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Günen H, Alzaabi A, Bakhatar A, Al Mutairi S, Maneechotesuwan K, Tan D, Zeitouni M, Aggarwal B, Berzanskis A, Cintra O. Key Challenges to Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Southeast Asia, the Middle East, and North Africa: An Expert Perspective. Adv Ther 2024; 41:4312-4334. [PMID: 39312107 DOI: 10.1007/s12325-024-02954-2] [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: 06/28/2024] [Accepted: 07/22/2024] [Indexed: 10/16/2024]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a common, highly contagious pathogen and a leading cause of serious illness among infants and older adults. While existing scientific evidence has predominantly focused on the epidemiology and disease burden of RSV in infants, data in older adults remain limited in some countries, including those in Southeast Asia (SEA) and the Middle East and North Africa (MENA) region. Here, we outline the key challenges for understanding the burden of RSV in older adults in SEA and the MENA region and we propose opportunities for improving understanding and eventually reducing the impact of RSV. MAIN FINDINGS AND CONCLUSIONS A key challenge identified by the expert group, particularly in older adults, is a lack of awareness (among healthcare professionals, policy makers, and the public) of RSV burden and the associated risks for severe outcomes. This is often confounded by the complexities of underdiagnosis, surveillance limitations, and comorbidities. To address these issues, we suggest medical education initiatives for physicians in SEA and the MENA region to better understand the need to protect older adults from RSV, and encourage more widespread routine testing to better understand the burden of RSV. We also recommend surveillance studies in these regions to provide comprehensive and accurate epidemiological data on RSV in older adults. Finally, in the absence of current surveillance data in these regions, we propose extrapolating existing global data and local pediatric data to inform the likely burden of RSV in older adults. A graphical abstract is available with this article.
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Affiliation(s)
- Hakan Günen
- Süreyyapaşa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Istanbul, Turkey
| | - Ashraf Alzaabi
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | | | - Sana Al Mutairi
- College of Medicine, Kuwait University, Kuwait City, Kuwait
- Respiratory Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Kittipong Maneechotesuwan
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Daniel Tan
- University of the East College of Medicine, Quezon City, Philippines
| | - Mohammed Zeitouni
- Pulmonary Section, Department of Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Dovizio M, Leogrande M, Esposti LD. Heart failure and economic impact: an analysis in real clinical practice in Italy. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:94-100. [PMID: 38690121 PMCID: PMC11060510 DOI: 10.33393/grhta.2024.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction: Heart failure (HF) affects 1% of subjects aged 45-55 and over 10% of subjects aged ≥ 80 and in Italy represents the third leading cause of hospitalization.
Objective: To analyse the clinical and economic burden of HF in the Italian real clinical practice.
Methods: A retrospective analysis was conducted on the administrative databases of healthcare institutions for 4.2 million health-assisted residents. Between January 2012 and March 2021, patients with a hospital discharge diagnosis for HF were included. Among healthcare utilization and costs, treatments, hospitalizations, and specialist services were evaluated. The HF group was compared with a population without HF (no-HF) similar for age, sex distribution, and cardiovascular risk factors.
Results: The same number of patients with (N = 74,085) and without HF (N = 74,085) was included. A profile of cardiovascular comorbidities emerged in the HF group, mainly hypertension (88.6%), cardiovascular disease (61.3%) and diabetes (32.1%). Hospitalizations from any cause were 635.6 vs 429.8/1,000 person-year in the HF vs no-HF group. At one-year follow-up, all-cause mortality was 24.9% in HF patients and 8.4% in no-HF. Resource utilization/patient was respectively 26.8 ± 15.9 vs 17.1 ± 12.5 for medications, 0.8 ± 1.2 vs 0.3 ± 0.8 for hospitalizations, and 9.4 ± 12.6 vs 6.5 ± 9.8 for specialist services. This resource utilization resulted in significantly higher total healthcare costs in the HF group vs no-HF group (€ 5,910 vs € 3,574, p < 0.001), mainly related to hospitalizations (€ 3,702 vs € 1,958).
Conclusions: HF patients show a significantly higher clinical and economic burden than no-HF, with total healthcare costs being about 1.7 times the costs of the no-HF group.
Keywords: Cardiovascular comorbidities, Healthcare costs, Heart failure, Hospitalizations
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Affiliation(s)
- Melania Dovizio
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna - Italy
| | - Melania Leogrande
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna - Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna - Italy
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Rivera FB, Choi S, Carado GP, Adizas AV, Bantayan NRB, Loyola GJP, Cha SW, Aparece JP, Rocha AJB, Placino S, Ansay MFM, Mangubat GFE, Mahilum MLP, Al-Abcha A, Suleman N, Shah N, Suboc TMB, Volgman AS. End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines. Am J Hosp Palliat Care 2024; 41:87-98. [PMID: 36705612 DOI: 10.1177/10499091231154575] [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] [Indexed: 01/28/2023] Open
Abstract
Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care (PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device therapy and discontinuation as part of advance care planning (ACP). ESHF patients who do not have indications for advanced therapies or those who wish not to have a left ventricular assist device (LVAD) or heart transplant (HT) often experience high symptom burden despite adequate medical management. The proper identification and assessment of symptoms such as pain, dyspnea, nausea, depression, and anxiety are essential to the management of ESHF and may be underdiagnosed and undertreated. Psychological support and spiritual care are also crucial to improving the quality of life during EOL. Caregivers of ESHF patients must also be provided supportive care to prevent compassion fatigue and improve resilience in patient care. In this narrative review, we compare the international guidelines and provide an overview of end-of-life and palliative care for patients with ESHF.
