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Konstantinos Rapis
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dawud Abawi
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heiner Post
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Mülheim, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Carlo Campana
- Department of Cardiology Sant'Anna Hospital, ASST-Lariana, Como, Italy
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17
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Garcia RA, Benton MC, Spertus JA. Patient-Reported Outcomes in Patients with Cardiomyopathy. Curr Cardiol Rep 2021; 23:91. [PMID: 34121150 DOI: 10.1007/s11886-021-01511-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW As medicine strives to become more patient-centered, patient-reported outcomes (PROs) are often used to describe patients' symptoms, function, and quality of life. This review describes the key concepts of PROs specific to heart failure in clinical trials and their potential role in clinical practice. RECENT FINDINGS As the Food and Drug Administration has increasingly emphasized how it values PROs as clinical outcome assessments, including its recent qualification of the Kansas City Cardiomyopathy Questionnaire (KCCQ), clinical trials have increasingly used them to evaluate novel therapies. This has been enhanced by an increasing understanding of how to interpret KCCQ scores. Its use in clinical practice, including the importance of providers sharing results with their patients, is just emerging. PROs provide unique insights into the benefits of treatment from patients' perspectives and while their role in clinical care is just beginning, they offer an important opportunity to improve the patient-centeredness of care.
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Affiliation(s)
- Raul Angel Garcia
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO, 64111, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
| | - Mary C Benton
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO, 64111, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO, 64111, USA. .,University of Missouri-Kansas City, Kansas City, MO, USA.
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18
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Butler J, Anker SD, Filippatos G, Khan MS, Ferreira JP, Pocock SJ, Giannetti N, Januzzi JL, Piña IL, Lam CSP, Ponikowski P, Sattar N, Verma S, Brueckmann M, Jamal W, Vedin O, Peil B, Zeller C, Zannad F, Packer M. Empagliflozin and health-related quality of life outcomes in patients with heart failure with reduced ejection fraction: the EMPEROR-Reduced trial. Eur Heart J 2021; 42:1203-1212. [PMID: 33420498 PMCID: PMC8014525 DOI: 10.1093/eurheartj/ehaa1007] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023] Open
Abstract
Aims In this secondary analysis of the EMPEROR-Reduced trial, we sought to evaluate whether the benefits of empagliflozin varied by baseline health status and how empagliflozin impacted patient-reported outcomes in patients with heart failure with reduced ejection fraction. Methods and results Health status was assessed by the Kansas City Cardiomyopathy Questionnaires-clinical summary score (KCCQ-CSS). The influence of baseline KCCQ-CSS (analyzed by tertiles) on the effect of empagliflozin on major outcomes was examined using Cox proportional hazards models. Responder analyses were performed to assess the odds of improvement and deterioration in KCCQ scores related to treatment with empagliflozin. Empagliflozin reduced the primary outcome of cardiovascular death or heart failure hospitalization regardless of baseline KCCQ-CSS tertiles [hazard ratio (HR) 0.83 (0.68–1.02), HR 0.74 (0.58–0.94), and HR 0.61 (0.46–0.82) for <62.5, 62.6–85.4, and ≥85.4 score tertiles, respectively; P-trend = 0.10]. Empagliflozin improved KCCQ-CSS, total symptom score, and overall summary score at 3, 8, and 12 months. More patients on empagliflozin had ≥5-point [odds ratio (OR) 1.20 (1.05–1.37)], 10-point [OR 1.26 (1.10–1.44)], and 15-point [OR 1.29 (1.12–1.48)] improvement and fewer had ≥5-point [OR 0.75 (0.64–0.87)] deterioration in KCCQ-CSS at 3 months. These benefits were sustained at 8 and 12 months and were similar for other KCCQ domains. Conclusion Empagliflozin improved cardiovascular death or heart failure hospitalization risk across the range of baseline health status. Empagliflozin improved health status across various domains, and this benefit was sustained during long-term follow-up. Clinical trial registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03057977.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, 2 Thivon Street, Athens 157 72, Greece
| | - Muhammad Shahzeb Khan
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - João Pedro Ferreira
- Department of Cardiothoracic Physiology and Surgery, Cardiovascular R&D Unit, Institut Lorrain du Coeur et des Vaisseaux, 5 Rue du Morvan, 54500 Vandeuvre-lès-Nancy, France
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, London WCIE 7HT, UK
| | - Nadia Giannetti
- Division of Cardiology, McGill University Health Center, 1001 Decarie Blvd.Royal Victoria Hospital, D05.5115 Montreal, Quebec H4A 3J1, Canada
| | - James L Januzzi
- Cardiology Division, Harvard Medical School, Massachusetts General Hospital, 25 Shattuck St, Boston, MA 02115, USA
| | - Ileana L Piña
- Department of Medicine, Wayne State and Central Michigan Universities, 540 E. Canfield Ave, Detroit, MI 48201, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, 8 College Rd, Singapore 169857, Singapore
| | - Piotr Ponikowski
- Centre for Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre (GCRC), 126 University Place, Glasgow G12 8TA, UK
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Binger Strasse 173 Ingelheim am Rhein, 55216, Germany.,Faculty of Medicine Mannheim, University of Heidelberg, Ludolf-Krehl-Straße 13-17, 68167 Mannheim, Germany
| | - Waheed Jamal
- Boehringer Ingelheim International GmbH, Binger Strasse 173 Ingelheim am Rhein, 55216, Germany
| | - Ola Vedin
- Boehringer Ingelheim AB, Hammarby allé 29, 120 32 Stockholm, Sweden
| | - Barbara Peil
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173 Ingelheim am Rhein, 55216, Germany
| | - Cordula Zeller
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Str. 65, 88397 Biberach an der Riß, Germany
| | - Faiez Zannad
- Department of Cardiothoracic Physiology and Surgery, Cardiovascular R&D Unit, Institut Lorrain du Coeur et des Vaisseaux, 5 Rue du Morvan, 54500 Vandeuvre-lès-Nancy, France
| | - Milton Packer
- Cardiovascular Science, Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 N. Hall Street, Dallas, TX 75226, USA.,Faculty of Medicine, National Heart and Lung Institute, Imperial College, Guy Scadding Building, Cale Street, SW3 6LY London, UK
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19
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Ravera A, Santema BT, Sama IE, Meyer S, Lombardi CM, Carubelli V, Ferreira JP, Lang CC, Dickstein K, Anker SD, Samani NJ, Zannad F, van Veldhuisen DJ, Teerlink JR, Metra M, Voors AA. Quality of life in men and women with heart failure: association with outcome, and comparison between the Kansas City Cardiomyopathy Questionnaire and the EuroQol 5 dimensions questionnaire. Eur J Heart Fail 2021; 23:567-577. [PMID: 33728762 PMCID: PMC8252457 DOI: 10.1002/ejhf.2154] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
Aims We sought to analyse quality of life (QoL) measures derived from two questionnaires widely used in clinical trials, the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL 5 dimensions (EQ‐5D), and to compare their prognostic value in men and women with heart failure and reduced ejection fraction (HFrEF). Methods and results From the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT‐CHF) we compared KCCQ and EQ‐5D at baseline and after 9 months in 1276 men and 373 women with new‐onset or worsening symptoms of HFrEF, who were sub‐optimally treated and in whom there was an anticipated up‐titration of guideline‐derived medical therapies. Women had significantly worse baseline QoL (median) as compared with men, both when assessed with KCCQ overall score (KCCQ‐OS, 44 vs. 53, P < 0.001) and EQ‐5D utility score (0.62 vs. 0.73, P < 0.001). QoL improved equally in women and men at follow‐up. All summary measures of QoL were independently associated with all‐cause mortality, with KCCQ‐OS showing the most remarkable association with mortality up to 1 year compared to the EQ‐5D scores (C‐statistic 0.650 for KCCQ‐OS vs. 0.633 and 0.599 for EQ‐5D utility score and EQ‐5D visual analogue scale, respectively). QoL was associated with all outcomes analysed, both in men and women (all P for interaction with sex >0.2). Conclusion Amongst patients with HFrEF, women reported significantly worse QoL than men. QoL was independently associated with subsequent outcome, similarly in men and women. The KCCQ in general, and the KCCQ‐OS in particular, showed the strongest independent association with outcome.
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Affiliation(s)
- Alice Ravera
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Bernadet T Santema
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Iziah E Sama
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Sven Meyer
- Department of Cardiology, University of Groningen, Groningen, The Netherlands.,Heart Center Oldenburg, Department of Cardiology, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Valentina Carubelli
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 1433, Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT Network, Nancy, France
| | - Chim C Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 1433, Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT Network, Nancy, France
| | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
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20
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Johansson I, Joseph P, Balasubramanian K, McMurray JJV, Lund LH, Ezekowitz JA, Kamath D, Alhabib K, Bayes-Genis A, Budaj A, Dans ALL, Dzudie A, Probstfield JL, Fox KAA, Karaye KM, Makubi A, Fukakusa B, Teo K, Temizhan A, Wittlinger T, Maggioni AP, Lanas F, Lopez-Jaramillo P, Silva-Cardoso J, Sliwa K, Dokainish H, Grinvalds A, McCready T, Yusuf S. Health-Related Quality of Life and Mortality in Heart Failure: The Global Congestive Heart Failure Study of 23 000 Patients From 40 Countries. Circulation 2021; 143:2129-2142. [PMID: 33906372 DOI: 10.1161/circulationaha.120.050850] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. METHODS We used the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. RESULTS The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17-1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03-1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21-1.42]; interaction P<0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14-1.19] and HR, 1.14 [95% CI, 1.12-1.17]; interaction P=0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13-1.17] versus 1.09 [95% CI, [1.07-1.11]; interaction P<0.0001). HR for death was greater in ejection fraction ≥40 versus <40% (HR, 1.23 [95% CI, 1.20-1.26] and HR, 1.15 [95% CI, 1.13-1.17]; interaction P<0.0001). CONCLUSION HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03078166.
