Cellular events linked to cardiac remodeling in heart failure: targets for pharmacologic intervention

Challenging and target-based shifting strategies for heart failure treatment: An update from the last decades

Heart failure (HF) is a major global health problem afflicting millions worldwide. Despite the significant advances in therapies and prevention, HF still carries very high morbidity and mortality, requiring enormous healthcare-related expenditure, and the search for new weapons goes on. Following initial treatment strategies targeting inotropism and congestion, attention has focused on offsetting the neurohormonal overactivation and three main therapies, including angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor antagonists, β-adrenoceptor antagonists, and mineralocorticoid receptor antagonists, have been the foundation of standard treatment for patients with HF. Recently, a paradigm shift, including angiotensin receptor-neprilysin inhibitor, sodium glucose co-transporter 2 inhibitor, and ivabradine, has been added. Moreover, soluble guanylate cyclase stimulator, elamipretide, and omecamtiv mecarbil have come out as a next-generation therapeutic agent for patients with HF. Although these pharmacologic therapies have been significantly successful in relieving symptoms, there is still no complete cure for HF. We may be currently entering a new era of treatment for HF with animal experiments and human clinical trials assessing the value of antibody-based immunotherapy and gene therapy as a novel therapeutic strategy. Such tempting therapies still have some challenges to be addressed but may become a weighty option for treatment of HF. This review article will compile the paradigm shifts in HF treatment over the past dozen years or so and illustrate current landscape of antibody-based immunotherapy and gene therapy as a new therapeutic algorithm for patients with HF.

A nationwide population-based cohort study to identify the correlation between heart failure and the subsequent risk of herpes zoster

Background

The association between heart failure (HF) and herpes zoster has rarely been studied. We investigated the hypothesis that HF may increase the risk of herpes zoster in Taiwan using a nationwide Taiwanese population-based claims database.

Method

Our study cohort consisted of patients who received a diagnosis of HF in 2001 ~ 2009 (N = 4785). For a comparison cohort, three age- and gender-matched control patients for every patient in the study cohort were selected using random sampling (N = 14,355). All subjects were tracked for 1 year from the date of cohort entry to identify whether or not they had developed herpes zoster. Cox proportional-hazard regressions were performed to evaluate 1-year herpes zoster-free survival rates.

Results

The main finding of this study was that patients with HF seemed to be at an increased risk of developing herpes zoster. Of the total patients, 211 patients developed herpes zoster during the 1-year follow-up period, among whom 83 were HF patients and 128 were in the comparison cohort. The adjusted hazard ratio (AHR) of herpes zoster in patients with HF was higher (AHR: 2.07; 95% confidence interval (CI): 1.54 ~ 2.78; p < 0.001) than that of the controls during the 1-year follow-up. Our study also investigated whether HF is a gender-dependent risk factor for herpes zoster. We found that male patients with HF had an increased risk of developing herpes zoster (AHR: 2.30 95% CI: 1.51 ~ 3.50; p < 0.001).

Conclusions

The findings of our population-based study suggest that patients with HF may have an increased risk of herpes zoster. These health associations should be taken into consideration, and further studies should focused on the cost-effectiveness of the herpes zoster vaccine should be designed for HF patients.

Animal-Assisted Therapy in Patients Hospitalized With Heart Failure

Background Animal-assisted therapy improves physiological and psychosocial variables in healthy and hypertensive patients.

Objectives To determine whether a 12-minute hospital visit with a therapy dog improves hemodynamic measures, lowers neurohormone levels, and decreases state anxiety in patients with advanced heart failure.

Methods A 3-group randomized repeated-measures experimental design was used in 76 adults. Longitudinal analysis was used to model differences among the 3 groups at 3 times. One group received a 12-minute visit from a volunteer with a therapy dog; another group, a 12-minute visit from a volunteer; and the control group, usual care. Data were collected at baseline, at 8 minutes, and at 16 minutes.

Results Compared with controls, the volunteer-dog group had significantly greater decreases in systolic pulmonary artery pressure during (−4.32 mm Hg, P = .03) and after (−5.78 mm Hg, P = .001) and in pulmonary capillary wedge pressure during (−2.74 mm Hg, P = .01) and after (−4.31 mm Hg, P = .001) the intervention. Compared with the volunteer-only group, the volunteer-dog group had significantly greater decreases in epinephrine levels during (−15.86 pg/mL, P = .04) and after (−17.54 pg/mL, P = .04) and in norepinephrine levels during (−232.36 pg/mL, P = .02) and after (−240.14 pg/mL, P = .02) the intervention. After the intervention, the volunteer-dog group had the greatest decrease from baseline in state anxiety sum score compared with the volunteer-only (−6.65 units, P =.002) and the control groups (−9.13 units, P &lt; .001).