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Affiliation(s)
| | - Sarang Choi
- Ateneo de Manila School of Medicine and Public Health, Pasig City, Philippines
| | - Genquen Philip Carado
- University of the East Ramon Magsaysay Memorial Medical Center, Inc, Quezon City, Philippines
| | - Arcel V Adizas
- University of the Philippines-Philippine General Hospital, Manila, Philippines
| | | | | | | | | | | | - Siena Placino
- St Luke's Medical Center College of Medicine, William H. Quasha Memorial, Manila, Philippines
| | | | | | | | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natasha Suleman
- Department of Palliative Care, Lincoln Medical Center, Bronx, NY, USA
| | - Nishant Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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Ashour D, Rebs S, Arampatzi P, Saliba AE, Dudek J, Schulz R, Hofmann U, Frantz S, Cochain C, Streckfuß-Bömeke K, Campos Ramos G. An interferon gamma response signature links myocardial aging and immunosenescence. Cardiovasc Res 2023; 119:2458-2468. [PMID: 37141306 PMCID: PMC10651211 DOI: 10.1093/cvr/cvad068] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/24/2023] [Accepted: 02/21/2023] [Indexed: 05/06/2023] Open
Abstract
AIMS Aging entails profound immunological transformations that can impact myocardial homeostasis and predispose to heart failure. However, preclinical research in the immune-cardiology field is mostly conducted in young healthy animals, which potentially weakens its translational relevance. Herein, we sought to investigate how the aging T-cell compartment associates with changes in myocardial cell biology in aged mice. METHODS AND RESULTS We phenotyped the antigen-experienced effector/memory T cells purified from heart-draining lymph nodes of 2-, 6-, 12-, and 18-month-old C57BL/6J mice using single-cell RNA/T cell receptor sequencing. Simultaneously, we profiled all non-cardiomyocyte cell subsets purified from 2- to 18-month-old hearts and integrated our data with publicly available cardiomyocyte single-cell sequencing datasets. Some of these findings were confirmed at the protein level by flow cytometry. With aging, the heart-draining lymph node and myocardial T cells underwent clonal expansion and exhibited an up-regulated pro-inflammatory transcription signature, marked by an increased interferon-γ (IFN-γ) production. In parallel, all major myocardial cell populations showed increased IFN-γ responsive signature with aging. In the aged cardiomyocytes, a stronger IFN-γ response signature was paralleled by the dampening of expression levels of transcripts related to most metabolic pathways, especially oxidative phosphorylation. Likewise, induced pluripotent stem cells-derived cardiomyocytes exposed to chronic, low grade IFN-γ treatment showed a similar inhibition of metabolic activity. CONCLUSIONS By investigating the paired age-related alterations in the T cells found in the heart and its draining lymph nodes, we provide evidence for increased myocardial IFN-γ signaling with age, which is associated with inflammatory and metabolic shifts typically seen in heart failure.
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Affiliation(s)
- DiyaaElDin Ashour
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
- Comprehensive Heart Failure Centre, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Sabine Rebs
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, 97078 Würzburg, Germany
| | - Panagiota Arampatzi
- Core Unit Systems Medicine, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Antoine-Emmanuel Saliba
- University of Würzburg, Faculty of Medicine, Institute of Molecular Infection Biology (IMIB), Josef-Schneider-Str. 2, 97080 Würzburg, Germany
- Helmholtz Institute for RNA-based Infection Research (HIRI), Helmholtz-Centre for Infection Research (HZI), Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Jan Dudek
- Comprehensive Heart Failure Centre, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Richard Schulz
- Departments of Pediatrics and Pharmacology, Mazankowski Alberta Heart Institute, University of Alberta, 4-62 HMRC, 11207 87 Ave NW, Edmonton, Alberta T6G, 2S2 Canada
| | - Ulrich Hofmann
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
- Comprehensive Heart Failure Centre, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
- Comprehensive Heart Failure Centre, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Clément Cochain
- Comprehensive Heart Failure Centre, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Institute of Experimental Biomedicine, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Katrin Streckfuß-Bömeke
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, 97078 Würzburg, Germany
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Gustavo Campos Ramos
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
- Comprehensive Heart Failure Centre, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
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Hsieh DJY, Tsai BCK, Barik P, Shibu MA, Kuo CH, Kuo WW, Lin PY, Shih CY, Lin SZ, Ho TJ, Huang CY. Human adipose-derived stem cells preconditioned with a novel herbal formulation Jing Shi attenuate doxorubicin-induced cardiac damage. Aging (Albany NY) 2023; 15:9167-9181. [PMID: 37708248 PMCID: PMC10522400 DOI: 10.18632/aging.205026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
Pathological cardiac hypertrophy is a considerable contributor to global disease burden. Chinese herbal medicine (CHM) has been used to treat cardiovascular diseases since antiquity. Enhancing stem cell-mediated recovery through CHM represents a promising approach for protection against doxorubicin (Dox)-induced cardiac hypertrophy. Herein, we investigated whether human adipose-derived stem cells (hADSCs) preconditioned with novel herbal formulation Jing Si (JS) improved protective ability of stem cells against doxorubicin-induced cardiac damage. The effect of JS on hADSC viability and migration capacity was determined via MTT and migration assays, respectively. Co-culture of hADSC or JS-preconditioned hADSCs with H9c2 cells was analyzed with immunoblot, flow cytometry, TUNEL staining, LC3B staining, F-actin staining, and MitoSOX staining. The in vivo study was performed M-mode echocardiography after the treatment of JS and JS-preconditioned hADSCs by using Sprague Dawley (SD) rats. Our results indicated that JS at doses below 100 μg/mL had less cytotoxicity in hADSC and JS-preconditioned hADSCs exhibited better migration. Our results also revealed that DOX enhanced apoptosis, cardiac hypertrophy, and mitochondrial reactive oxygen species in DOX-challenged H9c2 cells, while H9c2 cells co-cultured with JS-preconditioned hADSCs alleviated these effects. It also enhanced the expression of autophagy marker LC3B, mTOR and CHIP in DOX-challenged H9c2 cells after co-culture with JS-preconditioned hADSCs. In Dox-challenged rats, the ejection fraction and fractional shortening improved in DOX-challenged SD rats exposed to JS-preconditioned hADSCs. Taken together, our data indicate that JS-preconditioned stem cells exhibit a cardioprotective capacity both in vitro and in vivo, highlighting the value of this therapeutic approach for regenerative therapy.
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Affiliation(s)
- Dennis Jine-Yuan Hsieh
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
- Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Bruce Chi-Kang Tsai
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Parthasarathi Barik
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | | | - Chia-Hua Kuo
- Laboratory of Exercise Biochemistry, University of Taipei, Taipei, Taiwan
- Department of Kinesiology and Health Science, College of William and Mary, Williamsburg, USA
| | - Wei-Wen Kuo
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
- Ph.D. Program for Biotechnology Industry, China Medical University, Taichung, Taiwan
| | - Pi-Yu Lin
- Buddhist Compassion Relief Tzu Chi Foundation, Hualien, Taiwan
| | | | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, Taiwan
- Integration Center of Traditional Chinese and Modern Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tsung-Jung Ho
- Integration Center of Traditional Chinese and Modern Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
- School of Post-Baccalaureate Chinese Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Yang Huang
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
- Center of General Education, Buddhist Tzu Chi Medical Foundation, Tzu Chi University of Science and Technology, Hualien, Taiwan
- Graduate Institute of Basic Medical Science, China Medical University, Taichung City, Taiwan
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Kuntic M, Kuntic I, Hahad O, Lelieveld J, Münzel T, Daiber A. Impact of air pollution on cardiovascular aging. Mech Ageing Dev 2023; 214:111857. [PMID: 37611809 DOI: 10.1016/j.mad.2023.111857] [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: 07/06/2023] [Accepted: 08/19/2023] [Indexed: 08/25/2023]
Abstract
The world population is aging rapidly, and by some estimates, the number of people older than 60 will double in the next 30 years. With the increase in life expectancy, adverse effects of environmental exposures start playing a more prominent role in human health. Air pollution is now widely considered the most detrimental of all environmental risk factors, with some studies estimating that almost 20% of all deaths globally could be attributed to poor air quality. Cardiovascular diseases are the leading cause of death worldwide and will continue to account for the most significant percentage of non-communicable disease burden. Cardiovascular aging with defined pathomechanisms is a major trigger of cardiovascular disease in old age. Effects of environmental risk factors on cardiovascular aging should be considered in order to increase the health span and reduce the burden of cardiovascular disease in older populations. In this review, we explore the effects of air pollution on cardiovascular aging, from the molecular mechanisms to cardiovascular manifestations of aging and, finally, the age-related cardiovascular outcomes. We also explore the distinction between the effects of air pollution on healthy aging and disease progression. Future efforts should focus on extending the health span rather than the lifespan.