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Affiliation(s)
- Isabelle Johansson
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.).,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.)
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M.)
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (L.H.L.).,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Justin A Ezekowitz
- Faculty of Medicine and Dentistry, University of Alberta Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E.)
| | - Deepak Kamath
- Division of Clinical Research and Training, St John's Research Institute, India (D.K.)
| | - Khalid Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia (K.A.)
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.B.-G.).,Department of Medicine, Universitat Autonoma Barcelona, CIBERCV, Spain (A.B.-G.)
| | - Andrzej Budaj
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland (A.B.)
| | - Antonio L L Dans
- Department of Cardiac Sciences, University of Philippines, Manila, Philippines (A.L.L.D.)
| | - Anastase Dzudie
- Douala General Hospital, Cameroon (A.D.).,Clinical Research Education, Networking and Consultancy, Douala, Cameroon (A.D.).,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon (A.D.)
| | | | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.)
| | - Kamilu M Karaye
- Department of Medicine, Aminu Kano Teaching Hospital and Bayero University Kano, Nigeria (K.M.K.)
| | - Abel Makubi
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania (A.M.)
| | - Bianca Fukakusa
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Koon Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Ahmet Temizhan
- Ankara City Hospital, Department of Cardiology, University of Health Sciences, Turkey (A.T.)
| | | | - Aldo P Maggioni
- ANMCO Research Center, Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.)
| | | | - Patricio Lopez-Jaramillo
- Masira Research Institute, UDES, Bucaramanga, Colombia (P.L.-J.).,Facultad de Ciencias de la Salud, UTE, Quito, Ecuador (P.L.-J.)
| | - José Silva-Cardoso
- Faculty of Medicine, University of Porto, Sao Joao University Hospital Centre, Porto, Portugal (J.S.-C.)
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.)
| | - Hisham Dokainish
- Echocardiography Laboratory, Circulate Cardiac and Vascular Centre, Burlington, Canada (H.D.)
| | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.).,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.)
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21
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Cotter G, Davison BA, Mebazaa A, Takagi K, Novosadova M, Freund Y, Cohen-Solal A. Medical Therapy of Heart Failure with Reduced Ejection Fraction-A Call for Comparative Research. J Clin Med 2021; 10:jcm10091803. [PMID: 33919005 PMCID: PMC8122403 DOI: 10.3390/jcm10091803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022] Open
Abstract
The armamentarium of therapies for patients with heart failure and reduced ejection fraction (HFREF) has increase substantially with the introduction of Angiotensin Receptor Neprilysin Inhibitor (ARNi), sodium glucose cotransport inhibitors (SGLTis), ivabradine, and Vericinguat, bringing to seven the number of potential therapies for HFREF. In the current review we highlight available data on the different classes of medications. Renin angiotensin blockers (RAASbs) and beta blockers (BBs) were shown to have very substantial effects in patients with HFREF. These medications are generic and hence relatively inexpensive. They have a 30-year track record of relatively benign short- and long-term safety profiles and should remain the cornerstone of therapy for patients with HFREF. ARNis are effective in further reducing adverse effects and should replace RAASbs in symptomatic HFREF patients, despite their relatively high prices. The addition of SGLTis (congested patients), Ivabradine (tachycardic patients), and Vericinguat (hypertensive patients) should be considered in patients who remain symptomatic despite optimal doses of RAASbs/ARNis, MRAs, and BBs. Comparative studies examining the efficacy of these medications, and strategies and prioritizing some over others should be considered as, given their similar side effects on heart rate, blood pressure, and renal function, it is highly unlikely that all can be given to the same patient.
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Affiliation(s)
- Gad Cotter
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
- Inserm U942-MASCOT, 75010 Paris, France;
- Correspondence:
| | - Beth A. Davison
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
- Inserm U942-MASCOT, 75010 Paris, France;
| | - Alexandre Mebazaa
- Inserm U942-MASCOT, 75010 Paris, France;
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, 75010 Paris, France
- School of Medicine, Université de Paris, 75010 Paris, France
| | - Koji Takagi
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
| | - Maria Novosadova
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
| | - Yonathan Freund
- School of Medicine, Sorbonne University, 75005 Paris, France;
- Emergency Department, Hopital Pitié-Salpêtrière, 75013 Paris, France
| | - Alain Cohen-Solal
- Service de Cardiologie, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010 Paris, France;
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22
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Khan MS, Friede T, Anker SD, Butler J. Effect of Carillon Mitral Contour System on patient-reported outcomes in functional mitral regurgitation: an individual participant data meta-analysis. ESC Heart Fail 2021; 8:1885-1891. [PMID: 33784028 PMCID: PMC8120406 DOI: 10.1002/ehf2.13301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/07/2021] [Indexed: 12/28/2022] Open
Abstract
Aims The Carillon Mitral Contour System has been shown to reduce mitral regurgitation and left ventricular volumes in symptomatic heart failure patients with functional mitral regurgitation. We sought to evaluate the effects of the Carillon device on quality of life and functional capacity in these patients. Methods and results An individual participant data meta‐analysis was conducted utilizing data from REDUCE‐FMR, TITAN, and TITAN II studies. The main outcomes assessed were changes from baseline in Kansas City Cardiomyopathy Questionnaire overall summary scores (KCCQ‐OSS), 6 min walk test (6MWT) distance, and New York Heart Association (NYHA) classification at Months 1 and 12 after device implantation. Subgroup analyses were conducted for patients with severe functional mitral regurgitation (Grade 3 or 4). Pooled estimates were calculated using a random‐effects model and are presented as weighted proportions or weighted mean differences along with 95% confidence intervals (CIs). Among 139 patients included in the analysis, Carillon device significantly improved the 6MWT distance (63.0 m; 95% CI 18.8–107.2, P = 0.0056) and KCCQ‐OSS score (15.1; 95% CI 5.6–24.7, P = 0.0022) at 1 month from baseline. These benefits were sustained at 12 months (64.1 m; 95% CI 13.2–115.0, P = 0.0141, for 6MWT distance, and 12.3; 95% CI 4.7–19.8, P = 0.0019, for KCCQ‐OSS score). More than 50% of the patients had improvements in KCCQ‐OSS by ≥5 (60.4%; 95% CI 47.4–72.1) and 10 points (50.5%; 95% CI 34.9–66.0) at 12 months. Almost half of the patients experienced a ≥1 class improvement in NYHA class after implantation of the device at 1 month (67.9%; 95% CI 37.3–88.3) and at 12 months (48.8%; 95% CI 31.8–66.2). Results remained similar for KCCQ‐OSS, 6MWT distance, and NYHA classification when only patients with Grade 3 or 4 mitral regurgitation were analysed. The pooled estimates of 30 day and 1 year all‐cause mortality were 2.2% (95% CI 0.7–6.5) and 17.3% (95% CI 11.8–24.5), respectively. Conclusions The Carillon Mitral Contour System significantly improved patient‐reported quality‐of‐life outcomes in heart failure patients with functional mitral regurgitation.
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Affiliation(s)
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
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23
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Turgeon RD, Barry AR, Hawkins NM, Ellis UM. Pharmacotherapy for heart failure with reduced ejection fraction and health-related quality of life: a systematic review and meta-analysis. Eur J Heart Fail 2021; 23:578-589. [PMID: 33634543 DOI: 10.1002/ejhf.2141] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS The aim of this study was to synthesize the evidence on the effect of heart failure with reduced ejection fraction (HFrEF) pharmacotherapy on health-related quality of life (HRQoL). METHODS AND RESULTS We searched MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform in June 2020. Randomized placebo-controlled trials evaluating contemporary HFrEF pharmacotherapy and reporting HRQoL as an outcome were included. Two reviewers independently assessed studies for eligibility, extracted data, and assessed risk of bias and GRADE certainty of evidence. The primary outcome was HRQoL at last available follow-up analysed using a random-effects model. We included 37 studies from 5770 identified articles. Risk of bias was low in 10 trials and high/unclear in 27 trials. High certainty evidence from meta-analyses demonstrated improved HRQoL over placebo with sodium-glucose co-transporter 2 (SGLT2) inhibitors [standardized mean difference (SMD) 0.16, 95% confidence interval (CI) 0.08-0.23] and intravenous iron (SMD 0.52, 95% CI 0.04-1.00). Furthermore, high certainty evidence from ≥1 landmark trial further supported improved HRQoL with angiotensin receptor blockers (ARBs) (SMD 0.09, 95% CI 0.02-0.17), ivabradine (SMD 0.14, 95% CI 0.04-0.23), hydralazine-nitrate (SMD 0.24, 95% CI 0.04-0.44) vs. placebo, and for angiotensin receptor-neprilysin inhibitor (ARNI) compared with an angiotensin-converting enzyme (ACE) inhibitor (SMD 0.09, 95% CI 0.02-0.17). Findings were inconclusive for ACE inhibitors, beta-blockers, digoxin, and oral iron based on low-to-moderate certainty evidence. CONCLUSION ARBs, ARNIs, SGLT2 inhibitors, ivabradine, hydralazine-nitrate, and intravenous iron improved HRQoL in patients with HFrEF. These findings can be incorporated into discussions with patients to enable shared decision-making.
