1
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Masarone D, Houston B, Falco L, Martucci ML, Catapano D, Valente F, Gravino R, Contaldi C, Petraio A, De Feo M, Tedford RJ, Pacileo G. How to Select Patients for Left Ventricular Assist Devices? A Guide for Clinical Practice. J Clin Med 2023; 12:5216. [PMID: 37629257 PMCID: PMC10455625 DOI: 10.3390/jcm12165216] [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: 07/22/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, a significant improvement in left ventricular assist device (LVAD) technology has occurred, and the continuous-flow devices currently used can last more than 10 years in a patient. Current studies report that the 5-year survival rate after LVAD implantation approaches that after a heart transplant. However, the outcome is influenced by the correct selection of the patients, as well as the choice of the optimal time for implantation. This review summarizes the indications, the red flags for prompt initiation of LVAD evaluation, and the principles for appropriate patient screening.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Brian Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC 158155, USA (R.J.T.)
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Maria L. Martucci
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Marisa De Feo
- Cardiac Surgery Unit, Department of Cardiac Surgery and Transplant, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Ryan J. Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC 158155, USA (R.J.T.)
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
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2
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Obeidat O, Abdullahi AH, Ismail Z, Ismail MF, Alzghoul H, Tarawneh M, Elsadek R, Al-Ani H, Hurlock NP, Smock AL. Diabetes mellitus impact on left ventricular assist device outcomes in heart failure patients: National Inpatient Sample study. Future Cardiol 2023; 19:397-404. [PMID: 37578268 DOI: 10.2217/fca-2023-0013] [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: 08/15/2023] Open
Abstract
Aim: Diabetes mellitus (DM) is a recognized risk factor for heart failure (HF), increasing the likelihood of requiring left ventricular assist device (LVAD) therapy. Objective: This retrospective cohort study aims to assess the impact of DM on LVAD patients, focusing on in-hospital mortality as the primary outcome. Methods: Utilizing the National Inpatient Sample administrative database, data from 11,506 adult HF patients who underwent LVAD implantation were analyzed. Results: Of the patients, 44.28% had diabetes. Adjusting for various factors, diabetic patients exhibited shorter hospital stays, lower admission costs and similar in-hospital mortality rates compared with non-diabetic patients. Conclusion: These findings enhance our understanding of the risks and benefits of LVAD therapy in patients with refractory HF and DM.
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Affiliation(s)
- Omar Obeidat
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Abdullah H Abdullahi
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Zeeshan Ismail
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Mohamed F Ismail
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Hamza Alzghoul
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Mohammed Tarawneh
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Rabab Elsadek
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Hashim Al-Ani
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Natalie P Hurlock
- Graduate Medical Education, Physician Services Group, HCA Research, HCA Healthcare, Nashville, TN 37203, USA
| | - Andrew L Smock
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL 32816, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
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3
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Tibrewala A, Wehbe RM, Wu T, Harap R, Ghafourian K, Wilcox JE, Okwuosa IS, Vorovich EE, Ahmad FS, Yancy C, Pawale A, Anderson AS, Pham DT, Rich JD. Hyponatremia Is a Powerful Predictor of Poor Prognosis in Left Ventricular Assist Device Patients. ASAIO J 2022; 68:1475-1482. [PMID: 35696712 PMCID: PMC9908070 DOI: 10.1097/mat.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Serum sodium is an established prognostic marker in heart failure (HF) patients and is associated with an increased risk of morbidity and mortality. We sought to study the prognostic value of serum sodium in left ventricular assist device (LVAD) patients and whether hyponatremia reflects worsening HF or an alternative mechanism. We identified HF patients that underwent LVAD implantation between 2008 and 2019. Hyponatremia was defined as Na ≤134 mEq/L at 3 months after implantation. We assessed for differences in hyponatremia before and after LVAD implantation. We also evaluated the association of hyponatremia with all-cause mortality and recurrent HF hospitalizations. There were 342 eligible LVAD patients with a sodium value at 3 months. Among them, there was a significant improvement in serum sodium after LVAD implantation compared to preoperatively (137.2 vs. 134.7 mEq/L, P < 0.0001). Patients with and without hyponatremia had no significant differences in echocardiographic and hemodynamic measurements. In a multivariate analysis, hyponatremia was associated with a markedly increased risk of all-cause mortality (HR 3.69, 95% CI, 1.93-7.05, P < 0.001) when accounting for age, gender, co-morbidities, use of loop diuretics, and B-type natriuretic peptide levels. Hyponatremia was also significantly associated with recurrent HF hospitalizations (HR 2.11, 95% CI, 1.02-4.37, P = 0.04). Hyponatremia in LVAD patients is associated with significantly higher risk of all-cause mortality and recurrent HF hospitalizations. Hyponatremia may be a marker of ongoing neurohormonal activation that is more sensitive than other lab values, echocardiography parameters, and hemodynamic measurements.