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Affiliation(s)
- Marin Kuntic
- University Medical Center Mainz, Department for Cardiology 1, Molecular Cardiology, Mainz, Germany
| | - Ivana Kuntic
- University Medical Center Mainz, Department for Cardiology 1, Molecular Cardiology, Mainz, Germany
| | - Omar Hahad
- University Medical Center Mainz, Department for Cardiology 1, Molecular Cardiology, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
| | - Jos Lelieveld
- Max Planck Institute for Chemistry, Atmospheric Chemistry, Mainz, Germany
| | - Thomas Münzel
- University Medical Center Mainz, Department for Cardiology 1, Molecular Cardiology, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.
| | - Andreas Daiber
- University Medical Center Mainz, Department for Cardiology 1, Molecular Cardiology, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.
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Murphy SP, Januzzi JL. Reply: Increasing the Utilization of Sac/Val in Elderly HFrEF Patients Eligible for ARNI Treatment. JACC. HEART FAILURE 2023; 11:372-373. [PMID: 36889886 DOI: 10.1016/j.jchf.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
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Nuzzi V, Raafs A, Manca P, Henkens MTHM, Gregorio C, Boscutti A, Verdonschot J, Hazebroek M, Knackstedt C, Merlo M, Stolfo D, Sinagra G, Heymans SRB. Left Atrial Reverse Remodeling in Dilated Cardiomyopathy. J Am Soc Echocardiogr 2023; 36:154-162. [PMID: 36332803 DOI: 10.1016/j.echo.2022.10.017] [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: 04/08/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Left atrial (LA) dilation is associated with a worse prognosis in several cardiovascular settings, but therapies can promote LA reverse remodeling. The aim of this study was to characterize and define the prognostic implications of LA volume index (LAVI) reduction in patients with dilated cardiomyopathy (DCM). METHODS Consecutive patients with DCM from two tertiary care centers, with available echocardiograms at baseline and at 1-year follow-up, were retrospectively analyzed. LA dilation was defined as LAVI > 34 mL/m2, and change in LAVI (ΔLAVI) was defined as the 1-year relative LAVI reduction. The outcome was a composite of death, heart transplantation (HTx), or heart failure hospitalization (HFH). RESULTS Five hundred sixty patients were included (mean age, 54 ± 13 years; mean left ventricular ejection fraction, 31 ± 10%; mean LAVI, 45 ± 18 mL/m2). Baseline LAVI had a non-linear association with the risk for death, HTx, or HFH, independent of age, left ventricular ejection fraction, mitral regurgitation, and medical therapy (P < .01). At 1-year follow-up, LAVI decreased in 374 patients (67%; median ΔLAVI, -24%; interquartile range, -37% to -11%). Factors independently associated with ΔLAVI were higher baseline LAVI and lower baseline left ventricular ejection fraction. After multivariable adjustment, ΔLAVI showed a linear association with the risk for death, HTx, or HFH (hazard ratio, 0.96 per 5% decrease; 95% CI, 0.93-0.99; P = .042). At 1-year follow-up, patients with reductions in LAVI of >10% and LAVI normalization (i.e., follow-up LAVI ≤ 34 mL/m2; 31% of the overall cohort) were at lower risk for death, HTx, or HFH (hazard ratio, 0.37; 95% CI, 0.35-0.97; P = .028). CONCLUSIONS In a large cohort of patients with DCM, 1-year reduction in LAVI was observed in a number of patients. The association between reduction in LAVI and death, HTx, or HFH suggests that LA structural reverse remodeling might be considered an additional parameter useful in the individualized risk stratification of patients with DCM.
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Affiliation(s)
- Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Anne Raafs
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Paolo Manca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Michiel T H M Henkens
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Caterina Gregorio
- Biostatistics Unit, University of Trieste, Trieste, Italy; MOX - Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Andrea Boscutti
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy; Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Job Verdonschot
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mark Hazebroek
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Stephane R B Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
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Seo EJ, Won MH, Son YJ. Association of sleep duration and physical frailty with cognitive function in older patients with coexisting atrial fibrillation and heart failure. Nurs Open 2022; 10:3201-3209. [PMID: 36560851 PMCID: PMC10077387 DOI: 10.1002/nop2.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
AIM To investigate the associations of sleep duration and physical frailty with cognitive function in older patients with both atrial fibrillation and heart failure. DESIGN This study used a cross-sectional, secondary data analysis design. METHOD We included outpatients aged ≥ 65 years with coexisting atrial fibrillation and heart failure in South Korea. We used a sample of 176 patients (men = 100) with HF among 277 data from the parent study. The data were collected through a self-report, structured questionnaire and electronic medical record. RESULTS Our main finding showed that long sleep duration and physically frail status were significant predictors of cognitive impairment in older adults with both atrial fibrillation and heart failure. Healthcare providers should be aware of the importance of assessing sleep duration and physical activity in older adults with both atrial fibrillation and heart failure to prevent or delay cognitive impairment.