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Affiliation(s)
- Ricky D Turgeon
- Greg Moore Professorship in Clinical & Community Cardiovascular Pharmacy, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.,St. Paul's Hospital, Vancouver, Canada
| | - Arden R Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.,Chilliwack General Hospital, Lower Mainland Pharmacy Services, Chilliwack, Canada
| | | | - Ursula M Ellis
- Woodward Library, University of British Columbia, Vancouver, Canada
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Bryan Richard S, Huang B, Liu G, Yang Y, Luo S. Impact of ivabradine on the cardiac function of chronic heart failure reduced ejection fraction: Meta-analysis of randomized controlled trials. Clin Cardiol 2021; 44:463-471. [PMID: 33638556 PMCID: PMC8027585 DOI: 10.1002/clc.23581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/26/2023] Open
Abstract
Elevated resting heart rate in chronic heart failure (HF) patients has been associated with higher mortality and poor prognosis. Ivabradine is a new pure bradycardic agent that has been used to treat angina or heart failure reduced ejection fraction (HFrEF) with sinus heart rate above 70 beats per minute. However, the effect of ivabradine for chronic HF patients on rehospitalization and cardiac function is still inconsistent. Thus, this meta‐analysis aimed to elucidate the effect of Ivabradine in chronic HFrEF patients. We systematically searched PubMed, Medline, Clinical Trials.gov, and The Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) of ivabradine with search terms Ivabradine (MeSH Terms), chronic heart failure and beta‐blocker. The primary endpoints of the study include the impact of Ivabradine on heart rate, left ventricle ejection fraction (LVEF), left ventricular remodeling, exercise capacity, and quality of life (QoL) in patients with chronic HFrEF. Secondary endpoints were safety analysis of Ivabradine including cardiovascular mortality, worsening HF readmission, visual disturbances, and asymptomatic bradycardia. The analysis was done by Review Manager 5.4 Analyzer, to analyze the mean differences (MD) for continuous data and risks ratio (RR) for dichotomous data. A total of six RCTs and one subgroup analysis showed add of Ivabradine to standard HF therapy was associated with greater resting heart rate reduction (MD = −9.57; 95% CI ‐11.15, −8.00), improved LVEF (MD = 3.89; 95% CI 2.61, 5.17), left ventricular reverse remodeling improvement (MD = −3.73; 95% CI ‐4.25, −3.21, LVESV; MD = −17.00, 95%CI ‐29.65, −4.35, LVEDD; MD = −1.43, 95%CI ‐2.78, −0.08, LVEDV; MD = −14.75, 95%CI ‐34.36, 4.87), increased exercise capacity (exercise duration; MD = 8.52; 95%CI 0.09, 16.94), and significant reduction on rehospitalization due to worsening HF (RR = 0.76, 95%CI 0.69, 0.84). However, Ivabradine has no significant effect on the quality of life (MD = 0.65; 95%CI ‐10.52, 11.82), and cardiovascular mortality (RR = 0.92; 95%CI 0.82, 1.03). Moreover, there were some events of visual disturbances and asymptomatic bradycardia observed in the Ivabradine group compared to the placebo group (RR = 4.76; 95%CI 3.03, 7.48; RR = 3.78; 95%CI 2.77, 5.15, respectively). Addition of Ivabradine to standard HF therapy is associated with cardiac function improvement, reduction on worsening HF readmission, greater HR reduction, and better exercise capacity in chronic HFrEF patients, although it cannot reduce cardiovascular mortality or improve the quality of life.
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Affiliation(s)
- Sasmita Bryan Richard
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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25
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Abstract
Ivabradine is a unique agent that is distinct from beta-blockers and calcium channel blockers as it reduces heart rate without affecting myocardial contractility or vascular tone. Ivabradine is a use-dependent inhibitor targeting the sinoatrial node. It is approved for use in the United States as an adjunct therapy for heart rate reduction in patients with heart failure with reduced ejection fraction. In this scenario, ivabradine has demonstrated improved clinical outcomes due to reduction in heart failure readmissions. However, there has been conflicting evidence from prospective studies and randomized controlled trials for its use in stable ischemic heart disease regarding efficacy in symptom reduction and mortality benefit. Ivabradine may also play a role in the treatment of patients with inappropriate sinus tachycardia, who often cannot tolerate beta-blockers and/or calcium channel blockers. In this review, we highlight the evidence for the nuances of using ivabradine in heart failure, stable ischemic heart disease, and inappropriate sinus tachycardia to raise awareness for its vital role in the treatment of select populations.
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Barzanjeh Atri S, Pakpour V, Farshbaf Khalili A, Asghari Jafarabadi M, Nosrati Kharajo Z. Social Capital and Its Predictive Role in Quality of Life among the Elderly Referring to Health Centers in Tabriz, Iran: A Community- Based Study. J Caring Sci 2020; 9:212-219. [PMID: 33409165 PMCID: PMC7770394 DOI: 10.34172/jcs.2020.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/05/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction: Paying attention to the quality of life (QOL) in the elderly life is an important issue, given the criticality of this period. The Objective of the present study is to determine social capital and its predictive role on QOL among elderly people living in Tabriz, East- Azerbaijan province, Iran. Methods: The present cross-sectional study was accomplished in 2018 on 522 elderly people referred to the health centers in city of Tabriz. A multi-stage random cluster sampling was implemented. The data were collected, using a demographical questionnaire, Onyx-Bullen social capital, and WHOQOL-BREF QOL questionnaires. Then, they were analyzed by SPSS software version 15 and descriptive (frequency, percentage, mean (SD) and inferential statistics (Pearson, and Multivariate linear regression) were provided. Results: The mean age of the participants was 65.7 years, 58% were women, 85.5% were married, and 37.5% were illiterate. The mean )SD (of social capital score was 71.87 (10.51) (in the range of 36-144) and for QOL, it was 64.64 (10.81) (in the range of 0-100). Social capital had positive and direct relation with QOL. Out of all the variables studied; marital status, education, economic status, health status, the absence of cardiovascular diseases (CVDs), and joint pains had significant relation with QOL. By some modifications in context factors, social capital was considered to be a predictive factor for QOL [β (95%CI): 0.28 to 0.36)]. Conclusion: For the promotion of QOL among the elderly, certain strategies must be implemented by health policy makers to enhance social capital among elderly people.
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Affiliation(s)
- Shirin Barzanjeh Atri
- Department of Community Health Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Pakpour
- Department of Community Health Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azizeh Farshbaf Khalili
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Nosrati Kharajo
- Department of Community Health Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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27
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Wan H, Huang T, Zhang H, Wu Q. Effects of Ivabradine on Cardiac Remodeling in Patients With Stable Symptomatic Heart Failure: A Systematic Review and Meta-analysis. Clin Ther 2020; 42:2289-2297.e0. [PMID: 33160681 DOI: 10.1016/j.clinthera.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/30/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Ivabradine reduces heart rate (HR) in patients with heart failure (HF). However, its effect on cardiac remodeling is not obvious. The goal of this study was to explore the extra effect of ivabradine on cardiac remodeling in patients with HF. METHODS We searched PubMed from database inception to January 31, 2020, Cochrane and Embase from database inception to February 2, 2020, and Web of Science and ClinicalTrials.gov from database inception to February 3, 2020, for randomized controlled trials on ivabradine treatments in patients with stable symptomatic HF, left ventricular ejection fraction (LVEF) < 45%, and resting HR ≥ 60 beats/min in sinus rhythm. We pooled the mean differences (MDs) or standardized mean differences and their 95% CIs. An inverse variance was used to combine data. Fixed- or random-effects models were used to outline the outcomes based on heterogeneity levels. We assessed the heterogeneity among studies according to the I2 statistic. A sensitivity analysis for select results was performed to assess the robustness of the outcomes. FINDINGS Of 2277 trials, 9 trials fulfilled the inclusion criteria. A total of 1523 patients were enrolled in 9 studies. There were 796 participants in the ivabradine group and 727 participants in the control group. The duration of follow-up ranged from 6 weeks to 19.6 months. The mean (SD) age of the participants was 59.7 (11.2) years, and 1187 participants (77.9%) were men. Therapy with ivabradine was related to reversing cardiac remodeling with a significant increase in LVEF (MD = 3.04%; 95% CI, 2.07%-4.00%; p < 0.001), decrease in the left ventricular end-systolic volume index (LVESVI) (MD = -7.30 mL/m2; 95% CI, -12.94 to -1.66 mL/m2; p = 0.01), and reduction in the left ventricular end-diastolic volume index (LVEDVI) (MD = -7.27 mL/m2; 95% CI, -14.04 to -0.50 mL/m2; p = 0.04). In the subgroup of enrolled patients with a resting HR of ≥70 beats/min, greater progress in LVEF was detected in the ivabradine group (MD = 3.60%; 95% CI, 2.40%-4.81%; p < 0.001), and a higher improvement in LVESVI was identified in the ivabradine group (MD = -11.06 mL/m2; 95% CI, -21.15 to -0.98 mL/m2; p = 0.03). IMPLICATIONS In patients with stable symptomatic HF, LVEF <45%, and resting HR ≥ 60 beats/min in sinus rhythm, ivabradine use was associated with reversing cardiac remodeling with a significant increase in LVEF, a decrease in LVESVI, and a reduction in LVEDVI.