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Affiliation(s)
- Anjan Tibrewala
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ramsey M. Wehbe
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Tingqing Wu
- Clinical Trials Unit, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rebecca Harap
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Kambiz Ghafourian
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Jane E. Wilcox
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ike S. Okwuosa
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Esther E. Vorovich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Faraz S. Ahmad
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Amit Pawale
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Allen S. Anderson
- Department of Medicine, Division of Cardiology, University of Texas at San Antonio, San Antonio, Texas
| | - Duc T. Pham
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Jonathan D. Rich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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4
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Higashi H, Inaba S, Yamaguchi O. Diabetes in Left Ventricular Assist Device Therapy - Harmful or Harmless? Circ J 2022; 86:1959-1960. [PMID: 35831129 DOI: 10.1253/circj.cj-22-0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
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5
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Yoshioka D, Toda K, Ono M, Fukushima N, Shiose A, Saiki Y, Usui A, Wakasa S, Niinami H, Matsumiya G, Arai H, Sawa Y, Miyagawa S. Effect of Diabetes Mellitus on Outcomes in Patients With Left Ventricular Assist Device - Analysis of Data From a Japanese National Database. Circ J 2022; 86:1950-1958. [PMID: 35786688 DOI: 10.1253/circj.cj-21-1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study is to investigate the effect of preoperative diabetes on all-cause mortality and major postoperative complications among patients with continuous-flow left ventricular assist device (LVAD) by using data from a national database.Methods and Results: The 545 study patients who underwent primary HeartMateII implantation between 2013 and 2019 were divided into 2 groups according to their diabetes mellitus (DM) status; patients with DM (n=116) and patients without DM (n=429). First, the on-device survival and incidence of adverse events were evaluated. Second, after adjusting for patients' backgrounds, the change of laboratory data in the 2 groups were compared. Overall, on-device survival at 1, 2, and 3 years was almost equivalent between the 2 groups; it was 95%, 94%, and 91% in patients without DM, and 93%, 91%m and 91% in patients with DM (P=0.468) The incidence of adverse events was similar between 2 groups of patients, except for driveline exit site infection in the adjusted cohort. Cox proportional hazards regression analysis revealed younger age (HR: 0.98 (95% confidence interval (CI): 0.97-0.99, P=0.001) and presence of DM (HR: 1.83 (95% CI: 1.14-2.88), P=0.016) as significant predictors of driveline infection. Laboratory findings revealed no differences between groups throughout the periods. CONCLUSIONS The clinical results after LVAD implantation in DM patients were comparable with those in non-DM patients, except for the driveline exit site infection.
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Affiliation(s)
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital
| | | | | | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University
| | | | - Akihiko Usui
- Department of Cardiovascular Surgery, Nagoya University Hospital
| | - Satoru Wakasa
- Department of Cardiovascular Surgery, Hokkaido University
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University
| | | | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital
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6
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Zhu T, Dufendach KA, Hong Y, Thoma FW, Kilic A. Infectious complications following contemporary left ventricular assist device implantation. J Card Surg 2022; 37:2297-2306. [PMID: 35502490 DOI: 10.1111/jocs.16545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the source of infectious complications following contemporary left ventricular assist device (LVAD) implantation and to determine the impact of infections on patient outcomes. METHODS All patients who underwent centrifugal LVAD implantation between 2014 and 2020 at a single center were retrospectively reviewed. Postimplant infections were categorized as VAD-specific, VAD-related, or non-VAD according to previously published definitions. Postoperative survival and freedom from readmission were assessed using Kaplan-Meier analysis. Univariable and multivariable analyses were performed to determine the risk factors for postoperative infectious complications. RESULTS A total of 212 patients underwent centrifugal LVAD implantation (70 HeartMate 3, 142 HeartWare HVAD) during the study period. One hundred and two patients (48.1%) developed an infection, including 34 VAD-specific, 11 VAD-related, and 57 non-VAD. Staphylococcus species were the most common source of postoperative infection (n = 57, 33.7%). In multivariable analysis, diabetes significantly impacted overall postoperative infection rate. At 12 and 24 months, respectively, Kaplan-Meier survival was 81.1% and 61.6% in the infection group and 83.4% and 78.1% in the noninfection group (p = 0.006). Within the total cohort, 12- and 24-month freedom from infection were 46.2% and 31.9%, respectively. Patients with infectious complication had significantly lower rate of transplantation (16.4% vs. 43.6%; p < 0.001), increased overall mortality (46.3% vs. 17.3%, p < 0.001), and increased rates of noncardiac readmission (58.2% vs. 37.3%, p = 0.007). CONCLUSIONS Infections are common following contemporary LVAD implantation and are most commonly non-VAD related. Patients with postoperative infectious complications have significantly reduced rates of transplantation, survival, and freedom from noncardiac readmission.
