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Bozkurt B. Contemporary pharmacological treatment and management of heart failure. Nat Rev Cardiol 2024; 21:545-555. [PMID: 38532020 DOI: 10.1038/s41569-024-00997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/28/2024]
Abstract
The prevention and treatment strategies for heart failure (HF) have evolved in the past two decades. The stages of HF have been redefined, with recognition of the pre-HF state, which encompasses asymptomatic patients who have developed either structural or functional cardiac abnormalities or have elevated plasma levels of natriuretic peptides or cardiac troponin. The first-line treatment of patients with HF with reduced ejection fraction includes foundational therapies with angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors and diuretics. The first-line treatment of patients with HF with mildly reduced ejection fraction or with HF with preserved ejection fraction includes SGLT2 inhibitors and diuretics. The timely initiation of these disease-modifying therapies and the optimization of treatment are crucial in all patients with HF. Reassessment after initiation of these therapies is recommended to evaluate patient symptoms, health status and left ventricular function, and timely referral to a HF specialist is necessary if a patient has persistent advanced HF symptoms or worsening HF. Lifestyle modification and treatment of comorbidities such as diabetes mellitus, ischaemic heart disease and atrial fibrillation are crucial through each stage of HF. This Review provides an overview of the management strategies for HF according to disease stages that are derived from the recommendations in the latest US and European HF guidelines.
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Affiliation(s)
- Biykem Bozkurt
- Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA.
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Trobec KČ, Grabnar I, Trontelj J, Lainščak M, Kos MK. Population pharmacokinetics of ramipril in patients with chronic heart failure: A real-world longitudinal study. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2024; 74:315-328. [PMID: 38815200 DOI: 10.2478/acph-2024-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 06/01/2024]
Abstract
In patients with chronic heart failure (CHF), the use of angiotensin-converting enzyme inhibitors, including ramipril, is recommended to reduce the risk of heart failure worsening, hospitalisation, and death. Our aim was to investigate the influence of body composition on the pharmacokinetics of ramipril and its active metabolite ramiprilat and to evaluate the changes in pharmacokinetics after prolonged therapy. Twenty-three patients with CHF who were on regular therapy with ramipril participated at the first study visit ( median age 77 years, 65 % male, and 70 % New York Heart Association Class II); 19 patients attended the second study visit and the median time between the two visits was 8 months. Pharmacokinetics were assessed using a nonlinear mixed-effects parent-metabolite model comprising two compartments for ramipril and one compartment for ramiprilat. The influence of body size and composition was best described by an allometric relationship with fat-free mass. In addition, ramipril clearance was related to patient age and daily ramipril dose, while clearance of ramiprilat was influenced by glome rular filtration rate and daily ramipril dose. There were no clinically relevant changes in the pharmacokinetics of ramipril and ramiprilat between the study visits. Due to the relatively stable pharmacokinetics of ramipril, regular outpatient visits at 6-month intervals seem appropriate to evaluate ramipril therapy.
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Affiliation(s)
- Katja Čvan Trobec
- 1University of Ljubljana Faculty of Pharmacy 1000 Ljubljana, Slovenia
| | - Iztok Grabnar
- 1University of Ljubljana Faculty of Pharmacy 1000 Ljubljana, Slovenia
| | - Jurij Trontelj
- 1University of Ljubljana Faculty of Pharmacy 1000 Ljubljana, Slovenia
| | - Mitja Lainščak
- 2Faculty of Medicine, University of Ljubljana 1000 Ljubljana, Slovenia
- 3Division of Cardiology General Hospital Murska Sobota, 9000 Murska Sobota Slovenia
| | - Mojca Kerec Kos
- 1University of Ljubljana Faculty of Pharmacy 1000 Ljubljana, Slovenia
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Presume J, Gomes D, Ferreira J. TOGETHER we can overcome barriers for optimal management of heart failure. Rev Port Cardiol 2024; 43:237-239. [PMID: 38215905 DOI: 10.1016/j.repc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024] Open
Affiliation(s)
- João Presume
- Department of Cardiology, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Daniel Gomes
- Department of Cardiology, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal.