Conclusions Animal-assisted therapy improves cardiopulmonary pressures, neurohormone levels, and anxiety in patients hospitalized with heart failure.

Insuficiência Cardíaca: antiga síndrome, novos conceitos e a atuação do enfermeiro

Atualmente, a Insuficiência Cardíaca (IC) é causa de preocupação crescente em todo o mundo, frente a sua prevalência e incidência progressivas e sua repercussão socio-econômica, apontando para a necessidade de revisão do conceito da síndrome e de adoção de medidas para redução dos seus custos econômicos e sociais. Este artigo tem como finalidade contextualizar os avanços na compreensão da fisiopatologia e do tratamento da IC e a atuação de Enfermagem junto aos pacientes portadores desta síndrome.

Neurohormone activation

Neurohormonal activation plays a significant role in left ventricular remodeling and progression of heart failure. Treatment strategies that antagonize the RAS and sympathetic nervous system can attenuate the left ventricular remodeling process. Natriuretic peptides, specifically BNP, are a marker of left ventricular dysfunction. With the progressive increase in the incidence and prevalence of heart failure, treatment approaches must focus on the underlying cause as well as on blocking the neurohormonal activation that leads to the remodeling process.

How heart failure complicates care

Review why heart failure (HF) develops and how it affects the nursing care of patients with other health problems.

Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology

In the United States, in both sexes and all races, long-term heavy alcohol consumption (of any beverage type) is the leading cause of a nonischemic, dilated cardiomyopathy, herein referred to as alcoholic cardiomyopathy (ACM). ACM is a specific heart muscle disease of a known cause that occurs in two stages: an asymptomatic stage and a symptomatic stage. In general, alcoholic patients consuming > 90 g of alcohol a day (approximately seven to eight standard drinks per day) for > 5 years are at risk for the development of asymptomatic ACM. Those who continue to drink may become symptomatic and develop signs and symptoms of heart failure. ACM is characterized by an increase in myocardial mass, dilation of the ventricles, and wall thinning. Changes in ventricular function may depend on the stage, in that asymptomatic ACM is associated with diastolic dysfunction, whereas systolic dysfunction is a common finding in symptomatic ACM patients. The pathophysiology of ACM is complex and may involve cell death (possibly due to apoptosis) and changes in many aspects of myocyte function. ACM remains an important cause of a dilated cardiomyopathy, and in latter stages can lead to heart failure. Alcohol abstinence, as well as the use of specific heart failure pharmacotherapies, is critical in improving ventricular function and outcomes in these patients.

Heart failure in older adults: keys to successful management

Recent American Heart Association statistics indicate that approximately 5 million people experience heart failure, and that an estimated 400,000 to 700,000 new cases are expected annually. Improved efforts in the emergency care of myocardial infarction and the increased life expectancy of the population in general are credited for the rapidly increasing number of elderly adults with such chronic cardiac diseases as heart failure. New drug therapies are tested daily to improve the treatment of heart failure. However, drugs alone cannot improve the lives of elderly men and women with this disorder. Skillful delivery of expert care is necessary if advanced practice nurses are to reduce the burden of heart failure and improve the lives of the individuals who must live with this devastating disease.

The natriuretic peptides: physiology and role in left-ventricular dysfunction

The natriuretic peptides (NPs), atrial natriuretic peptide, and brain natriuretic peptide (BNP) have been shown to have important roles in fluid volume homeostasis and blood pressure regulation. In addition, plasma NP levels are elevated in a number of cardiac pathologies and have been used as biochemical markers of left-ventricular dysfunction (LVD) in small- and large-scale clinical studies. In this review, the authors describe NP physiology and summarize the findings of selected studies that have examined the reliability and feasibility of NP measurement in LVD. In particular, BNP is proposed to be a biochemical marker that may provide a useful and inexpensive screening test of LVD. In addition, the authors discuss possible roles of the NPs in the etiology and progression of LVD. The findings of these studies suggest that the NPs may directly contribute to cardiac pathophysiology and LVD progression.