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Affiliation(s)
- Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon, Korea
| | - Mi Hwa Won
- Wonkwang University, Department of Nursing 460 Iksandaero, Iksan, Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Frampton JE. Empagliflozin: A Review in Symptomatic Chronic Heart Failure. Drugs 2022; 82:1591-1602. [DOI: 10.1007/s40265-022-01778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
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Sattar Y, Song D, Almas T, Zghouzi M, Talib U, Suleiman ARM, Ahmad B, Arshad J, Ullah W, Zia Khan M, Bianco CM, Bagur R, Rashid M, Mamas MA, Alraies MC. Cardiovascular outcomes and trends of Transcatheter vs. Surgical aortic valve replacement among octogenarians with heart failure: A Propensity Matched national cohort analysis. IJC HEART & VASCULATURE 2022; 42:101119. [PMID: 36161232 PMCID: PMC9489740 DOI: 10.1016/j.ijcha.2022.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022]
Abstract
Background Methods Results Conclusion
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Murphy SP, Ward JH, Piña IL, Felker GM, Butler J, Maisel AS, Meng X, Prescott MF, Solomon SD, Januzzi JL. Age Differences in Effects of Sacubitril/Valsartan on Cardiac Remodeling, Biomarkers and Health Status. JACC: HEART FAILURE 2022; 10:976-988. [PMID: 36456072 DOI: 10.1016/j.jchf.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sacubitril/valsartan (Sac/Val) improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES In this study, the authors sought to explore age differences in effects of Sac/Val on biomarkers, Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 scores and cardiac remodeling. METHODS After initiation and titration of Sac/Val, concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-cTnT), and soluble suppressor of tumorigenicity 2 (sST2) were measured and KCCQ-23 scores obtained from baseline to 12 months. Left ventricular ejection fraction (LVEF), and indexed left ventricular end-systolic (LVESVi) and indexed left ventricular end-diastolic (LVEDVi) and left atrial volume index (LAVi) volumes were measured with the use of echocardiography. Safety end points were assessed. Age-stratified analysis was performed for groups aged <65, 65-74, and ≥75 years. RESULTS Among 794 participants with HFrEF (mean age 65.1 years, 28.5% women), compared with patients aged <65 years (n = 369), 65-74 years (n = 237), and those aged ≥75 years (n = 188), had similar reductions in hs-cTnT and sST2, but less NT-proBNP reduction (-45.6% vs -40.2% vs -30.5%, respectively; P = 0.02). Gains in KCCQ-23 were smaller (+11.8 vs +11.4 vs +6.0 points; P = 0.03) in patients aged ≥75 years, although similar proportions of each age group achieved ≥10-point and ≥20-point increases in KCCQ-23 by month 12. Improvements in LVEF, LVEDVi, LVESVi, and LAVi were similar among age groups. Incidence of safety end points was also similar. CONCLUSIONS Sac/Val resulted in significant improvements in prognostic biomarkers and measures of cardiac remodeling and health status from baseline to month 12 across age categories. Older study participants showed somewhat blunted reduction in NT-proBNP and less improvement in KCCQ-23 overall summary scores. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling, and Outcomes [PROVE-HF]; NCT02887183).
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Affiliation(s)
- Sean P Murphy
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - G Michael Felker
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Alan S Maisel
- University of California, San Diego School of Medicine, San Diego, California, USA
| | - Xiangyi Meng
- Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | | | - Scott D Solomon
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - James L Januzzi
- Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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13
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Adams J, Mosler C. Safety and efficacy considerations amongst the elderly population in the updated treatment of heart failure: a review. Expert Rev Cardiovasc Ther 2022; 20:529-541. [PMID: 35786091 DOI: 10.1080/14779072.2022.2098118] [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] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Heart failure is one of the cardiovascular diseases that impacts the geriatric population. As new clinical trials investigating heart failure are conducted, groundbreaking information is assessable to further evolve the treatment. To correctly improve the quality of life of elderly patients, it is critical to evaluate the safety and efficacy of new and improved therapy regimens. AREAS COVERED In reviewal of the 2021 and 2022 updated guidelines, the safety and efficacy of the newly indicated medications will be addressed. The new indications cover sacubitril/valsartan and two SGLT2 inhibitors: dapagliflozin and empagliflozin. An introduction to the medications discussed covers the pharmacology before addressing the efficacy and safety considerations in the elderly population. Furthermore, prime drug-drug interactions associated with the two classes of medications will be considered as well as providing possible solutions to further create the safest drug therapy for geriatric patients with common comorbidities. EXPERT OPINION The two classes of medications, the ARNI and SGLT2 inhibitors, are well-tolerated amongst the elderly population. With the release of new guidelines, the updated medications will provide safer and better therapy in this disease state for geriatrics. One major limitation includes the high cost of these brand-named medications.
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Affiliation(s)
- Jack Adams
- College of Pharmacy, The University of Findlay, Findlay, OH, 45840
| | - Charles Mosler
- College of Pharmacy, The University of Findlay, Findlay, OH, 45840
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14
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Stubbs H, MacLellan A, McGettrick M, Jani B, Brewis M, Church C, Johnson M. Predicting Group II pulmonary hypertension: diagnostic accuracy of the H2FPEF and OPTICS scores in Scotland. Open Heart 2022; 9:openhrt-2022-002023. [PMID: 35477699 PMCID: PMC9047890 DOI: 10.1136/openhrt-2022-002023] [Citation(s) in RCA: 2] [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: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Group II pulmonary hypertension (PH) can be challenging to distinguish from Group I PH without proceeding to right heart catheterisation (RHC). The diagnostic accuracy of the H2FPEF and OPTICS scores was investigated in Scotland. METHODS Patients were included in the study if they were referred to the Scottish Pulmonary Vascular Unit between 2016 and 2020 and subsequently diagnosed with Group II PH or Group I PH which was either idiopathic, heritable or pulmonary veno-occlusive disease. The established cut offs for the H2FPEF and for the OPTICS scores were applied retrospectively to predict the presence of Group II PH. The diagnosis from the scores were compared with the MDT consensus diagnosis following RHC. RESULTS 107 patients with Group I PH and 86 patients with Group II PH were included. Retrospective application of the OPTICS score demonstrated that pretest scoring would detect 28% of cases with Group II PH yet at the cost of misdiagnosing 4% of patients with Group I as Group II PH (specificity 0.96). The H2FPEF score had a far greater sensitivity (0.70) yet reduced specificity (0.91), leading to misdiagnosis of 9% of Group I PH cases. CONCLUSION While the specificity of these scores was high, the lack of perfect specificity limits their utility as it results in missed patients with Group I PH. As a consequence, they cannot replace RHC as the means of diagnosing the aetiology of PH in their current form. The scores may still be used to support clinical judgement or to indicate the advisability for further provocative testing at RHC.