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Affiliation(s)
- Hongbing Wan
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Tieqiu Huang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongzhou Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qinghua Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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28
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Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care. J Am Coll Cardiol 2020; 76:2379-2390. [DOI: 10.1016/j.jacc.2020.09.542] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022]
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Su Y, Ma T, Wang Z, Dong B, Tai C, Wang H, Zhang F, Yan C, Chen W, Xu Y, Ye L, Tye GJ, Ong SB, Zhang J, Xu D. Efficacy of early initiation of ivabradine treatment in patients with acute heart failure: rationale and design of SHIFT-AHF trial. ESC Heart Fail 2020; 7:4465-4471. [PMID: 32945150 PMCID: PMC7754724 DOI: 10.1002/ehf2.12997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Aims Elevated heart rate (HR) in heart failure (HF) is associated with worse outcomes, particularly in acute HF (AHF). HR reduction with ivabradine reduces cardiovascular events in HF patients with reduced ejection fraction. The present trial aimed to test the hypothesis that the early HR reduction using ivabradine improves clinical outcomes in patients with AHF. Methods and results SHIFT‐AHF is a prospective, multi‐centre, double‐blind, randomized, placebo‐controlled trial to evaluate the efficacy and safety of ivabradine when adding to standard therapy in AHF patients (SHIFT‐AHF). The trial will include 674 AHF patients with left ventricular ejection fraction < 45% and New York Heart Association functional classes III–IV. Participants were enrolled from March 2020 and will be followed up until December 2022. Patients are randomized to treatment with ivabradine or placebo (randomization 1:1). After allocation, the dose of ivabradine is titrated according to HR. Six months' follow‐up and three control visits (7, 90, and 180 days after enrolment) are required for every participant. Assessment involves clinical examination, laboratory tests, echocardiography, electrocardiography, heart rhythm, cardiac function, and quality of life. The primary endpoint is a composite of all‐cause mortality or re‐admission due to worsening HF. Secondary endpoints include the assessments of cardiac remodelling, cardiac functional capacity, and quality of life. Conclusions The SHIFT‐AHF trial will shed further light on the role of early HR reduction using ivabradine in patients with AHF.
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Affiliation(s)
- Yang Su
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Teng Ma
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zeyu Wang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Bin Dong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chenhui Tai
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, 6 Northern Haierxiang Road, Nantong, China
| | - Hao Wang
- Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai, 20090, China
| | - Fenglei Zhang
- Department of Cardiology, Qidong People's Hospital, Qidong, Jiangsu, 226200, China
| | - Chunxi Yan
- Department of Cardiology, Qidong People's Hospital, Qidong, Jiangsu, 226200, China
| | - Wei Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Gee Jun Tye
- Institute for Molecular Medicine Research (INFORMM), Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Sang-Bing Ong
- Centre for Cardiovascular Genomics and Medicine (CCGM), Lui Che Woo Institute of Innovative Medicine, Chinese University of Hong Kong (CUHK), Hong Kong.,Hong Kong Children's Hospital (HKCH), Hong Kong Hub of Paediatric Excellence (HK HOPE), Kowloon Bay, Hong Kong.,Department of Medicine and Therapeutics, Chinese University of Hong Kong (CUHK), Hong Kong.,Institute for Translational Medicine, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, 361004, China
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Dachun Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.,Department of Cardiology, Qidong People's Hospital, Qidong, Jiangsu, 226200, China
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30
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Berliner D, Bauersachs J. New drugs: big changes in conservative heart failure therapy? Eur J Cardiothorac Surg 2020; 55:i3-i10. [PMID: 31106335 PMCID: PMC6526100 DOI: 10.1093/ejcts/ezy421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/10/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
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During the last 20 years, the prognosis for heart failure (HF) with reduced ejection fraction has steadily improved due to advances in drug treatment and the consistent implementation of guideline-recommended evidence-based drug therapy. Nevertheless, the morbidity and mortality rates of patients with HF can still be improved. The prevalence of HF is high and continues to increase steadily. Thus, timely and efficient drug treatment plays a central role in improving the quality of life and prognosis for patients with HF. Current therapeutic concepts combine inhibition of the renin–angiotensin–aldosterone system with blockage of the sympathetic system. New therapeutic approaches such as selective heart rate reduction, attenuation of the degradation of natriuretic peptides by neutral endopeptidase inhibition and treatment of comorbidities (e.g. iron deficiency, diabetes mellitus, hyperkalaemia) have led to a further improvement in the survival, time-out-of hospital and quality of life of affected patients. The goal of this article was to give an overview of the current standard drug therapy for HF and the value of new therapeutic approaches implemented in recent years.
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Affiliation(s)
- Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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31
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Berliner D, Hänselmann A, Bauersachs J. The Treatment of Heart Failure with Reduced Ejection Fraction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:376-386. [PMID: 32843138 DOI: 10.3238/arztebl.2020.0376] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/02/2019] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent hospitalization and death. METHODS This review is based on articles retrieved by a selective search in PubMed, as well as on relevant guidelines. RESULTS Evidence-based treatment options are available only for congestive heart failure with a low ejection fraction. Pharma - cotherapy is based on neurohumoral inhibition of the renin-angiotensin-aldosterone system and the adrenergic system. The prognosis of patients with this condition has been further improved recently through the introduction of combined angiotensin receptor antagonists and neprilysin inhibitors. Modern implantable devices are a further component of treatment. Implantable defibrillators and special pacemakers for cardiac resynchronization are well established; the utility of alternative devices (baroreflex modulation or cardiac contractility modulation) needs to be investigated in further studies. It was recently shown that the catheter-based treatment of secondary mitral regurgitation with a MitraClip improves the outcome of selected patients. CONCLUSION The treatment of chronic systolic heart failure as recommended in the relevant guidelines, with drugs and implanted devices if indicated, can significantly improve the clinical outcome.
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Abstract
Ivabradine is a pure heart-rate lowering drug that is nowadays used, accordingly to the last ESC Guidelines, to reduce mortality and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction and in symptomatic patiens with inappropriate sinus tachycardia. Moreover, interesting effect of ivabradine on endothelial and myocardial function and on oxidative stress and inflamation pathways are progressively emerging. The aim of this paper is to highlight newer evidences about ivabradine effect (and consequently possible future application of the drug) in pathological settings different from guidelines-based clinical practice.
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Affiliation(s)
- Lucia Dallapellegrina
- Cardio-Thoracic Department, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, 25128, Italy.,Department of Medical and Surgical Specialties, Cardiology Unit, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Edoardo Sciatti
- Department of Medical and Surgical Specialties, Cardiology Unit, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Cardiology Unit, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
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Dewan P, Solomon SD, Jhund PS, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, DeMets DL, Sabatine MS, Bengtsson O, Sjöstrand M, Langkilde AM, Anand IS, Bělohlávek J, Chopra VK, Dukát A, Kitakaze M, Merkely B, O'Meara E, Schou M, Vinh PN, McMurray JJ. Efficacy and safety of sodium–glucose co‐transporter
2
inhibition according to left ventricular ejection fraction in
DAPA‐HF. Eur J Heart Fail 2020; 22:1247-1258. [DOI: 10.1002/ejhf.1867] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/22/2020] [Accepted: 05/07/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Pooja Dewan
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Scott D. Solomon
- Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Silvio E. Inzucchi
- Section of Endocrinology Yale University School of Medicine New Haven CT USA
| | - Lars Køber
- Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Mikhail N. Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri‐Kansas City Kansas City MO USA
| | | | | | - David L. DeMets
- Department of Biostatistics & Medical Informatics University of Wisconsin Madison WI USA
| | - Marc S. Sabatine
- TIMI Study Group, Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | | | | | | | | | - Jan Bělohlávek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General University Hospital, Charles University in Prague Czech Republic
| | - Vijay K. Chopra
- Department of Cardiology Max Super Specialty Hospital New Delhi India
| | - Andrej Dukát
- Department of Internal Medicine Comenius University in Bratislava Bratislava Slovakia
| | - Masafumi Kitakaze
- Cardiovascular Division of Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Béla Merkely
- Heart and Vascular Center Semmelweis University Budapest Hungary
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montreal Montreal Canada
| | - Morten Schou
- Department of Clinical Medicine Herlev‐Gentofte Hospital Herlev Denmark
| | - Pham Nguyen Vinh
- Department of Internal Medicine Tan Tao University Tan Duc city Vietnam
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von Haehling S, Arzt M, Doehner W, Edelmann F, Evertz R, Ebner N, Herrmann-Lingen C, Garfias Macedo T, Koziolek M, Noutsias M, Schulze PC, Wachter R, Hasenfuß G, Laufs U. Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials. Eur J Heart Fail 2020; 23:92-113. [PMID: 32392403 DOI: 10.1002/ejhf.1838] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/14/2020] [Indexed: 12/28/2022] Open
Abstract
Endpoints of large-scale trials in chronic heart failure have mostly been defined to evaluate treatments with regard to hospitalizations and mortality. However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and - with less certainty - testosterone in highly selected patients. Erythropoiesis-stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co-morbidities such as sleep-disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state-of-the-art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co-morbidities may be important for these patient-related outcomes. Additional studies on functional capacity and quality of life in heart failure are required.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Wolfram Doehner
- BCRT - Berlin Institute of Health Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Koziolek
- Department of Nephrology and Rheumatology, University of Göttingen Medical Center, Göttingen, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - P Christian Schulze
- Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Rolf Wachter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Resting heart rate and real-life treatment modalities in outpatients with left ventricular systolic dysfunction study: A multicenter, prospective, observational, and national registry. Anatol J Cardiol 2020; 25:304-312. [PMID: 33960305 DOI: 10.14744/anatoljcardiol.2020.13247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Heart rate (HR) reduction is associated with improved outcomes in heart failure (HF). This multicenter, prospective, observational, and national registry aimed to evaluate resting HR and the impacts of HR-related medications in real-life clinical practice in patients with HF. METHODS The Resting HR and Real-Life Treatment Modalities in Outpatients with Left Ventricular Systolic Dysfunction (REALITY HF) study enrolled 1054 patients with HF and left ventricular ejection fraction (LVEF) of <40% from 16 centers. Clinical characteristics, HR, and medications were noted (enrollment phase). A total of 487 patients with sinus rhythm and HR of ≥70 bpm were included in a further 4-month follow-up (FU) program (V0). Changes in HR and medications were reevaluated at 1-month (V1) and 4-month (V2) FU visits. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the quality of life (QoL) of 320 patients in a 4-month FU program. RESULTS During enrollment, 794 patients (75.3%) were in sinus rhythm, in whom resting HR was 76.7±14 bpm, 69.1% had a resting HR of ≥70 bpm, 79.1% were receiving beta blocker (BB), and 6.1% were receiving ivabradine. Resting HR was lower in patients receiving BB (75.8±13 vs. 80.4±16 bpm; p=0.001); however, 65.8% of those still had a resting HR of ≥70 bpm. A significant association was found between elevated HR and worse New York Heart Association (NYHA) class, worse QoL, or lower LVEF. During the 4-month FU, adjustment of HR-lowering therapy was left to the physician's discretion. Resting HR significantly reduced from 83.6±12 (80) bpm at V0 to 78.6±13 (77) bpm at V1 (p=0.001) and further decreased to 73.0±11 (73) bpm at V2 (p=0.001). Patients achieving a resting HR of <70 bpm were 21.7% at V1 (p=0.001) and 39.9% at V2 (p=0.001). KCCQ significantly increased from 59.7±23 (62.7) at V0 to 73.1±18 (78.5) at V2 (p=0.001). In addition, patients with NYHA I increased from 22.2% at V0 to 29.2% at V1 and 39.4% at V2 (p=0.01). CONCLUSION In real-life clinical practice, elevated HR is highly prevalent in HF despite widely used BB therapy and is associated with worse clinical picture. Therapeutic interventions targeting HR significantly reduce HR, and HR lowering is associated with improved clinical outcomes.