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Mouselimis D, Tsarouchas A, Vassilikos VP, Mitsas AC, Lazaridis C, Androulakis E, Briasoulis A, Kampaktsis P, Papadopoulos CE, Bakogiannis C. The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature. Hellenic J Cardiol 2024; 77:81-92. [PMID: 37926237 DOI: 10.1016/j.hjc.2023.11.001] [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: 08/08/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
Heart failure (HF) is a debilitating disease with 26 million patients worldwide. Consistent and complex self-care is required on the part of patients to adequately adhere to medication and to the lifestyle changes that the disease necessitates. Mobile health (mHealth) is being increasingly incorporated in patient interventions in HF, as smartphones prove to be ideal platforms for patient education and self-help assistance. This systematic review aims to summarize and report on all studies that have tested the effect of mHealth on HF patient outcomes. Our search yielded 17 studies, namely 11 randomized controlled trials and six non-randomized prospective studies. In these, patients with the assistance of an mHealth intervention regularly measured their blood pressure and/or body weight and assessed their symptoms. The outcomes were mostly related to hospitalizations, clinical biomarkers, patients' knowledge about HF, quality of life (QoL) and quality of self-care. QoL consistently increased in patients who received mHealth interventions, while study results on all other outcomes were not as ubiquitously positive. The first mHealth interventions in HF were not universally successful in improving patient outcomes but provided valuable insights for patient-oriented application development. Future trials are expected to build on these insights and deploy applications that measurably assist HF patients.
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Affiliation(s)
- Dimitrios Mouselimis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos C Mitsas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuel Androulakis
- Heart Imaging Centre, Royal Brompton, and Harefield Hospitals, London, United Kingdom
| | - Alexandros Briasoulis
- University of Iowa Hospitals & Clinics and the National and Kapodistrian University of Athens, Athens, Greece
| | - Polydoros Kampaktsis
- Division of Cardiology, New York University Langone Medical Center, New York, NY, USA
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Bozkurt B. Pre-Heart Failure: An Important Opportunity to Prevent a Deadly Disease. JACC. HEART FAILURE 2023; 11:1027-1031. [PMID: 37558381 DOI: 10.1016/j.jchf.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
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6
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Bozkurt B. Nonresponse to Heart Failure Therapy: An Important Trajectory. JACC. HEART FAILURE 2023; 11:729-732. [PMID: 37286263 DOI: 10.1016/j.jchf.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Dobbin SJ, Shen L, Petrie MC, Packer M, Solomon SD, McMurray JJ, Lang NN, Jhund PS. Characteristics and outcomes of patients with a history of cancer recruited to heart failure trials. Eur J Heart Fail 2023; 25:488-496. [PMID: 36919816 PMCID: PMC10947056 DOI: 10.1002/ejhf.2818] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/28/2022] [Accepted: 02/26/2023] [Indexed: 03/16/2023] Open
Abstract
AIMS Heart failure (HF) therapy trials usually exclude cancer patients. We examined the association between cancer history and outcomes in trial participants with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF). METHODS AND RESULTS We combined PARADIGM-HF and ATMOSPHERE, which enrolled HFrEF patients (n = 15 415) and we pooled HFpEF patients (ejection fraction ≥45%) enrolled in PARAGON-HF and CHARM-Preserved (n = 7363). The associations between cancer history, cardiovascular (CV) death, HF hospitalization, non-CV and all-cause death in these trials were examined. Incident cancer diagnoses during these trials were also measured. There were 658 (4.3%) and 624 (8.5%) patients with a cancer history in the HFrEF and HFpEF trials, respectively. HFrEF patients with a cancer history had a higher risk of HF hospitalization (adjusted hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.07-1.52, p = 0.007) and non-CV death (adjusted HR 1.57; 95% CI 1.16-2.12, p = 0.003) than those without. The risks of other outcomes were similar. There were no differences in the risk of any outcome in HFpEF patients with and without a cancer history. Adjusting for age and sex, the incidence of new cancer in the HFrEF and HFpEF trials was 1.09 (95% CI 0.83-1.36) and 1.07 (95% CI 0.81-1.32) per 100 person-years, respectively. CONCLUSIONS Although participants in HFrEF trials with a cancer history had higher risks of HF hospitalization and non-CV death than those without, the risks of CV and all-cause death were similar. Outcomes in HFpEF patients with and without a cancer history were similar. Incident cancer diagnoses were similar in HFrEF and HFpEF trials.