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Affiliation(s)
- Harrison Stubbs
- Scottish Pulmonary Vascular Unit, NHS Greater Glasgow and Clyde, Glasgow, UK .,Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Alexander MacLellan
- Scottish Pulmonary Vascular Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Michael McGettrick
- Scottish Pulmonary Vascular Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bhautesh Jani
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Melanie Brewis
- Scottish Pulmonary Vascular Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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15
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Gilstrap LG, Gorodeski EZ, Goyal P. Heart failure and cognitive impairment: Complexity that requires a new approach. J Am Geriatr Soc 2022; 70:1652-1654. [DOI: 10.1111/jgs.17779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lauren G. Gilstrap
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth Hanover New Hampshire USA
- Dartmouth‐Hitchcock Medical Center, Heart and Vascular Center Lebanon New Hampshire USA
| | - Eiran Z. Gorodeski
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center Cleveland Ohio USA
- Case Western Reserve University School of Medicine Cleveland Ohio USA
| | - Parag Goyal
- Department of Medicine Weill Cornell Medicine New York New York USA
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16
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Triggiani V, Cittadini A, Lisco G. Effect of levothyroxine replacement therapy in patients with subclinical hypothyroidism and chronic heart failure: A systematic review. Front Endocrinol (Lausanne) 2022; 13:1013641. [PMID: 36457560 PMCID: PMC9706201 DOI: 10.3389/fendo.2022.1013641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic heart failure (CHF) affects the health care system with high social and economic costs due to recurrent hospital admissions or frequent ambulatory reassessments. Subclinical hypothyroidism (SCH) is commonly observed in patients with CHF and negatively affects myocardial function and remodeling and, ultimately, increases the risk of hospitalizations and all-cause and cardiovascular (CV) mortality. The role of levothyroxine replacement on relevant CV outcomes in patients with SCH and CHF is unclear. OBJECTIVE To assess the effect of levothyroxine (compared to placebo or no treatment) on the incidence of all-cause and CV mortality, major adverse CV events, and heart failure in patients with SCH and CHF. METHODS PubMed/MEDLINE, Cochrane Library, and ClinicalTrial.gov were searched for randomized clinical trials, non-randomized observational, multicentric, and comparative studies. No language restrictions were included. After duplicate removal, articles were screened and extracted for the synthesis according to a hierarchical strategy that included title, abstract, and full-text appraisal. The risk of bias was assessed by RoB2 and ROBIN-I tools. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to rate the quality of evidence and grade the strength of recommendations. RESULTS Two trials were included in the systematic review with considerable indirectness and inaccuracy that down-graded the level of evidence. DISCUSSION No evidence supports the use of levothyroxine for treating SCH in CHF due to the lack of reliable and well-designed clinical trials. CONCLUSION CV outcome and dose-response trials are needed to understand better the role of levothyroxine replacement treatment for a safer prescription in this clinical setting.
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Affiliation(s)
- Vincenzo Triggiani
- Interdisciplinary Department of Internal Medicine, University of Bari “A. Moro”, Bari, Italy
- *Correspondence: Vincenzo Triggiani,
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Internal Medicine, University of Bari “A. Moro”, Bari, Italy
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17
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Forsyth F, Brimicombe J, Cheriyan J, Edwards D, Hobbs FR, Jalaludeen N, Mant J, Pilling M, Schiff R, Taylor CJ, Zaman MJ, Deaton C, Chakravorty M, Maclachlan S, Kane E, Odone J, Thorley N, Borja‐Boluda S, Wellwood I, Sowden E, Blakeman T, Chew‐Graham C, Hossain M, Sharpley J, Gordon B, Taffe J, Long A, Aziz A, Swayze H, Rutter H, Schramm C, MacDonald S, Papworth H, Smith J, Needs C, Cronk D, Newark C, Blake D, Brown A, Basuita A, Gayton E, Glover V, Fox R, Crawshaw J, Ashdown H, A'Court C, Ayerst R, Hernandez‐Diaz B, Knox K, Wooding N, Wanninayake S, Keast C, Jones A, Brown K, Gaw M, Thomas N, Dixon S, Angeleri‐Rand E. Diagnosis of patients with heart failure with preserved ejection fraction in primary care: cohort study. ESC Heart Fail 2021. [PMCID: PMC8712851 DOI: 10.1002/ehf2.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aims Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure (HF), but low awareness and diagnostic challenges hinder identification in primary care. Our aims were to evaluate the recruitment and diagnostic strategy in the Optimise HFpEF cohort and compare with recent recommendations for diagnosing HFpEF. Methods and results Patients were recruited from 30 primary care practices in two regions in England using an electronic screening algorithm and two secondary care sites. Baseline assessment collected clinical and patient‐reported data and diagnosis by history, assessment, and trans‐thoracic echocardiogram (TTE). A retrospective evaluation compared study diagnosis with H2FPEF score and HFA‐PEFF diagnostic algorithm. A total of 152 patients (86% primary care, mean age 78.5, 40% female) were enrolled; 93 (61%) had HFpEF confirmed. Most participants had clinical features of HFpEF, but those with confirmed HFpEF were more likely female, obese, functionally impaired, and symptomatic. Some echocardiographic findings were diagnostic for HFpEF, but no difference in natriuretic peptide levels were observed. The H2FPEF and HFA‐PEFF scores were not significantly different by group, although confirmed HFpEF cases were more likely to have scores indicating high probability of HFpEF. Conclusions Patients with HFpEF in primary care are difficult to identify, and greater awareness of the condition, with clear diagnostic pathways and specialist support, are needed. Use of diagnostic algorithms and scores can provide systematic approaches to diagnosis but may be challenging to apply in older multi‐morbid patients. Where diagnostic uncertainty remains, pragmatic decisions are needed regarding the value of additional testing versus management of presumptive HFpEF.
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Affiliation(s)
- Faye Forsyth
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - James Brimicombe
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine University of Cambridge School of Clinical Medicine Cambridge UK
| | - Duncan Edwards
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Navazh Jalaludeen
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine University of Cambridge School of Clinical Medicine Cambridge UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - Mark Pilling
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - Rebekah Schiff
- Department of Ageing and Health Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Clare J. Taylor
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - M. Justin Zaman
- Department of Cardiology West Suffolk Hospital Bury St Edmonds UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
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18
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Exploring the Pleiotropic Genes and Therapeutic Targets Associated with Heart Failure and Chronic Kidney Disease by Integrating metaCCA and SGLT2 Inhibitors' Target Prediction. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4229194. [PMID: 34540994 PMCID: PMC8443964 DOI: 10.1155/2021/4229194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
Background Previous studies have shown that heart failure (HF) and chronic kidney disease (CKD) have common genetic mechanisms, overlapping pathophysiological pathways, and therapeutic drug—sodium-glucose cotransporter 2 (SGLT2) inhibitors. Methods The genetic pleiotropy metaCCA method was applied on summary statistics data from two independent meta-analyses of GWAS comprising more than 1 million people to identify shared variants and pleiotropic effects between HF and CKD. Targets of SGLT2 inhibitors were predicted by SwissTargetPrediction and DrugBank databases. To refine all genes, we performed using versatile gene-based association study 2 (VEGAS2) and transcriptome-wide association studies (TWAS) for HF and CKD, respectively. Gene enrichment and KEGG pathway analyses were used to explore the potential functional significance of the identified genes and targets. Results After metaCCA analysis, 4,624 SNPs and 1,745 genes were identified to be potentially pleiotropic in the univariate and multivariate SNP-multivariate phenotype analyses, respectively. 21 common genes were detected in both metaCCA and SGLT2 inhibitors' target prediction. In addition, 169 putative pleiotropic genes were identified, which met the significance threshold both in metaCCA analysis and in the VEGAS2 or TWAS analysis for at least one disease. Conclusion We identified novel variants associated with HF and CKD using effectively incorporating information from different GWAS datasets. Our analysis may provide new insights into HF and CKD therapeutic approaches based on the pleiotropic genes, common targets, and mechanisms by integrating the metaCCA method, TWAS and VEGAS2 analyses, and target prediction of SGLT2 inhibitors.