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Docherty KF, Shen L, Castagno D, Petrie MC, Abraham WT, Böhm M, Desai AS, Dickstein K, Køber LV, Packer M, Rouleau JL, Solomon SD, Swedberg K, Vazir A, Zile MR, Jhund PS, McMurray JJ. Relationship between heart rate and outcomes in patients in sinus rhythm or atrial fibrillation with heart failure and reduced ejection fraction. Eur J Heart Fail 2019; 22:528-538. [DOI: 10.1002/ejhf.1682] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/14/2019] [Accepted: 10/27/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Li Shen
- BHF Cardiovascular Research CentreUniversity of Glasgow Glasgow UK
| | - Davide Castagno
- Division of Cardiology, Città della Salute e della Scienza Hospital, Department of Medical SciencesUniversity of Turin Torino Italy
| | - Mark C. Petrie
- BHF Cardiovascular Research CentreUniversity of Glasgow Glasgow UK
| | - William T. Abraham
- Division of Cardiovascular Medicine, Davis Heart and Lung Research InstituteThe Ohio State University Columbus OH USA
| | - Michael Böhm
- Department of Internal Medicine III, University Hospital of SaarlandSaarland University Homburg/Saar Germany
| | - Akshay S. Desai
- Cardiovascular MedicineBrigham and Women's Hospital Boston MA USA
| | - Kenneth Dickstein
- Department of CardiologyUniversity of Bergen, Stavanger University Hospital Stavanger Norway
| | - Lars V. Køber
- Department of Cardiology, The Heart CentreRigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical Center Dallas TX USA
| | - Jean L. Rouleau
- Institut de Cardiologie de MontréalUniversité de Montréal Montréal Canada
| | - Scott D. Solomon
- Cardiovascular MedicineBrigham and Women's Hospital Boston MA USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Heart and Lung InstituteImperial College London London UK
| | - Ali Vazir
- Department of Cardiology, Royal Brompton Hospital, National Heart and Lung InstituteImperial College London London UK
| | - Michael R. Zile
- Department of MedicineMedical University of South Carolina Charleston SC USA
| | - Pardeep S. Jhund
- BHF Cardiovascular Research CentreUniversity of Glasgow Glasgow UK
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McAlister FA, Ezekowitz JA, Armstrong PW. Heart failure treatment and the art of medical decision making. Eur J Heart Fail 2019; 21:1510-1514. [PMID: 31769152 DOI: 10.1002/ejhf.1655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Medicine and Dentistry, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Faculty of Medicine and Dentistry, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Armstrong
- Faculty of Medicine and Dentistry, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
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Kosiborod MN, Jhund PS, Docherty KF, Diez M, Petrie MC, Verma S, Nicolau JC, Merkely B, Kitakaze M, DeMets DL, Inzucchi SE, Køber L, Martinez FA, Ponikowski P, Sabatine MS, Solomon SD, Bengtsson O, Lindholm D, Niklasson A, Sjöstrand M, Langkilde AM, McMurray JJV. Effects of Dapagliflozin on Symptoms, Function, and Quality of Life in Patients With Heart Failure and Reduced Ejection Fraction: Results From the DAPA-HF Trial. Circulation 2019; 141:90-99. [PMID: 31736335 PMCID: PMC6964869 DOI: 10.1161/circulationaha.119.044138] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Goals of management in patients with heart failure and reduced ejection fraction include reducing death and hospitalizations, and improving health status (symptoms, physical function, and quality of life). In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), sodium–glucose cotransporter-2 inhibitor, dapagliflozin, reduced death and hospitalizations, and improved symptoms in patients with heart failure and reduced ejection fraction. In this analysis, we examine the effects of dapagliflozin on a broad range of health status outcomes, using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: KCCQ was evaluated at randomization, 4 and 8 months. Patients were divided by baseline KCCQ total symptom score (TSS); Cox proportional hazards models examined the effects of dapagliflozin on clinical events across these subgroups. We also evaluated the effects of dapagliflozin on KCCQ-TSS, clinical summary score, and overall summary score. Responder analyses were performed to compare proportions of dapagliflozin versus placebo-treated patients with clinically meaningful changes in KCCQ at 8 months. Results: A total of 4443 patients had available KCCQ at baseline (median KCCQ-TSS, 77.1 [interquartile range, 58.3–91.7]). The effects of dapagliflozin vs placebo on reducing cardiovascular death or worsening heart failure were consistent across the range of KCCQ-TSS (lowest to highest tertile: hazard ratio, 0.70 [95% CI, 0.57–0.86]; hazard ratio, 0.77 [95% CI, 0.61–0.98]; hazard ratio, 0.62 [95% CI, 0.46–0.83]; P for heterogeneity=0.52). Patients treated with dapagliflozin had greater improvement in mean KCCQ-TSS, clinical summary score, and overall summary score at 8 months (2.8, 2.5 and 2.3 points higher versus placebo; P<0.0001 for all). Fewer patients treated with dapagliflozin had a deterioration in KCCQ-TSS (odds ratio, 0.84 [95% CI, 0.78–0.90]; P<0.0001); and more patients had at least small, moderate, and large improvements (odds ratio, 1.15 [95% CI, 1.08–1.23]; odds ratio, 1.15 [95% CI, 1.08–1.22]; odds ratio, 1.14 [95% CI, 1.07–1.22]; number needed to treat=14, 15, and 18, respectively; P<0.0001 for all; results consistent for KCCQ clinical summary score and overall summary score). Conclusions: Dapagliflozin reduced cardiovascular death and worsening heart failure across the range of baseline KCCQ, and improved symptoms, physical function, and quality of life in patients with heart failure and reduced ejection fraction. Furthermore, dapagliflozin increased the proportion of patients experiencing at least small, moderate, and large improvements in health status; these effects were clinically important. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03036124.
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Affiliation(s)
- Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (M.N.K.).,The George Institute for Global Health and University of New South Wales, Sydney, Australia (M.N.K)
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (P.S.J., K.F.D., M.C.P., J.J.V.M.)
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (P.S.J., K.F.D., M.C.P., J.J.V.M.)
| | - Mirta Diez
- Division of Cardiology, Instituto Cardiovascular de Buenos Aires, Argentina (M.D.)
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (P.S.J., K.F.D., M.C.P., J.J.V.M.)
| | - Subodh Verma
- St Michael's Hospital, University of Toronto, Canada (S.V.)
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas Faculdade de Medicina, Universidade de São Paulo, Brazil (J.C.N.)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Suita Osaka, Japan (M.K.)
| | - David L DeMets
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison (D.L.D.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT (S.E.I.)
| | - Lars Køber
- Rigshospitalet, Department of Cardiology, University of Copenhagen, Denmark (L.K.)
| | | | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Marc S Sabatine
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.S.S., S.D.S.)