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Affiliation(s)
- Stephen J.H. Dobbin
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Li Shen
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
- Department of MedicineHangzhou Normal UniversityHangzhouChina
| | - Mark C. Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Milton Packer
- Department of Clinical SciencesUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Scott D. Solomon
- Division of Cardiovascular MedicineBrigham and Women's HospitalBostonMAUSA
| | - John J.V. McMurray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Ninian N. Lang
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Pardeep S. Jhund
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
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Effect of different blood pressure levels on short-term outcomes in hospitalized heart failure patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200169. [PMID: 36874045 PMCID: PMC9975204 DOI: 10.1016/j.ijcrp.2023.200169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
Background To investigate the influence of blood pressure (BP) level on short-term prognosis of heart failure (HF), the effect of the BP level on clinical end point events 3 months after discharge was observed. Methods A retrospective cohort study was performed on 1492 hospitalized HF patients. All patients were divided according to systolic blood pressure (SBP) per 20 mmHg and diastolic blood pressure (DBP) per 10 mmHg. Logistic regression analysis was used to analyze the relationship between BP level and heart failure rehospitalization, cardiac death, all-cause death and a composite end point of heart failure rehospitalization/all-cause death at 3 month follow-up after discharge. Results After multivariable adjustment, the relationship between SBP and DBP levels and outcomes followed an inverted J curve relationship. Compared with the reference group (110 < SBP≤130 mmHg), the risk of all end point events significantly increased in the SBP≤90 mmHg group included heart failure rehospitalization (OR 8.16, 95%CI 2.88-23.11, P < 0.001), cardiac death (OR 5.43, 95%CI 1.97-14.96, P = 0.001), all-cause death (OR 4.85, 95%CI 1.76-13.36, P = 0.002), and composite end point (OR 2.76, 95%CI 1.03-7.41, P = 0.044). SBP>150 mmHg significantly increased the risk of heart failure rehospitalization (OR 2.67, 95%CI 1.15-6.18, P = 0.022). Compared with.the reference group (65 < DBP≤75 mmHg), cardiac death (OR 2.64, 95%CI 1.15-6.05, P = 0.022) and all-cause death (OR 2.67, 95%CI 1.20-5.93, P = 0.016) was significantly increased in DBP≤55 mmHg group. There was no significant difference among subgroups according to left ventricular ejection fraction (P > 0.05). Conclusions There is a significant difference in the short-term prognosis 3 months after discharge in HF patients with different BP levels at discharge. There was an inverted J curve relationship between BP levels and prognosis.
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Fürst P, Schultz T, Strang P. Specialized Palliative Care for Patients with Chronic Heart Failure at End of Life: Transfers, Emergency Department Visits, and Hospital Deaths. J Palliat Med 2022. [PMID: 36576786 DOI: 10.1089/jpm.2022.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: Specialized palliative care (SPC) may contribute to improved quality of life in patients with life-limiting chronic heart failure (CHF). This study examined SPC and possible differences in the care process regarding emergency department (ED) visits, transfers, and place of death for severely ill patients with CHF. Materials and Methods: This retrospective observational registry study used the health care consumption data from the Stockholm Regional Council. Logistic regression analyses of age, sex, palliative care, comorbidities, and socioeconomic status were performed. Results: Of the 4322 individuals who died of heart failure between 2015 and 2019 and did not reside in a nursing home, 24% received SPC. Receiving SPC was associated with a lower odds ratio (OR) of ED visits (OR 0.24, p < 0.0001), unplanned transfers (OR 0.39, p < 0.0001), and emergency hospital as a place of death (OR 0.10, p < 0.0001). Furthermore, a better socioeconomic situation, younger age, and fewer comorbidities were associated with a lower OR of ED visits and transfers (p < 0.0001 to p = 0.013 in different comparisons). Multiple comorbidities (p < 0.0002) and younger age (p < 0.0001) were associated with a higher OR of emergency hospitals as a place of death. Conclusion: Approximately one-quarter of patients who died of heart failure received SPC. Receipt of SPC was associated with a significantly reduced number of ED visits, transfers between health care services, and risk of dying in emergency hospitals.