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19
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Clark KAA, Reinhardt SW, Chouairi F, Miller PE, Kay B, Fuery M, Guha A, Ahmad T, Desai NR. Trends in Heart Failure Hospitalizations in the US from 2008 to 2018. J Card Fail 2021; 28:171-180. [PMID: 34534665 DOI: 10.1016/j.cardfail.2021.08.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/28/2021] [Accepted: 08/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heart failure (HF) is a major driver of health care costs in the United States and is increasing in prevalence. There is a paucity of contemporary data examining trends among hospitalizations for HF that specifically compare HF with reduced or preserved ejection fraction (HFrEF or HFpEF, respectively). METHODS AND RESULTS Using the National Inpatient Sample, we identified 11,692,995 hospitalizations due to HF. Hospitalizations increased from 1,060,540 in 2008 to 1,270,360 in 2018. Over time, the median age of patients hospitalized because of HF decreased from 76.0 to 73.0 years (P < 0.001). There were increases in the proportions of Black patients (18.4% in 2008 to 21.2% in 2018) and of Hispanic patients (7.1% in 2008 to 9.0% in 2018; P < 0.001, all). Over the study period, we saw an increase in comorbid diabetes, sleep apnea and obesity (P < 0.001, all) in the entire cohort with HF as well as in the HFrEF and HFpEF subgroups. Persons admitted because of HFpEF were more likely to be white and older compared to admissions because of HFrEF and also had lower costs. Inpatient mortality decreased from 2008 to 2018 for overall HF (3.3% to 2.6%) and HFpEF (2.4% to 2.1%; P < 0.001, all) but was stable for HFrEF (2.8%, both years). Hospital costs, adjusted for inflation, decreased in all 3 groups across the study period, whereas length of stay was relatively stable over time for all groups. CONCLUSIONS The volume of patients hospitalized due to HF has increased over time and across subgroups of ejection fraction. The demographics of HF, HFrEF and HFpEF have become more diverse over time, and hospital inpatient costs have decreased, regardless of HF type. Inpatient mortality rates improved for overall HF and HFpEF admissions but remained stable for HFrEF admissions.
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Affiliation(s)
- Katherine A A Clark
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Samuel W Reinhardt
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - P Elliott Miller
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Bradley Kay
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Michael Fuery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH; Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH
| | - Tariq Ahmad
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Nihar R Desai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, New Haven, CT.
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20
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Kawakami R, Nakada Y, Hashimoto Y, Ueda T, Nakagawa H, Nishida T, Onoue K, Soeda T, Watanabe M, Saito Y. Prevalence and Prognostic Significance of Pulmonary Function Test Abnormalities in Hospitalized Patients With Acute Decompensated Heart Failure With Preserved and Reduced Ejection Fraction. Circ J 2021; 85:1426-1434. [PMID: 33867406 DOI: 10.1253/circj.cj-20-1069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study evaluated the prevalence and prognostic impact of lung function abnormalities in patients with acute decompensated heart failure (ADHF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). METHODS AND RESULTS Of the 1,012 consecutive patients who were admitted to Nara Medical University with ADHF between 2011 and 2018, 657 routinely underwent spirometry (pulmonary function test [PFT]) before discharge. Lung function was classified as normal or abnormal (restrictive, obstructive, or mixed). Abnormal PFTs were seen in 63.0% of patients with ADHF (36.7%, 13.1%, and 13.2% for restrictive, obstructive, and mixed, respectively). The prevalence of abnormal PFT increased with age (P<0.001). Overall, abnormal PFT was an independent predictor of the composite endpoint of cardiovascular mortality or hospitalization for HF (adjusted hazard ratio [HR] 1.402; 95% confidence interval [CI] 1.039-1.914; P=0.027). Abnormal PFT (adjusted HR 2.294; 95% CI 1.368-4.064; P=0.001), as well as the restrictive (HR 2.299; 95% CI 1.322-4.175; P=0.003) and mixed (HR 2.784; 95% CI 1.399-5.581; P=0.004) patterns, were predictive of the composite endpoint in HFpEF, but not in HFrEF. CONCLUSIONS Abnormal PFT was prevalent and associated with poor outcomes in ADHF. Spirometry may be a useful tool in patients with ADHF, especially in those with HFpEF, to identify those at higher risk of a poorer outcome.
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Affiliation(s)
- Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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21
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Sedlar N, Lainscak M, Farkas J. Self-care perception and behaviour in patients with heart failure: A qualitative and quantitative study. ESC Heart Fail 2021; 8:2079-2088. [PMID: 33719209 PMCID: PMC8120357 DOI: 10.1002/ehf2.13287] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background and objective Self‐care strategies in heart failure (HF) are effective for disease management, yet adherence in many patients is inadequate. Reasons are presumably multifactorial but remain insufficiently investigated; thus, we aimed to analyse self‐care adherence and associated factors in outpatients with HF. Methods and results To measure self‐care levels and explore barriers and facilitators to self‐care adherence in patients with HF, quantitative study using the European Self‐Care Behaviour Scale (EHFScBS‐9) (n = 80; NYHA II–III, mean age 72 ± 10 years, 58% male) and qualitative study using semi‐structured interviews (n = 32; NYHA II–III, mean age 73 ± 11, 63% male) were conducted. We detected lowest adherence to regular exercise (39%) and contacts with healthcare provider in case of worsening symptoms (47%), whereas adherence was highest for regular medication taking (94%). Using the EHFScBS‐9 standardized cut‐off score ≤ 70, 51% of patients reported inadequate self‐care. Binary logistic regression analysis showed significant influence of education (OR = 0.314, 95% CI: 0.103–0.959) and perceived control (OR = 1.236, 95% CI: 1.043–1.465) on self‐care adequacy. According to the situation‐specific theory of HF self‐care, most commonly reported factors affecting the process of self‐care were knowledge about HF self‐care behaviours (84%), experience with healthcare professionals (84%), beliefs about their expertise (69%) and habits related to medication taking (72%). Among values, working responsibilities (53%) and maintenance of traditions (31%) appeared as the most prevalent socially based values affecting motivation for self‐care. Situational characteristics related to the person (self‐confidence, 53%; adaptive coping strategies, 88%), problem (burdensome breathing difficulties, 56%; co‐morbidities, 81%) and environment (practical support from family/caregivers, 59%; financial difficulties, 50%) were also commonly reported. Conclusions Various factors, including health‐related beliefs, habits and socially based values, need to be taken into account when planning self‐care interventions in patients with HF. A patient tailored approach should be based on adequate patient evaluation, taking into consideration the particular personal and social context.