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Affiliation(s)
- Toby Zhu
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Keith A Dufendach
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Yeahwa Hong
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Floyd W Thoma
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Arman Kilic
- Division of Cardiac Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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7
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Ono M, Yamaguchi O, Ohtani T, Kinugawa K, Saiki Y, Sawa Y, Shiose A, Tsutsui H, Fukushima N, Matsumiya G, Yanase M, Yamazaki K, Yamamoto K, Akiyama M, Imamura T, Iwasaki K, Endo M, Ohnishi Y, Okumura T, Kashiwa K, Kinoshita O, Kubota K, Seguchi O, Toda K, Nishioka H, Nishinaka T, Nishimura T, Hashimoto T, Hatano M, Higashi H, Higo T, Fujino T, Hori Y, Miyoshi T, Yamanaka M, Ohno T, Kimura T, Kyo S, Sakata Y, Nakatani T. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J 2022; 86:1024-1058. [PMID: 35387921 DOI: 10.1253/circj.cj-21-0880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kenji Yamazaki
- Advanced Medical Research Institute, Hokkaido Cardiovascular Hospital
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Teruhiko Imamura
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
| | - Miyoko Endo
- Department of Nursing, The University of Tokyo Hospital
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Koichi Kashiwa
- Department of Medical Engineering, The University of Tokyo Hospital
| | - Osamu Kinoshita
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Kaori Kubota
- Department of Transplantation Medicine, Osaka University Graduate School of Medicine
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroshi Nishioka
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Hospital
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Yumiko Hori
- Department of Nursing and Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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8
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Dunlay SM, Killian JM, McCoy RG, Redfield MM. Diabetes Mellitus in Advanced Heart Failure. J Card Fail 2022; 28:503-508. [PMID: 34648970 PMCID: PMC8923953 DOI: 10.1016/j.cardfail.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Diabetes mellitus is associated with increased rates of mortality in patients with less severe (stage C) heart failure (HF). The prevalence of diabetes and its complications in advanced (stage D) HF and their contributions to mortality risk are unknown. METHODS AND RESULTS We conducted a retrospective population-based cohort study of all adult residents of Olmsted County, Minnesota, who had advanced HF between 2007 and 2017. Patients with diabetes were identified by using the criteria of the Healthcare Effectiveness Data and Information Set. Diabetes complications were captured by using the Diabetes Complications Severity Index. Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Overall, median survival time after development of advanced HF was 13.1 (3.9-33.1) months; mortality did not vary by diabetes status (aHR 1.06, 95% CI 0.90-1.25; P = 0.45) or by glycated hemoglobin levels in those with diabetes (aHR 1.01 per 1% increase, 95% CI 0.93-1.10; P = 0.82). However, patients with diabetes and 4 (aHR 1.24, 95% CI 0.92-1.67) or 5-7 (aHR 1.49, 95% CI 1.09-2.03) diabetes complications were at increased risk of mortality compared to those with ≤ 3 complications. CONCLUSIONS More than one-third of patients with advanced HF have diabetes. In advanced HF, overall prognosis is poor, but we found no evidence that diabetes is associated with a significantly higher mortality risk.
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Affiliation(s)
- Shannon M. Dunlay
- Department of Cardiovascular Medicine,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery,Address for Correspondence: Shannon M. Dunlay MD MS, 200 First St. SW, Rochester, MN 55905.