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Affiliation(s)
- Per Fürst
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Torbjörn Schultz
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Edwards JJ, O’Driscoll JM. Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2022; 8:76. [PMID: 35674912 PMCID: PMC9177931 DOI: 10.1186/s40798-022-00464-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
Background While exercise training (ET) is an established tool in heart failure (HF), no research to date has analysed the efficacy of ET in both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes across the same clinically important parameters. Methods A comprehensive systematic search was performed to identify trials published between 1990 and May 2021. Controlled trials of adults reporting pre- and post-ET peak VO2, 6-min walk distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) and left ventricular ejection fraction (LVEF) were considered. Parameters of cardiac diastolic function, brain natriuretic peptides (BNP)/N-terminal prohormone of BNP (NTproBNP) and follow-up hospitalisation and mortality data were also analysed. Results Ninety-three studies (11 HFpEF and 82 HFrEF) were included in the final analysis, with a pooled sample size of 11,081 participants. HFpEF analysis demonstrated significant improvements in peak VO2 (weighted mean difference: 2.333 ml·min-1·kg-1, Pfixed < 0.001), 6MWD (WMD: 35.396 m, Pfixed < 0.001), MLHFQ (WMD: − 10.932, Prandom < 0.001), KCCQ (WMD: 3.709, Pfixed = 0.037) and E/e′ (WMD: − 1.709, [95% CI] = − 2.91–0.51, Prandom = 0.005). HFrEF analysis demonstrated significant improvements in peak VO2 (WMD: 3.050 ml·min-1·kg-1, Prandom < 0.001), 6MWD (WMD: 37.299 m, Prandom < 0.001), MLHFQ (WMD: − 10.932, Prandom < 0.001), LVEF (WMD: 2.677%, Prandom = 0.002) and BNP/NTproBNP (SMD: − 1.349, Prandom < 0.001). Outcome analysis was only performed in HFrEF, which found no significant changes in hospitalisation, all-cause mortality or composite end-points. Conclusion ET significantly improves exercise capacity and quality of life in both HFpEF and HFrEF patients. In HFpEF patients, ET significantly improved an important index of diastolic function, with significant improvements in LVEF and NTproBNP/BNP seen in HFrEF patients only. Such benefits did not translate into significantly reduced hospitalisation or mortality after short-term follow-up. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00464-5.
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Howie-Esquivel J, Byon HD, Lewis C, Travis A, Cavanagh C. Quality of work-life among advanced practice nurses who manage care for patients with heart failure: The effect of resilience during the Covid-19 pandemic. Heart Lung 2022; 55:34-41. [PMID: 35447467 PMCID: PMC8995301 DOI: 10.1016/j.hrtlng.2022.04.005] [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] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Background Clinician burnout, stress and job dissatisfaction among Advance Practice Registered Nurses (APRNS) may have impacted work-related quality of life (WRQoL) during the COVID-19 pandemic. No studies describe burnout and resilience in APRNs who manage care for patients with HF. Objectives Among APRNs who manage care for patients with HF, study aims included: 1) Describe burnout and WRQoL levels; 2) Determine the relationship between burnout and WRQoL; 3) Examine whether resilience moderates the association between WRQoL and burnout. METHODS An online survey of American Association of Heart Failure Nurses and the Heart Failure Society of America APRN members were queried. INCLUSION CRITERIA APRN's who practiced in ambulatory or inpatient cardiology settings at least 8 h weekly. OUTCOMES MEASURED Burnout, WRQoL, and resilience. Results Participants' (N = 101) mean age was 50 (±10) years and 93% identified as female. APRNs worked more than 42 h weekly and reported moderate levels of resilience, high levels of personal (M = 51.7, norm-referenced mean: 35.9) and work-related burnout (M = 50.1, norm-referenced mean: 33.0). Correlations between high levels of burnout and low WRQoL (r range: -0.74 - -0.39 -, p<.001) were found. Burnout moderated the relationships among resilience and WRQoL. Conclusion APRNs had high levels of burnout during the COVID-19 pandemic. Patient-related burnout was not high. Level of burnout influenced the relationships among resilience and WRQoL suggesting that burnout is from workplace and personal sources, and that level of resilience could not overcome the effect of burnout. Interventions are needed regarding systems changes to uplift and support our workforce.