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Affiliation(s)
- Natasa Sedlar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - Jerneja Farkas
- National Institute of Public Health, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Research, General Hospital Murska Sobota, Murska Sobota, Slovenia
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22
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Silva-Cardoso J, Juanatey JRG, Comin-Colet J, Sousa JM, Cavalheiro A, Moreira E. The Future of Telemedicine in the Management of Heart Failure Patients. Card Fail Rev 2021; 7:e11. [PMID: 34136277 PMCID: PMC8201465 DOI: 10.15420/cfr.2020.32] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Telemedicine (TM) is potentially a way of escalating heart failure (HF) multidisciplinary integrated care. Despite the initial efforts to implement TM in HF management, we are still at an early stage of its implementation. The coronavirus disease 2019 pandemic led to an increased utilisation of TM. This tendency will probably remain after the resolution of this threat. Face-to-face medical interventions are gradually transitioning to the virtual setting by using TM. TM can improve healthcare accessibility and overcome geographic inequalities. It promotes healthcare system efficiency gains, and improves patient self-management and empowerment. In cooperation with human intervention, artificial intelligence can enhance TM by helping to deal with the complexities of multicomorbidity management in HF, and will play a relevant role towards a personalised HF patient approach. Artificial intelligence-powered/telemedical/heart team/multidisciplinary integrated care may be the next step of HF management. In this review, the authors analyse TM trends in the management of HF patients and foresee its future challenges within the scope of HF multidisciplinary integrated care.
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Affiliation(s)
- José Silva-Cardoso
- Faculty of Medicine, University of PortoPorto, Portugal
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | | | - Josep Comin-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de LlobregatBarcelona, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L’Hospitalet de LlobregatBarcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - José Maria Sousa
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | - Ana Cavalheiro
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
- Department of Physical Rehabilitation, Centro Hospitalar do PortoPorto, Portugal
| | - Emília Moreira
- Faculty of Medicine, University of PortoPorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
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23
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Seferović PM, Vardas P, Jankowska EA, Maggioni AP, Timmis A, Milinković I, Polovina M, Gale CP, Lund LH, Lopatin Y, Lainscak M, Savarese G, Huculeci R, Kazakiewicz D, Coats AJS. The Heart Failure Association Atlas: Heart Failure Epidemiology and Management Statistics 2019. Eur J Heart Fail 2021; 23:906-914. [PMID: 33634931 DOI: 10.1002/ejhf.2143] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) developed the HFA Atlas to provide a contemporary description of heart failure (HF) epidemiology, resources, reimbursement of guideline-directed medical therapy (GDMT) and activities of the National Heart Failure Societies (NHFS) in ESC member countries. METHODS AND RESULTS The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness of source data varied across countries. The median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from ≤2 in Italy and Denmark to >6 in Germany. The median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people, ranging from ≤12 in Greece and Spain to >30 in Lithuania and Germany. The median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people annually, ranging from <1000 in Latvia and North Macedonia to >6000 in Romania, Germany and Norway. The median length of hospital stay for an admission with HF was 8.50 (IQR 7.38-10) days. Diagnostic and management resources for HF varied, with high-income ESC member countries having substantially more resources compared with middle-income countries. The median number of hospitals with dedicated HF centres was 1.16 (IQR 0.51-2.97) per million people, ranging from <0.10 in Russian Federation and Ukraine to >7 in Norway and Italy. Nearly all countries reported full or partial reimbursement of standard GDMT, except ivabradine and sacubitril/valsartan. Almost all countries reported having NHFS or working groups and nearly half had HF patient organizations. CONCLUSIONS The first report from the HFA Atlas has shown considerable heterogeneity in HF disease burden, the resources available for its management and data quality across ESC member countries. The findings emphasize the need for a systematic approach to the capture of HF statistics so that inequalities and improvements in care may be quantified and addressed.
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Affiliation(s)
- Petar M Seferović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Panagiotis Vardas
- Hygeia Heart Sector, Hygeia Group of Hospitals, Athens, Greece.,European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | | | - Ivan Milinković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Marija Polovina
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lars H Lund
- Department of Medicine, Karolinska Institute, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd, Volgograd, Russia
| | - Mitja Lainscak
- Department of Internal Medicine, and Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institute, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Radu Huculeci
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
| | - Dzianis Kazakiewicz
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
| | - Andrew J S Coats
- Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy
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24
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Negarandeh R, Aghajanloo A, Seylani K. Barriers to Self-care Among Patients with Heart Failure: A Qualitative Study. J Caring Sci 2020; 10:196-204. [PMID: 34849365 PMCID: PMC8609122 DOI: 10.34172/jcs.2020.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: Heart failure is the most prevalent cardiovascular disease. It is the end stage of most cardiovascular diseases and is characterized by the reduced ability of the heart to pump enough blood to fulfill the metabolic needs of the body. Self-care is the basis of the management of chronic diseases such as heart failure. The aim of this study was to explore the barriers to self-care among patients with heart failure. Methods: This was a qualitative content analysis. Participants were fourteen patients with heart failure and three healthcare providers who were purposively recruited from cardiac care centers in Zanjan, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional qualitative content analysis approach proposed by Elo and Kyngäs. Results: Self-care barriers -care among patients with HF were categorized into three main categories, namely personal factors, disease burden, and inefficient support system. Each category had three subcategories which were respectively lack of self-care knowledge, heart failure-related negative emotions, the difficulty of changing habits, progressive physical decline, comorbid conditions, financial strain, inadequate social support, healthcare providers' inattention to self-care, and limited access to healthcare providers. Conclusion: Patients with heart failure face different personal, disease-related, and support-related barriers to self-care. Based on these barriers, healthcare providers can develop interventions for promoting self-care among patients with heart failure.
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Affiliation(s)
- Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Iran
| | - Ali Aghajanloo
- Critical Care Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Seylani
- Critical Care Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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25
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Lelli D, Pedone C, Leosco D, Onder G, Antonelli Incalzi R. Management of heart failure: an Italian national survey on fellows/specialists in geriatrics. Aging Clin Exp Res 2020; 32:2049-2055. [PMID: 32383033 DOI: 10.1007/s40520-020-01577-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) is often managed by geriatricians. Few data are available on their knowledge and attitudes about this condition. AIMS To compare perceptions and knowledge on HF of specialists/fellows in geriatrics working in Italy. METHODS This nation-wide survey carried out by the Italian Society of Gerontology and Geriatrics in May-June 2019 enrolled 283 specialists/fellows in geriatrics in Italy. Results were stratified by qualification (specialist/fellow) and performance (lower/higher quartile of correct answers). RESULTS About half (55.5%) of the participants worked in acute care wards, 190 were residents, and 93 specialists. The overall proportion of correct answers was 70.8%, with no differences between specialists and fellows. There was a poor knowledge, with no differences between groups, about the target doses of ACE-inhibitors (36% of correct answers), the pharmacological treatment of HF with preserved ejection fraction (HFpEF) (37% of correct answers), and the inotropes indicated in acute HF (35% of correct answers). Compared to specialists, fellows performed better on indication (88% vs 76%, P = 0.019) and mechanism of action (93% vs 84%, P = 0.023) of sacubitril/valsartan, and on therapeutic indications of patients with atrial fibrillation (92% vs 75%, P < 0.001). CONCLUSIONS Globally, there was a good knowledge of the latest guidelines on the diagnosis and management of HF. However, for some important topics, such as HFpEF, that is the most common HF manifestation in older adults, the observed performance was relatively poor, indicating the need for focused educational campaigns.