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.S.S., S.D.S.)
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., D.L., A.N., M.S., A.M.L.)
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., D.L., A.N., M.S., A.M.L.)
| | - Anna Niklasson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., D.L., A.N., M.S., A.M.L.)
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., D.L., A.N., M.S., A.M.L.)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., D.L., A.N., M.S., A.M.L.)
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (P.S.J., K.F.D., M.C.P., J.J.V.M.)
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Bouabdallaoui N, O'Meara E, Bernier V, Komajda M, Swedberg K, Tavazzi L, Borer JS, Bohm M, Ford I, Tardif JC. Beneficial effects of ivabradine in patients with heart failure, low ejection fraction, and heart rate above 77 b.p.m. ESC Heart Fail 2019; 6:1199-1207. [PMID: 31591826 PMCID: PMC6989297 DOI: 10.1002/ehf2.12513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
Aims Ivabradine has been approved in heart failure with reduced ejection fraction (HFrEF) and elevated heart rate despite guideline‐directed medical therapy (GDMT) to reduce cardiovascular (CV) death and hospitalization for worsening HF. The median value of 77 b.p.m. is the lower bound selected for the regulatory approval in Canada, South Africa, and Australia. Patient‐reported outcomes (PROs) including symptoms, quality of life, and global assessment are considered of major interest in the global plan of care of patients with HF. However, the specific impact of GDMT, and specifically ivabradine, on PRO remains poorly studied. In the subgroup of patients from the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT) who had heart rate above the median of 77 b.p.m. (pre‐specified analysis) and for whom the potential for improvement was expected to be larger, we aimed (i) to evaluate the effects of ivabradine on PRO (symptoms, quality of life, and global assessment); (ii) to consolidate the effects of ivabradine on the primary composite endpoint of CV death and hospitalization for HF; and (iii) to reassess the effects of ivabradine on left ventricular (LV) remodelling. Methods and results Comparisons were made according to therapy, and proportional hazards models (adjusted for baseline beta‐blocker therapy) were used to estimate the association between ivabradine and various outcomes. In SHIFT, n = 3357 (51.6%) patients had a baseline heart rate > 77 b.p.m. After a median follow‐up of 22.9 months (inter‐quartile range 18–28 months), ivabradine on top of GDMT improved symptoms (28% vs. 23% improvement in New York Heart Association functional class, P = 0.0003), quality of life (5.3 vs. 2.2 improvement in Kansas City Cardiomyopathy Questionnaire overall summary score, P = 0.005), and global assessment [from both patient (improved in 72.3%) and physician (improved in 61.0%) perspectives] significantly more than did placebo (both P < 0.0001). Ivabradine induced a 25% reduction in the combined endpoint of CV death and hospitalization for HF (hazard ratio 0.75; P < 0.0001), which translates into a number of patients needed to be treated for 1 year of 17. Patients under ivabradine treatment demonstrated a significant reduction in LV dimensions when reassessed at 8 months (P < 0.05). Conclusions In patients with chronic HFrEF, sinus rhythm, and a heart rate > 77 b.p.m. while on GDMT, the present analysis brings novel insights into the role of ivabradine in improving the management of HFrEF, particularly with regard to PRO (ISRCTN70429960).
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Virginie Bernier
- Scientific and Medical Affairs, Servier Canada Inc., Laval, Quebec, Canada
| | - Michel Komajda
- Department of Cardiology, Paris Saint Joseph Hospital, Paris, France
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Jeffrey S Borer
- Howard Gilman and Schiavone Institutes, State University of New York Downstate Medical Center, New York, NY, USA
| | - Michael Bohm
- Internal Medicine Clinic III, Saarland University Clinic, Saarland University, Homburg, Saar, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
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Jorsal A, Pryds K, McMurray JJV, Wiggers H, Sommer A, Nielsen JC, Nielsen RR. Optimizing heart failure treatment following cardiac resynchronization therapy. Clin Res Cardiol 2019; 109:638-645. [DOI: 10.1007/s00392-019-01553-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/13/2019] [Indexed: 12/28/2022]
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Nassif ME, Windsor SL, Tang F, Khariton Y, Husain M, Inzucchi SE, McGuire DK, Pitt B, Scirica BM, Austin B, Drazner MH, Fong MW, Givertz MM, Gordon RA, Jermyn R, Katz SD, Lamba S, Lanfear DE, LaRue SJ, Lindenfeld J, Malone M, Margulies K, Mentz RJ, Mutharasan RK, Pursley M, Umpierrez G, Kosiborod M. Dapagliflozin Effects on Biomarkers, Symptoms, and Functional Status in Patients With Heart Failure With Reduced Ejection Fraction: The DEFINE-HF Trial. Circulation 2019; 140:1463-1476. [PMID: 31524498 DOI: 10.1161/circulationaha.119.042929] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Outcome trials in patients with type 2 diabetes mellitus have demonstrated reduced hospitalizations for heart failure (HF) with sodium-glucose co-transporter-2 inhibitors. However, few of these patients had HF, and those that did were not well-characterized. Thus, the effects of sodium-glucose co-transporter-2 inhibitors in patients with established HF with reduced ejection fraction, including those with and without type 2 diabetes mellitus, remain unknown. METHODS DEFINE-HF (Dapagliflozin Effects on Biomarkers, Symptoms and Functional Status in Patients with HF with Reduced Ejection Fraction) was an investigator-initiated, multi-center, randomized controlled trial of HF patients with left ventricular ejection fraction ≤40%, New York Heart Association (NYHA) class II-III, estimated glomerular filtration rate ≥30 mL/min/1.73m2, and elevated natriuretic peptides. In total, 263 patients were randomized to dapagliflozin 10 mg daily or placebo for 12 weeks. Dual primary outcomes were (1) mean NT-proBNP (N-terminal pro b-type natriuretic peptide) and (2) proportion of patients with ≥5-point increase in HF disease-specific health status on the Kansas City Cardiomyopathy Questionnaire overall summary score, or a ≥20% decrease in NT-proBNP. RESULTS Patient characteristics reflected stable, chronic HF with reduced ejection fraction with high use of optimal medical therapy. There was no significant difference in average 6- and 12-week adjusted NT-proBNP with dapagliflozin versus placebo (1133 pg/dL (95% CI 1036-1238) vs 1191 pg/dL (95% CI 1089-1304), P=0.43). For the second dual-primary outcome of a meaningful improvement in Kansas City Cardiomyopathy Questionnaire overall summary score or NT-proBNP, 61.5% of dapagliflozin-treated patients met this end point versus 50.4% with placebo (adjusted OR 1.8, 95% CI 1.03-3.06, nominal P=0.039). This was attributable to both higher proportions of patients with ≥5-point improvement in Kansas City Cardiomyopathy Questionnaire overall summary score (42.9 vs 32.5%, adjusted OR 1.73, 95% CI 0.98-3.05), and ≥20% reduction in NT-proBNP (44.0 vs 29.4%, adjusted OR 1.9, 95% CI 1.1-3.3) by 12 weeks. Results were consistent among patients with or without type 2 diabetes mellitus, and other prespecified subgroups (all P values for interaction=NS). CONCLUSIONS In patients with heart failure and reduced ejection fraction, use of dapagliflozin over 12 weeks did not affect mean NT-proBNP but increased the proportion of patients experiencing clinically meaningful improvements in HF-related health status or natriuretic peptides. Benefits of dapagliflozin on clinically meaningful HF measures appear to extend to patients without type 2 diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02653482.
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Affiliation(s)
- Michael E Nassif
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.)
| | - Sheryl L Windsor
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.)
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.)
| | - Yevgeniy Khariton
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.)
| | - Mansoor Husain
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada (M.H.).,Ted Rogers Centre for Heart Research, Toronto, Canada (M.H.).,University of Toronto, Canada (M.H.).,Peter Munk Cardiac Centre, Toronto, Canada (M.H)
| | | | - Darren K McGuire
- University of Texas Southwestern Medical Center, Dallas (D.K.M., M.H.D.)
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Benjamin M Scirica
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.M.S., M.M.G.)
| | - Bethany Austin
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.)
| | - Mark H Drazner
- University of Texas Southwestern Medical Center, Dallas (D.K.M., M.H.D.)
| | - Michael W Fong
- Keck School of Medicine of USC, University of Southern California, Los Angeles (M.W.F.)
| | - Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.M.S., M.M.G.)
| | | | | | - Stuart D Katz
- New York University Langone Health, New York (S.D.K.)
| | - Sumant Lamba
- First Coast Cardiovascular Institute, Jacksonville, FL (S.L.)
| | | | - Shane J LaRue
- Washington University School of Medicine, St. Louis, MO (S.J.L.)
| | | | - Michael Malone
- Charlotte Heart Group Research Center, Port Charlotte, FL (M.M.)
| | | | | | | | | | | | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.).,The George Institute for Global Health, Sydney, Australia (M.K.).,University of New South Wales, Sydney, Australia (M.K.)