| | | | - Rozalina G. McCoy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery,Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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9
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Kogan A, Frogel J, Ram E, Jamal T, Peled-Potashnik Y, Maor E, Grupper A, Morgan A, Segev A, Raanani E, Sternik L. The impact of diabetes on short-, intermediate- and long-term mortality following left ventricular assist device implantation. Eur J Cardiothorac Surg 2022; 61:1432-1437. [PMID: 35021207 DOI: 10.1093/ejcts/ezab575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Type 2 diabetes mellitus (DM) is a frequent comorbidity among patients suffering from advanced heart failure necessitating a left ventricular assist device (LVAD) implant. The goal of this study was to evaluate the impact of type 2 DM on early and long-term outcomes of patients following an LVAD implant. METHODS We performed an observational cohort study in a large tertiary care centre in Israel. All data of patients who underwent a continuous flow LVAD implant between 2006 and 2020 were extracted from our departmental database. Patients were divided into 2 groups: group I (patients without diabetes) and group II (patients with diabetes). We compared short-term (30-day and 3-month) mortality, intermediate-term (1- and 3-year) mortality and long-term (5 year) mortality between the 2 groups. RESULTS The study population included 154 patients. Group I (patients without diabetes) comprised 88 patients and group II (patients with diabetes) comprised 66 patients. The mean follow-up duration was 38.2 ± 30.3 months. Short- and intermediate-term mortality (30 days, 1 year and 3 years) was higher in the group with DM compared with the group without DM but did not reach any statistically significant difference: 16.1% vs 9.8% (P = 0.312), 24.2% vs 17.3% (P = 0.399) and 30.6% vs 21.9% (P = 0.127) respectively. Long-term 5-year mortality was significantly higher in the group with DM compared to the group without: 38.7% vs 24.4% (P = 0.038). Furthermore, predictors of long-term mortality included diabetes (hazard ratio 2.09, confidence interval 1.34-2.84, P = 0.004), as demonstrated by regression analysis. CONCLUSIONS Patients with diabetes and those without diabetes have similar 30-day and short- and intermediate-term mortality rates. The mortality risk of diabetic patients begins to increase 3 years after an LVAD implant. Diabetes is an independent predictor of long-term, 5-year mortality after an LVAD implant. CLINICAL TRIAL REGISTRATION Ethical Committee of Sheba Medical Centre, Israel, on 2 December 2014, Protocol 4257.
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Affiliation(s)
- Alexander Kogan
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Frogel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamer Jamal
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled-Potashnik
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Elad Maor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Avishay Grupper
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Avi Morgan
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Gustafsson F, Ben Avraham B, Chioncel O, Hasin T, Grupper A, Shaul A, Nalbantgil S, Hammer Y, Mullens W, Tops LF, Elliston J, Tsui S, Milicic D, Altenberger J, Abuhazira M, Winnik S, Lavee J, Piepoli MF, Hill L, Hamdan R, Ruhparwar A, Anker S, Crespo-Leiro MG, Coats AJS, Filippatos G, Metra M, Rosano G, Seferovic P, Ruschitzka F, Adamopoulos S, Barac Y, De Jonge N, Frigerio M, Goncalvesova E, Gotsman I, Itzhaki Ben Zadok O, Ponikowski P, Potena L, Ristic A, Jaarsma T, Ben Gal T. HFA of the ESC position paper on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider Part 3: at the hospital and discharge. ESC Heart Fail 2021; 8:4425-4443. [PMID: 34585525 PMCID: PMC8712918 DOI: 10.1002/ehf2.13590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/22/2021] [Accepted: 08/19/2021] [Indexed: 12/28/2022] Open
Abstract
The growing population of left ventricular assist device (LVAD)‐supported patients increases the probability of an LVAD‐ supported patient hospitalized in the internal or surgical wards with certain expected device related, and patient‐device interaction complication as well as with any other comorbidities requiring hospitalization. In this third part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, definitions and structured approach to the hospitalized LVAD‐supported patient are presented including blood pressure assessment, medical therapy of the LVAD supported patient, and challenges related to anaesthesia and non‐cardiac surgical interventions. Finally, important aspects to consider when discharging an LVAD patient home and palliative and end‐of‐life approaches are described.
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Affiliation(s)
- Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Binyamin Ben Avraham
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C., Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avishai Grupper
- Heart Failure Institute, Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviv Shaul
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yoav Hammer
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, University Hasselt, Hasselt, Belgium
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeremy Elliston
- Anesthesiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Davor Milicic
- Department for Cardiovascular Diseases, Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Johann Altenberger
- SKA-Rehabilitationszentrum Großgmain, Salzburger, Straße 520, Großgmain, 5084, Austria
| | - Miriam Abuhazira
- Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stephan Winnik
- Department of Cardiology, University Heart Center, University Hospital Zurich, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Lorrena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Righab Hamdan
- Department of Cardiology, Beirut Cardiac Institute, Beirut, Lebanon
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Stefan Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marisa Generosa Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, Instituto de Investigacion Biomedica A Coruña (INIBIC), Universidad de a Coruña (UDC), A Coruña, Spain
| | | | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Greece. School of Medicine, University of Cyprus, Nicosia, Cyprus
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK.,RCCS San Raffaele Pisana, Rome, Italy
| | - Petar Seferovic
- Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Yaron Barac
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicolaas De Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Osnat Itzhaki Ben Zadok
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Piotr Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Luciano Potena
- Heart and Lung Transplant Program, Bologna University Hospital, Bologna, Italy
| | - Arsen Ristic
- Department of Cardiology of the Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia
| | - Tiny Jaarsma
- Department of Nursing, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Shaw JA, Cooper ME. Contemporary Management of Heart Failure in Patients With Diabetes. Diabetes Care 2020; 43:2895-2903. [PMID: 33218978 DOI: 10.2337/dc20-2173] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 02/03/2023]
Abstract
Both heart failure and diabetes are increasing in prevalence in Western communities. The interrelationship between these two conditions is well known, with conventional heart failure therapies including several newer drug classes providing benefit to subjects with diabetes. Furthermore, several of the more recently introduced medications for type 2 diabetes have resulted in significant cardiovascular morbidity and mortality benefits with a marked improvement in heart failure symptoms and hospital presentations as well as deaths. This review outlines current therapies used to treat patients with or at risk for heart failure and their particular role in subjects with diabetes. Newer therapies, including certain glucose-lowering medications and their benefits in treating heart failure patients with and without diabetes, are also discussed. Finally, heart failure is also observed in long-duration, aging patients with type 1 diabetes, but this clinical issue has not been as extensively explored as in patients with type 2 diabetes and warrants further clinical investigation.