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Affiliation(s)
- Diana Lelli
- Area di Geriatria, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Claudio Pedone
- Area di Geriatria, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Dario Leosco
- Dipartimento di Scienze Mediche Traslazionali, Università Degli Studi di Napoli "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Graziano Onder
- Dipartimento di Malattie Cardiovascolari, endocrino-metaboliche ed invecchiamento, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
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26
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Waku R, Tokoi S, Toyoda S, Kitahara K, Naganuma J, Yazawa H, Sakuma M, Abe S, Nakajima T, Inoue T. Flow-Mediated Vasodilation and Reactive Hyperemia Index in Heart Failure with Reduced or Preserved Ejection Fraction. TOHOKU J EXP MED 2020; 252:85-93. [PMID: 32893258 DOI: 10.1620/tjem.252.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular endothelial dysfunction is part of the underlying pathophysiology of heart failure. However, there are no reports in which vascular endothelial function of both conduit arteries and microvasculature was assessed in patients with heart failure. This study was aimed to assess vascular endothelial function separately in heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF). We performed simultaneous measurement of both flow-mediated vasodilation for endothelial function of conduit arteries and reactive hyperemia-peripheral arterial tonometry for that of microvasculature in 88 consecutive patients with chronic heart failure. In 55 patients with ischemic heart disease as an underlying cause of heart failure, flow-mediated vasodilation value was comparable between the two groups of HFrEF (left ventricular ejection fraction < 50%, n = 31) and HFpEF (left ventricular ejection fraction ≥ 50%, n = 24). Reactive hyperemia index measured by reactive hyperemia peripheral arterial tonometry, however, was lower in HFrEF patients compared to HFpEF patients (P = 0.014). In contrast, among 33 patients with non-ischemic heart disease, the degree of flow-mediated vasodilation was lower in HFpEF patients (n = 18) compared with HFrEF patients (n = 15) (P = 0.009), while reactive hyperemia index was comparable between the two groups. The clinical and pathophysiological significance of endothelial function in heart failure differs between conduit artery and microvasculature, and these differences may contribute to the underlying pathophysiology of HFpEF and HFrEF, as well as in ischemic heart disease and non-ischemic heart disease.
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Affiliation(s)
- Ryutaro Waku
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Seiko Tokoi
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Keijiro Kitahara
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Jin Naganuma
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Hiroko Yazawa
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Shichiro Abe
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
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27
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Testai L, Citi V, Martelli A, Brogi S, Calderone V. Role of hydrogen sulfide in cardiovascular ageing. Pharmacol Res 2020; 160:105125. [PMID: 32783975 DOI: 10.1016/j.phrs.2020.105125] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/17/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular diseases are the main cause of morbidity and mortality in the Western society and ageing is a relevant non-modifiable risk factor. Morphological and functional alterations at endothelial level represent first events of ageing, inevitably followed by vascular dysfunction and consequent atherosclerosis that deeply influences cardiovascular health. Indeed, myocardial hypertrophy and fibrosis typically occur and contribute to compromise overall cardiac output. As regards the intracellular molecular mechanisms involved in the cardiovascular ageing, an intricate network is emerging, revealing a role for many mediators, including SIRT1/AMPK/PCG1α pathway, anti-oxidants factors (i.e. Nrf-2 and FOXOs) and pro-inflammatory cytokines. Thus, the search for pharmacological and non-pharmacological strategies that can promote a "healthy ageing", in order to slow down age-related machinery, are currently an exciting challenge for the biomedical research. Interestingly, hydrogen sulfide (H2S) has been recently recognized as a new player capable to influence intracellular machinery involved in ageing and then it is view as a potential target for preventing cardiovascular diseases. Therefore, this review is focused on the role of H2S in cardiovascular ageing, and on the evidence of the relationship between progressive decline in endogenous H2S levels and the onset of various cardiovascular age-related diseases.
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Affiliation(s)
- Lara Testai
- Department of Pharmacy, University of Pisa, via Bonanno, 6-56120, Pisa, Italy; Interdepartmental Research Centre of Ageing, Biology and Pathology, University of Pisa, 56120, Pisa, Italy; Interdepartmental Research Centre "Nutraceuticals and Food for Health (NUTRAFOOD)", University of Pisa, 56120, Pisa, Italy.
| | - Valentina Citi
- Department of Pharmacy, University of Pisa, via Bonanno, 6-56120, Pisa, Italy
| | - Alma Martelli
- Department of Pharmacy, University of Pisa, via Bonanno, 6-56120, Pisa, Italy; Interdepartmental Research Centre of Ageing, Biology and Pathology, University of Pisa, 56120, Pisa, Italy; Interdepartmental Research Centre "Nutraceuticals and Food for Health (NUTRAFOOD)", University of Pisa, 56120, Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, via Bonanno, 6-56120, Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, via Bonanno, 6-56120, Pisa, Italy; Interdepartmental Research Centre of Ageing, Biology and Pathology, University of Pisa, 56120, Pisa, Italy; Interdepartmental Research Centre "Nutraceuticals and Food for Health (NUTRAFOOD)", University of Pisa, 56120, Pisa, Italy
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28
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Living with Chronic Heart Failure: Exploring Patient, Informal Caregiver, and Healthcare Professional Perceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082666. [PMID: 32294975 PMCID: PMC7215740 DOI: 10.3390/ijerph17082666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
Due to the complexity of heart failure (HF) and its treatment process, a high level of patient and informal caregiver engagement is required for management results. We aimed to explore the views of HF patients, informal caregivers, and healthcare professionals about personal experiences, perceived needs, and barriers to optimal HF management. A qualitative study using semi-structured interviews with HF patients (n = 32), their informal caregivers (n = 21), and healthcare professionals (n = 5) was conducted in the outpatient HF clinic in Slovenia in 2018. A content analysis method was used to analyze the data. Negative emotional response to disease and its limitations (especially the inability to continue with work) and changes in family roles were the most prevalent topics regarding the impact of HF on livelihood. Among the most common barriers to HF self-care, were the difficulties in changing lifestyle, financial difficulties due to the disease, traditional cuisine/lack of knowledge regarding a healthy diet and lack of self-confidence regarding physical activity. Despite psychological and social difficulties due to HF being highlighted by patients and informal caregivers, only healthcare professionals emphasized the need to address psychosocial aspects of care in HF management. Established differences could inform the implementation of necessary support mechanisms in HF management.
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