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Khariton Y, Fonarow GC, Arnold SV, Hellkamp A, Nassif ME, Sharma PP, Butler J, Thomas L, Duffy CI, DeVore AD, Albert NM, Patterson JH, Williams FB, McCague K, Spertus JA. Association Between Sacubitril/Valsartan Initiation and Health Status Outcomes in Heart Failure With Reduced Ejection Fraction. JACC-HEART FAILURE 2019; 7:933-941. [PMID: 31521679 DOI: 10.1016/j.jchf.2019.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to describe the short-term health status benefits of angiotensin-neprilysin inhibitor (ARNI) therapy in patients with heart failure and reduced ejection fraction (HFrEF). BACKGROUND Although therapy with sacubitril/valsartan, a neprilysin inhibitor, improved patients' health status (compared with enalapril) at 8 months in the PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) study, the early impact of ARNI on patients' symptoms, functions, and quality of life is unknown. METHODS Health status was assessed by using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ) in 3,918 outpatients with HFrEF and left ventricular ejection fraction ≤40% across 140 U.S. centers in the CHAMP-HF (Change the Management of Patients with Heart Failure) registry. ARNI therapy was initiated in 508 patients who were matched 1:2 to 1,016 patients who were not initiated on ARNI (no-ARNI), using a nonparsimonious time-dependent propensity score (6 sociodemographic factors, 23 clinical characteristics), prior KCCQ overall summary (KCCQ-OS) score, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker status. RESULTS Multivariate linear regression demonstrated a greater mean improvement in KCCQ-OS in patients initiated on ARNI therapy (5.3 ± 19 vs. 2.5 ± 17.4, respectively; p < 0.001) over a median (interquartile range [IQR]) of 57 (32 to 104) days. The proportions of ARNI versus no-ARNI groups with ≥10-point (large) and ≥20-point (very large) improvements in KCCQ-OS were 32.7% versus 26.9%, respectively, and 20.5% versus 12.1%, respectively, consistent with numbers needed to treat of 18 and 12, respectively. CONCLUSIONS In routine clinical care, ARNI therapy was associated with early improvements in health status, with 20% experiencing a very large health status benefit compared with 12% who were not started on ARNI therapy. These findings support the use of ARNI to improve patients' symptoms, functions, and quality of life.
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Affiliation(s)
- Yevgeniy Khariton
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri.
| | - Gregg C Fonarow
- Department of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California
| | - Suzanne V Arnold
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Ann Hellkamp
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael E Nassif
- Department of Cardiology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Puza P Sharma
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | - Carol I Duffy
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Adam D DeVore
- Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | | | - Kevin McCague
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - John A Spertus
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
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Abstract
The prevalence of heart failure has been steadily increasing during the past few years, with a further increase predicted in the years to come. Without treatment, the syndrome of heart failure has a very poor prognosis. Advances in drug treatments and the consequent implementation of a guideline-recommended drug therapy have significantly improved the prognosis in heart failure with reduced ejection fraction (HFrEF). Besides angiotensin-converting enzyme (ACE) inhibitors (ACEi) or angiotensin receptor blockers, beta-blockers and diuretics treatment with mineralocorticoid receptor antagonists and ivabradine have become standard in the therapy of symptomatic patients with HFrEF. Recently, the impact of the adequate dosage of ACEi and beta-blockers was emphasized again. Angiotensin receptor-neprilysin inhibition is an auspicious new therapeutic approach and is predicted to play a crucial role in heart failure treatment in the coming years. The role of cardiac glycosides in the modern era of heart failure therapy is the focus of a current randomized controlled trial. Last but not least, potassium binders such as the new substance patiromer might help in overcoming the problem of hyperkalemia, which frequently limits the dosing of vital heart failure drugs. These advances offer optimism for further improvements in the prognosis and quality of life of HFrEF patients.
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Pei H, Miao W, Xie WZ, Wang W, Zhao D, Su GH, Zhao Z. Ivabradine Improves Cardiac Function and Increases Exercise Capacity in Patients with Chronic Heart Failure. Int Heart J 2019; 60:899-909. [PMID: 31308326 DOI: 10.1536/ihj.18-559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To systematically review and conduct a meta-analysis of the ivabradine-induced improvement in cardiopulmonary function, exercise capacity, and primary composite endpoints in patients with chronic heart failure (CHF).This study was a systematic review and meta-analysis.Databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinical Trials and European Union Clinical Trials, were searched for randomized placebo-controlled trials. The efficacy and safety of ivabradine treatment in patients with CHF were assessed and compared to those of the standard anti-heart failure treatment. Review Manager 5.3 software was used to analyze the relative risk (RR) for dichotomous data and the mean difference (MD) for continuous data.In total, 22 studies with 24,562 patients were included. Cardiopulmonary function analysis showed that treatment with added ivabradine reduced the heart rate (MD = -17.30, 95% confidence interval (CI): 19.52--15.08, P < 0.00001), significantly increased the left ventricular ejection fraction (LVEF) (MD = 3.90, 95% CI: 0.40-7.40, P < 0.0001), and led to a better New York Heart Association (NYHA) classification. Ivabradine significantly reduced the minute ventilation/carbon dioxide production (VE/VCO2) (MD = -2.68, 95% CI: -4.81--0.55, P = 0.01) and improved the peak VO2 (MD = 2.80, 95% CI: 1.05-4.55, P = 0.002) and the exercise capacity, including the exercise duration with a submaximal load (MD = 7.82, 95% CI: -2.57--18.21, P < 0.00001) and the 6-minute walk distance. The RR of cardiovascular death or worsening heart failure was significantly decreased (RR = 0.93, 95% CI: 0.87--0.98, P = 0.01) in the patients treated with ivabradine. Additionally, the RRs of heart failure and hospitalization also decreased (RR = 0.91, 95% CI: 0.85--0.97, P = 0.006; RR = 0.86, 95% CI: 0.79--0.93, P = 0.0002). Safety analysis showed no significant difference in the RR of severe adverse events between the ivabradine group and the standard anti-heart failure treatment group (P = 0.40). However, ivabradine significantly increased the RR of visual symptoms in CHF patients (RR = 3.82, 95% CI: 1.80--8.13, P = 0.0005).Existing evidence showed that adding ivabradine treatment significantly improved the cardiopulmonary function and increased the exercise capacity of patients with CHF. Adding ivabradine to the standard anti-heart failure treatment reduced the mortality and hospitalization risk and improved the quality of life. Finally, ivabradine significantly increased the RR of visual symptoms in CHF patients.This is the first systematic review and meta-analysis to focus on the efficacy of ivabradine, which improved the cardiac function and increased the exercise capacity in patients with chronic heart failure (CHF). Therefore, this study will help evaluate the quality of life after adding ivabradine to the treatment of patients with CHF, even though there are differences in the standard for resting heart rate, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class in the included studies. This hybrid effect might be smaller when analyzed separately but might have a higher heterogeneity when analyzed in multiple studies.
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Affiliation(s)
- Hui Pei
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University.,Ti'an City Central Hospital
| | - Wei Miao
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
| | - Wen-Zhi Xie
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
| | - Wei Wang
- Department of Cardiology, Shandong Provincial Chest Hospital
| | - Di Zhao
- Department of Cardiology, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Guo-Hai Su
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
| | - Zhuo Zhao
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
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McMurray JJ, DeMets DL, Inzucchi SE, Køber L, Kosiborod MN, Langkilde AM, Martinez FA, Bengtsson O, Ponikowski P, Sabatine MS, Sjöstrand M, Solomon SD. A trial to evaluate the effect of the sodium-glucose co-transporter 2 inhibitor dapagliflozin on morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction (DAPA-HF). Eur J Heart Fail 2019; 21:665-675. [PMID: 30895697 PMCID: PMC6607736 DOI: 10.1002/ejhf.1432] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce the risk of incident heart failure hospitalization in individuals with type 2 diabetes who have, or are at high risk of, cardiovascular disease. Most patients in these trials did not have heart failure at baseline and the effect of SGLT2 inhibitors on outcomes in individuals with established heart failure (with or without diabetes) is unknown. DESIGN AND METHODS The Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) is an international, multicentre, parallel group, randomized, double-blind, study in patients with chronic heart failure, evaluating the effect of dapagliflozin 10 mg, compared with placebo, given once daily, in addition to standard care, on the primary composite outcome of a worsening heart failure event (hospitalization or equivalent event, i.e. an urgent heart failure visit) or cardiovascular death. Patients with and without diabetes are eligible and must have a left ventricular ejection fraction ≤ 40%, a moderately elevated N-terminal pro B-type natriuretic peptide level, and an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2 . The trial is event-driven, with a target of 844 primary outcomes. Secondary outcomes include the composite of total heart failure hospitalizations (including repeat episodes), and cardiovascular death and patient-reported outcomes. A total of 4744 patients have been randomized. CONCLUSIONS DAPA-HF will determine the efficacy and safety of the SGLT2 inhibitor dapagliflozin, added to conventional therapy, in a broad spectrum of patients with heart failure and reduced ejection fraction.
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Affiliation(s)
| | - David L. DeMets
- Department of Biostatistics and Medical Informatics, School of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Silvio E. Inzucchi
- Section of EndocrinologyYale University School of MedicineNew HavenCTUSA
| | - Lars Køber
- Rigshospitalet Copenhagen University HospitalCopenhagenDenmark
| | - Mikhail N. Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri‐Kansas CityKansas CityMOUSA
- The George Institute for Global HealthSydneyAustralia
| | | | | | | | | | - Marc S. Sabatine
- TIMI Study Group, Division of Cardiovascular MedicineBrigham and Women's Hospital, and Harvard Medical SchoolBostonMAUSA
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46
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Butler J, Lam CS, Anstrom KJ, Ezekowitz J, Hernandez AF, O’Connor CM, Pieske B, Ponikowski P, Shah SJ, Solomon SD, Voors AA, Wu Y, Carvalho F, Bamber L, Blaustein RO, Roessig L, Armstrong PW. Rationale and Design of the VITALITY-HFpEF Trial. Circ Heart Fail 2019; 12:e005998. [DOI: 10.1161/circheartfailure.119.005998] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B.)