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Affiliation(s)
- James A Shaw
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Mark E Cooper
- Baker Heart and Diabetes Institute, Melbourne, Australia .,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.,Deparment of Endocrinology and Diabetes, Central Clinical School, The Alfred Hospital, Melbourne, Australia
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12
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Cheshire C, Bhagra CJ, Bhagra SK. A review of the management of patients with advanced heart failure in the intensive care unit. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:828. [PMID: 32793673 PMCID: PMC7396251 DOI: 10.21037/atm-20-1048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite progress in the medical and device therapy for heart failure (HF), the prognosis for those with advanced HF remains poor. Acute heart failure (AcHF) is the rapid development of, or worsening of symptoms and signs of HF typically leading to hospitalization. Whilst many HF decompensations are managed at a ward-based level, a proportion of patients require higher acuity care in the intensive care unit (ICU). Admission to ICU is associated with a higher risk of in-hospital mortality, and in those who fail to respond to standard supportive and medical therapy, a proportion maybe suitable for mechanical circulatory support (MCS). The optimal pre-operative management of advanced HF patients awaiting durable MCS or cardiac transplantation (CTx) is vital in improving both short and longer-term outcomes. This review will summarize the clinical assessment, hemodynamic profiling and management of the patient with AcHF in the ICU. The general principles of pre-surgical optimization encompassing individual systems (the kidneys, the liver, blood and glycemic control) will be discussed. Other factors impacting upon post-operative outcomes including nutrition and sarcopenia and pre-surgical skin decolonization have been included. Issues specific to durable MCS including the assessment of the right ventricle and strategies for optimization will also be discussed.
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Affiliation(s)
- Caitlin Cheshire
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Catriona Jane Bhagra
- Department of Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sai Kiran Bhagra
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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13
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Zhou P, Xiao Z, Zhu P, Nie Z, Pavan D, Zheng S. Diabetes Mellitus Is Not a Risk Factor for Patients Supported With Left Ventricular Assist Device. Ann Thorac Surg 2020; 109:1614-1622. [DOI: 10.1016/j.athoracsur.2019.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 01/15/2023]
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14
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Lateef N, Usman MS, Colombo PC, Ahmed S, Khan MS, Khan SU, Garan AR, Yuzefpolskaya M, Demmer RT. Meta-Analysis Comparing Risk for Adverse Outcomes After Left Ventricular Assist Device Implantation in Patients With Versus Without Diabetes Mellitus. Am J Cardiol 2019; 124:1918-1923. [PMID: 31653350 DOI: 10.1016/j.amjcard.2019.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
Patients with diabetes mellitus (DM) are known to have reduced life expectancy and be at increased risk for multiple morbidities including serious infection. However, published data on DM outcomes after left ventricular assist device (LVAD) implantation are sparse, inconsistent and individual studies are small with limited power. We conducted a systematic review and meta-analysis to compare survival and adverse events post-LVAD in DM versus non-DM (NDM) patients. Medline, Scopus, and Cochrane Central databases were searched for studies comparing outcomes in DM and NDM patients who underwent LVAD implantation for advanced heart failure. Results were reported as random effect risk ratios (RR) with 95% confidence intervals. We identified 5 retrospective cohort studies, at low risk of bias, reporting on 1,351 patients (n = 488 DM). There was increased 30-day mortality (RR 1.57 [1.00, 2.47]; p = 0.05; I2 = 0%) among DM versus NDM. The DM and NDM groups did not differ significantly in terms of 1-year mortality (RR 1.15 [0.98, 1.35]; p = 0.08; I2 = 39%), device-related infection (RR 1.05 [0.92, 1.19]; p = 0.88; I2 = 0%), ischemic stroke (RR 1.29 [0.91, 1.83]; p = 0.69; I2 = 0%), hemorrhagic stroke (RR 1.10 [0.42, 2.83]; p = 0.85; I2 = 69%), or bleeding (RR 1.06 [0.80, 1.40]; p = 0.70; I2 = 27%). After LVAD implantation, patients with DM, versus patients without, have a modestly elevated 30-day mortality rate. However, 1-year mortality and morbidity did not differ.
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15
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Clinical Significance of Early Hospital Readmission in Continuous-Flow Left Ventricular Assist Device Patients. ASAIO J 2019; 66:760-765. [DOI: 10.1097/mat.0000000000001065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Impact of Diabetes Mellitus on Survival in Patients Bridged to Transplantation with Left Ventricular Assist Devices in the United States. ASAIO J 2019; 65:587-592. [DOI: 10.1097/mat.0000000000000896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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May‐Newman K, Montes R, Campos J, Marquez‐Maya N, Vu V, Zebrowski E, Motomura T, Benkowski R. Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD. Artif Organs 2019; 43:834-848. [DOI: 10.1111/aor.13477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Karen May‐Newman
- Bioengineering Program, Department of Mechanical Engineering San Diego State University San Diego California
| | - Ricardo Montes
- Bioengineering Program, Department of Mechanical Engineering San Diego State University San Diego California
| | - Josue Campos
- Bioengineering Program, Department of Mechanical Engineering San Diego State University San Diego California
| | - Nikolas Marquez‐Maya
- Bioengineering Program, Department of Mechanical Engineering San Diego State University San Diego California
| | - Vi Vu
- Bioengineering Program, Department of Mechanical Engineering San Diego State University San Diego California
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18
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Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, Deswal A, Dickson VV, Kosiborod MN, Lekavich CL, McCoy RG, Mentz RJ, Piña IL. Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America: This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation 2019; 140:e294-e324. [PMID: 31167558 DOI: 10.1161/cir.0000000000000691] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes mellitus is a risk factor for incident heart failure and increases the risk of morbidity and mortality in patients with established disease. Secular trends in the prevalence of diabetes mellitus and heart failure forecast a growing burden of disease and underscore the need for effective therapeutic strategies. Recent clinical trials have demonstrated the shared pathophysiology between diabetes mellitus and heart failure, the synergistic effect of managing both conditions, and the potential for diabetes mellitus therapies to modulate the risk of heart failure outcomes. This scientific statement on diabetes mellitus and heart failure summarizes the epidemiology, pathophysiology, and impact of diabetes mellitus and its control on outcomes in heart failure; reviews the approach to pharmacological therapy and lifestyle modification in patients with diabetes mellitus and heart failure; highlights the value of multidisciplinary interventions to improve clinical outcomes in this population; and outlines priorities for future research.
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19
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Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, Deswal A, Dickson VV, Kosiborod MN, Lekavich CL, McCoy RG, Mentz RJ, PiÑa IL. Type 2 Diabetes Mellitus and Heart Failure, A Scientific Statement From the American Heart Association and Heart Failure Society of America. J Card Fail 2019; 25:584-619. [PMID: 31174952 DOI: 10.1016/j.cardfail.2019.05.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes mellitus is a risk factor for incident heart failure and increases the risk of morbidity and mortality in patients with established disease. Secular trends in the prevalence of diabetes mellitus and heart failure forecast a growing burden of disease and underscore the need for effective therapeutic strategies. Recent clinical trials have demonstrated the shared pathophysiology between diabetes mellitus and heart failure, the synergistic effect of managing both conditions, and the potential for diabetes mellitus therapies to modulate the risk of heart failure outcomes. This scientific statement on diabetes mellitus and heart failure summarizes the epidemiology, pathophysiology, and impact of diabetes mellitus and its control on outcomes in heart failure; reviews the approach to pharmacological therapy and lifestyle modification in patients with diabetes mellitus and heart failure; highlights the value of multidisciplinary interventions to improve clinical outcomes in this population; and outlines priorities for future research.
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20
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Young JB, Vest AR. Is There a Sweet Spot for Left Ventricular Assist Devices and Diabetes Mellitus? Circ Heart Fail 2019; 10:CIRCHEARTFAILURE.117.004594. [PMID: 29141861 DOI: 10.1161/circheartfailure.117.004594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- James B Young
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, the Kaufman Center for Heart Failure, and the Endocrinology and Metabolism and Heart and Vascular Institutes of the Cleveland Clinic, OH (J.B.Y.); and the Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA (A.V.).
| | - Amanda R Vest
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, the Kaufman Center for Heart Failure, and the Endocrinology and Metabolism and Heart and Vascular Institutes of the Cleveland Clinic, OH (J.B.Y.); and the Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA (A.V.)