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Duke-National University of Singapore (C.S.P.L.)
- The George Institute for Global Health (C.S.P.L.)
- University Medical Center Groningen, (C.S.P.L.), the Netherlands
| | | | - Justin Ezekowitz
- Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (J.E., P.W.A.)
| | | | - Christopher M. O’Connor
- Duke University Medical Center, Durham, NC (C.M.O.)
- Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.)
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Germany (B.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, and German Centre for Cardiovascular Research (DZHK), Partner site Berlin, and Berlin Institute of Health (BIH), Germany (B.P.)
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Poland (P.P.)
- Cardiology Department, Military Hospital, Wrocław, Poland (P.P.)
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Scott D. Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Adriaan A. Voors
- Department of Cardiology, University of Groningen (A.A.V.), the Netherlands
| | - Yi Wu
- Bayer AG, Wuppertal, Germany (Y.W., F.C., L.B., L.R.)
| | | | - Luke Bamber
- Bayer AG, Wuppertal, Germany (Y.W., F.C., L.B., L.R.)
| | | | | | - Paul W. Armstrong
- Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (J.E., P.W.A.)
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47
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Sattar Y, Neisani Samani E, Zafrullah F, Latchana S, Patel NB. Ivabradine in Congestive Heart Failure: Patient Selection and Perspectives. Cureus 2019; 11:e4448. [PMID: 31205834 PMCID: PMC6561528 DOI: 10.7759/cureus.4448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Heart failure (HF) is the fourth-most frequent cause of death and remains a challenge for public health. Therapy goals for HF with reduced ejection fraction (HFrEF) are the improvement in the quality of life, prolonged survival, a reduction of signs and symptoms, and the prevention of hospitalization. Angiotensin-converting enzyme inhibitors, beta‐blockers, and mineralocorticoid receptor antagonists are the treatments of choice for HFrEF. Although ivabradine is not available in all countries, it is likely a new promising approach to improve outcomes in patients with HFrEF, either alone or with beta-blockers. Here, we review the current knowledge about ivabradine in HFrEF and assess its effect on outcomes in HF.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Fnu Zafrullah
- Internal Medicine, Steward Carney Hospital, Tufts University School of Medicine, Boston, USA
| | - Sharaad Latchana
- Internal Medicine, American University of Integrative Sciences, Tucker, BRB
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48
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Ide T, Ohtani K, Higo T, Tanaka M, Kawasaki Y, Tsutsui H. Ivabradine for the Treatment of Cardiovascular Diseases. Circ J 2018; 83:252-260. [PMID: 30606942 DOI: 10.1253/circj.cj-18-1184] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Higher heart rate (HR) is independently related to worse outcomes in various cardiac diseases, including hypertension, coronary artery disease, and heart failure (HF). HR is determined by the pacemaker activity of cells within the sinoatrial node. The hyperpolarization-activated cyclic nucleotide-gated (HCN) 4 channel, one of 4 HCN isoforms, generates the If current and plays an important role in the regulation of pacemaker activity in the sinoatrial node. Ivabradine is a novel and only available HCN inhibitor, which can reduce HR and has been approved for stable angina and chronic HF in many countries other than Japan. In this review, we summarize the current knowledge of the HCN4 channel and ivabradine, including the function of HCN4 in cardiac pacemaking, the mechanism of action of If inhibition by ivabradine, and the pharmacological and clinical effects of ivabradine in cardiac diseases as HF, coronary artery disease, and atrial fibrillation.
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Affiliation(s)
- Tomomi Ide
- Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kisho Ohtani
- Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
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49
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Guzman M, Gomez R, Romero SP, Aranda R, Andrey JL, Pedrosa MJ, Egido J, Gomez F. Prognosis of heart failure treated with digoxin or with ivabradine: A cohort study in the community. Int J Clin Pract 2018; 72:e13217. [PMID: 30248211 DOI: 10.1111/ijcp.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Resting heart rate (HR) reduction with ivabradine (IVA) improves outcomes of patients with heart failure and reduced ejection fraction (HFrEF). Nevertheless, the best option to slow HR in patients with HFrEF treated with beta-blockers and a HR >70 bpm is unsettled. AIMS To evaluate whether, in patients with HFrEF, commencing therapy with digoxin (CT-DIG) is associated to a worse prognosis than commencing treatment with ivabradine (CT-IVA). METHODS Observational study over 10 years on 2364 patients with HFrEF in sinus rhythm and a HR >70 bpm. Main outcomes were mortality, hospitalisations and visits. We analyse the independent relationship of CT-DIG or CT-IVA with the prognosis, stratifying patients for cardiovascular comorbidity, and for other potential confounders (378 patients who CT-DIG vs another 355 patients who CT-IVA vs another 1631 patients non-exposed to IVA or DIG). RESULTS During a median follow-up of 57.5 months, 1751 patients (74.1%) died, and 2151 (91.0%) were hospitalised for HF. CT-DIG or CT-IVA was associated with a lower all-cause mortality (DIG: HR = 0.86 [95% CI, 0.82-0.90], and IVA: HR = 0.88 [0.83-0.93]), cardiovascular mortality (DIG: HR = 0.84 [0.80-0.89] and IVA: HR = 0.83 [0.78-0.89]), hospitalisation (DIG: HR = 0.86 [0.83-0.89] and IVA: HR = 0.87 [0.83-0.91]) and 30-day readmission (DIG: HR = 0.84 [0.79-0.90] and IVA: HR = 0.88 [0.79-0.95]), after adjustment for cardiovascular comorbidity, and other potential confounders. These associations with the prognosis of HFrEF did not differ between patients who CT-DIG and those who CT-IVA. CONCLUSION Commencing therapy with digoxin or with ivabradine is associated with an improved prognosis of patients with HFrEF.
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Affiliation(s)
- Marcos Guzman
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Rocio Gomez
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Sotero P Romero
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Rocio Aranda
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Jose L Andrey
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Maria J Pedrosa
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Julio Egido
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Francisco Gomez
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
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50
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Lopatin YM, Cowie MR, Grebennikova AA, Sisakian HS, Pagava ZM, Hayrapetyan HG, Abdullaev TA, Voronkov LG, Chesnikova AI, Tseluyko VI, Tarlovskaya EI, Dadashova GM, Berkinbaev SF, Glezer MG, Koziolova NA, Rakisheva AG, Kipiani ZV, Kurlyanskaya AK. Optimization of heart rate lowering therapy in hospitalized patients with heart failure: Insights from the Optimize Heart Failure Care Program. Int J Cardiol 2018; 260:113-117. [PMID: 29622423 DOI: 10.1016/j.ijcard.2017.12.093] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. METHODS AND RESULTS A retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. RESULTS At 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32-0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone. CONCLUSIONS Heart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy.
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Affiliation(s)
- Yuri M Lopatin
- Volgograd State Medical University, Volgograd Regional Cardiology Centre, 106, Universitetsky Prospect, Volgograd 400008, Russian Federation.
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), Sydney Street, London SW3 6HP, United Kingdom.
| | - Anna A Grebennikova
- Volgograd State Medical University, Volgograd Regional Cardiology Centre, 106, Universitetsky Prospect, Volgograd 400008, Russian Federation
| | - Hamayak S Sisakian
- University State Hospital 1, Yerevan State Medical University, 2, Koryun Street, Yerevan 375025, Armenia
| | - Zurab M Pagava
- Centre of Vascular and Heart Diseases, 5, Lubliana Street, Tbilisi, Georgia
| | | | | | - Leonid G Voronkov
- National Scientific Center Strazhesko Institute of Cardiology, National Academy of Medical Sciences, 5, Narodnogo Opolchenia Street, Kyiv 03680, Ukraine
| | - Anna I Chesnikova
- Rostov State Medical University, 29, Nahichevansky Avenue, Rostov-on-Don 344022, Russian Federation
| | - Vira I Tseluyko
- Kharkiv Medical Academy of Postgraduate Education, 58, Korchahintsiv Street, Kharkiv 61176, Ukraine
| | - Ekaterina I Tarlovskaya
- Nizhny Novgorod State Medical Academy, 10/1, Minin & Pozharsky Square, Nizhny Novgorod 603950, Russian Federation
| | - Gülnaz M Dadashova
- Scientific Research Institute of Cardiology, 316, Tbilisi Avenue, Baku, AZ1012, Azerbaijan
| | - Salim F Berkinbaev
- Scientific Research Institute of Cardiology and Internal Diseases, 120, Aiteke Bi Street, Almaty 050000, Kazakhstan
| | - Maria G Glezer
- I.M. Sechenov First Moscow State Medical University, 2, Bolshaya Pirogovskaya Street, Moscow 119991, Russian Federation
| | - Natalia A Koziolova
- Perm State Medical Academy, 39, Petropavlovskaya v Street, Perm 614000, Russian Federation
| | - Amina G Rakisheva
- Scientific Research Institute of Cardiology and Internal Diseases, 120, Aiteke Bi Street, Almaty 050000, Kazakhstan
| | | | - Alena K Kurlyanskaya
- Republican Scientific and Practical Centre of Cardiology, 110B, R. Luxemburg Street, Minsk 220036, Belarus
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