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21
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Hamdan A, Puymirat E, Danchin N, Aissaoui N. Left ventricular assist device may improve glycemic control in diabetes mellitus patients but the reverse is not true. J Thorac Dis 2019; 10:S4093-S4095. [PMID: 30631564 DOI: 10.21037/jtd.2018.09.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Amer Hamdan
- Department of Intensive Care, Hôpital Européen Georges Pompidou (HEGP) Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Etienne Puymirat
- Department of cardiology, HEGP, APHP, Paris, France.,Université Paris Descartes, Paris, France
| | - Nicolas Danchin
- Department of cardiology, HEGP, APHP, Paris, France.,Université Paris Descartes, Paris, France
| | - Nadia Aissaoui
- Department of Intensive Care, Hôpital Européen Georges Pompidou (HEGP) Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Université Paris Descartes, Paris, France.,Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France
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22
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Yassin AS, Subahi A, Adegbala O, Abubakar H, Akintoye E, Ahmed A, Ismail A, Elhag A, Kambal A, Alade A, Shokr M, Weinberger J, Levine D, Afonso L. Clinical Impact of Diabetes Mellitus on Short-Term Outcomes andIn-Hospital Mortality of Cardiac Mechanical Support with Left Ventricular Assist Device (LVAD): A Retrospective Study from a National Database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:883-886. [PMID: 30578171 DOI: 10.1016/j.carrev.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiac support with left ventricular assist devices (LVAD) is a growing field. LVAD are increasingly used for patients with advanced congestive heart failure. Multiple studies have evaluated the outcomes of cardiac support with LVAD in patients with and without diabetes mellitus (DM), yet we still have conflicting results. This study aimed to assess the clinical impact of diabetes mellitus on patients undergoing cardiac support with LVAD. METHODS Diabetic patients who underwent mechanical support with LVAD between 2011 and 2014 were identified in the National Inpatient Sample (NIS) database using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The primary outcome was the effect of diabetes mellitus on inpatient mortality. Secondary outcomes were the impact of diabetes on other immediate post-LVAD complications and the cost of hospitalization. Multivariable logistic regression models analysis was performed to address potential confounding. RESULTS After adjusting for patient-level and hospital-level characteristics, diabetic patients who underwent cardiac support with LVAD have no significant increase in in-hospital mortality (OR: 0.79, 95% CI (0.57-1.10), p = 0.166), post-LVAD short-term complications and cost of hospitalization (OR: 0.97, 95% CI (0.93-1.01), p = 0.102). CONCLUSION Cardiac mechanical support with LVAD implantation is feasible and relatively safe in patients with diabetes and stage-D heart failure as a bridge for transplantation or as destination therapy for patients who are not candidates for transplantation. However, further trials and studies using bigger study sample and more comprehensive databases, need to be conducted for a stronger and more valid evidence.
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Affiliation(s)
- Ahmed S Yassin
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA.
| | - Ahmed Subahi
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, USA
| | - Hossam Abubakar
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Emmanuel Akintoye
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Abdelrahman Ahmed
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | | | - Ahmed Elhag
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahmed Kambal
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Mohamed Shokr
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI, USA
| | - Jarrett Weinberger
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Diane Levine
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Luis Afonso
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI, USA
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23
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Patel N, Gluck JA, Radojevic J, Coleman CI, Baker WL. Left ventricular assist device implantation improves glycaemic control: a systematic review and meta-analysis. ESC Heart Fail 2018; 5:1141-1149. [PMID: 30052326 PMCID: PMC6300809 DOI: 10.1002/ehf2.12337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/15/2018] [Accepted: 06/22/2018] [Indexed: 01/08/2023] Open
Abstract
AIMS Heart failure (HF) and diabetes mellitus (DM) often coexist and have bidirectional association. Advanced HF is associated with worsened glycaemic control. This meta-analysis investigated the effects of left ventricular assist device (LVAD) implantation on markers of DM control. METHODS AND RESULTS We performed a systematic search of MEDLINE and Cochrane through October 2017 to identify studies evaluating advanced HF patients who had received an LVAD and reported markers of glycaemic control. The primary outcome was glycosylated haemoglobin A1c (HbA1c), and the secondary outcomes included fasting glucose, daily insulin requirements, and body mass index (BMI). Outcomes were pooled using a Hartung-Knapp random-effects model producing a mean difference (MD) and 95% confidence interval (CI). Thirteen studies, including 820 participants, were included. HbA1c was 1.23% lower following LVAD implantation (95% CI -1.49 to -0.98). Greater HbA1c reductions were seen with higher pre-LVAD values. Similarly, fasting plasma glucose (-24.4 mg/dL, 95% CI -33.4 to -15.5), daily insulin requirements (-18.8 units, 95% CI -28.8 to -8.7), and serum creatinine levels (MD -0.20, 95% CI -0.35 to -0.06) were significantly lower than pre-LVAD levels. We saw no difference in BMI (MD 0.09, 95% CI -1.24 to 1.42). CONCLUSIONS LVAD implantation was associated with significant improvement in HbA1c, fasting plasma glucose, and daily insulin need in advanced HF patients.
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Affiliation(s)
- Nirav Patel
- Center for Advanced Heart Failure & Pulmonary Vascular Disease, Department of CardiologyHartford HospitalHartfordCTUSA
| | - Jason A. Gluck
- Center for Advanced Heart Failure & Pulmonary Vascular Disease, Department of CardiologyHartford HospitalHartfordCTUSA
| | - Joseph Radojevic
- Center for Advanced Heart Failure & Pulmonary Vascular Disease, Department of CardiologyHartford HospitalHartfordCTUSA
| | - Craig I. Coleman
- Department of Pharmacy PracticeUniversity of Connecticut School of Pharmacy69 N. Eagleville Rd, Unit 3092StorrsCT06269‐3092USA
| | - William L. Baker
- Department of Pharmacy PracticeUniversity of Connecticut School of Pharmacy69 N. Eagleville Rd, Unit 3092StorrsCT06269‐3092USA
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24
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Pinsino A, Castagna F, Zuver AM, Royzman EA, Nasiri M, Stöhr EJ, Cagliostro B, McDonnell B, Cockcroft JR, Garan AR, Topkara VK, Schulze PC, Takeda K, Takayama H, Naka Y, Demmer RT, Willey JZ, Yuzefpolskaya M, Colombo PC. Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device. J Heart Lung Transplant 2018; 38:396-405. [PMID: 30559034 DOI: 10.1016/j.healun.2018.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/06/2018] [Accepted: 11/09/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Department of Medicine, Yale New Haven Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Amelia M Zuver
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Eugene A Royzman
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Mojdeh Nasiri
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Eric J Stöhr
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Cardiff Metropolitan University, Cardiff, UK
| | - Barbara Cagliostro
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | | | - John R Cockcroft
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - A Reshad Garan
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - P Christian Schulze
- Department of Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joshua Z Willey
- Department of Neurology, Columbia University, New York, New York, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
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25
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Walther CP, Niu J, Winkelmayer WC, Cheema FH, Nair AP, Morgan JA, Fedson SE, Deswal A, Navaneethan SD. Implantable Ventricular Assist Device Use and Outcomes in People With End-Stage Renal Disease. J Am Heart Assoc 2018; 7:JAHA.118.008664. [PMID: 29980520 PMCID: PMC6064848 DOI: 10.1161/jaha.118.008664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background People with end‐stage renal disease (ESRD) are at risk for advanced heart failure, but little is known about use and outcomes of durable mechanical circulatory support in this setting. We examined use and outcomes of implantable ventricular assist devices (VADs) in a national ESRD cohort. Methods and Results We performed a retrospective cohort study of Medicare beneficiaries with ESRD who underwent implantable VAD placement from 2006 to 2014. We examined in‐hospital and 1‐year mortality, all‐cause and cause‐specific hospitalizations, and heart/kidney transplantation outcomes. We investigated as predictors demographic factors, time‐period of VAD implantation, primary or post‐cardiotomy implantation, and duration of ESRD before VAD implantation. We identified 96 people with ESRD who underwent implantable VAD placement. At time of VAD implantation, 74 (77.1%) were receiving hemodialysis, 10 (10.4%) were receiving peritoneal dialysis and 12 (12.5%) had renal transplant. Time from incident ESRD to VAD implantation was median 4.0 (interquartile range 1.1, 8.2) years. Mortality during the implantation hospitalization was 40.6%. Within 1 year of implantation 61.5% of people had died. On multivariable analysis, males had half the mortality risk of females. Lower mortality risk was also seen with VAD implantation in a primary setting, and with more recent year of implantation, but these results did not reach statistical significance. Conclusions Medicare beneficiaries with ESRD are undergoing durable VAD implantation, often several years after incident ESRD, although in low numbers. Mortality is high among these patients, highlighting the need for investigations to improve treatment selection and management.
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Affiliation(s)
- Carl P Walther
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX
| | - Jingbo Niu
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX
| | - Faisal H Cheema
- Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX
| | - Ajith P Nair
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jeffrey A Morgan
- Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX.,Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX
| | - Savitri E Fedson
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Anita Deswal
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Sankar D Navaneethan
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health Baylor College of Medicine, Houston, TX.,Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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