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Affiliation(s)
| | - Ha Do Byon
- University of Virginia, Charlottesville, VA, United States
| | | | - Arlene Travis
- Mount Sinai Health System, New York, NY, United States
| | - Casey Cavanagh
- University of Virginia School of Medicine, Charlottesville, VA, United States
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Almeida DRD, Pereira-Barretto AC, Forestiero FJ, Nakamuta JS, Bichels A. The Medical Burden of Heart Failure: A Comparative Delineation with Cancer in Brazil. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20200382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lundberg CE, Jamaly S, Adiels M, Lagergren J, Svensson CJ, Björck L, Rosengren A. Surgical treatment of obesity and excess risk of developing heart failure in a controlled cohort study. ESC Heart Fail 2022; 9:1844-1852. [PMID: 35274493 PMCID: PMC9065827 DOI: 10.1002/ehf2.13880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/25/2022] [Accepted: 02/24/2022] [Indexed: 11/11/2022] Open
Abstract
AIM We aim to assess the risk of heart failure in patients with obesity with and without gastric bypass surgery compared with population controls. METHODS AND RESULTS This cohort study included all patients aged 20-65 years with a first ever registered principal diagnosis of obesity in the Swedish Patient Register in 2001-2013. These patients were matched by age, sex, and region with two population controls from the general Swedish population without obesity diagnosis. The obesity cohort was divided into two groups: 27 882 patients who had undergone gastric bypass surgery within 2 years of obesity diagnosis and 39 564 patients who had not undergone such surgery. These groups were compared with 55 149 and 78 004 matched population controls, respectively. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, education, and sex. During follow-up (maximum 10 years, median 4.4 years, and interquartile range 2.5-7.2 years), 1884 participants were hospitalized for heart failure. Compared with population controls, gastric bypass patients had no excess risk of heart failure during the initial 0-≤4 years of follow-up (HR = 1.35 [95% CI = 0.96-1.91]) but a marked increased risk during the final >4-10 years of follow-up (HR = 3.28 [95% CI = 2.25-4.77]). Non-operated patients with obesity had a marked excess risk of heart failure throughout the study period compared with population controls. CONCLUSIONS Gastric bypass for obesity seems to reduce the risk of heart failure to levels similar to the general population during the initial 4 years after surgery, but not thereafter.
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Affiliation(s)
- Christina E Lundberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg, 41650, Sweden
| | - Shabbar Jamaly
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg, 41650, Sweden.,Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg, 41650, Sweden.,School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Solna, Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Carl Johan Svensson
- Department of Anesthesiology and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg, 41650, Sweden.,Department of Medicine Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg, 41650, Sweden.,Department of Medicine Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Gong H, Lyu X, Dong L, Tan S, Li S, Peng J, Liu Y, Zhang X. Obstructive Sleep Apnea Impacts Cardiac Function in Dilated Cardiomyopathy Patients Through Circulating Exosomes. Front Cardiovasc Med 2022; 9:699764. [PMID: 35321104 PMCID: PMC8936144 DOI: 10.3389/fcvm.2022.699764] [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: 04/24/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is common and independently associated with heart failure. This study aimed to investigate the impact of OSA on heart function in patients with dilated cardiomyopathy (DCM) as well as the possible mechanism related to exosomes regulated autophagy. Methods and Results A total of 126 patients with DCM who underwent sleep evaluations were analyzed retrospectively. Cardiomyocytes were treated with exosomes isolated from untreated OSA patients and healthy controls. Fibrotic and hypertrophic markers were evaluated, and Akt/mTOR pathway-mediated autophagy was investigated. DCM patients with severe OSA had larger right ventricular end-diastolic diameter (RVEDd) and right atrial diameter (RAD) and increased N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels than DCM patients without OSA. Moreover, NT-proBNP and diabetes mellitus were independently correlated with the apnea-hypopnea index in multiple linear regression analysis. Treatment with OSA-derived exosomes significantly increased Col1A1, ANP, and BNP protein expression and decreased the expression of the autophagy markers LC3B II/I and beclin1. Rapamycin treatment significantly increased the decreased autophagy markers and attenuated the increased expression of Col1A1, ANP and BNP induced by OSA-derived exosomes. Conclusion The severity of OSA is significantly associated with cardiac injury and remodeling. The underlying mechanism may be related to changed autophagy levels, which are regulated by circulating exosomes via the Akt/mTOR signaling pathway. This study may provide a new clue for the treatment of heart failure with OSA.
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Affiliation(s)
- Hui Gong
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xing Lyu
- Laboratory of Clinical Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lini Dong
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shengyu Tan
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shizhen Li
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jieting Peng
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Liu
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyu Zhang
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Xiangyu Zhang
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15
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Beattie JM, Higginson IJ, McDonagh TA, Gao W. Implementation of the Mental Capacity Act: a national observational study comparing resultant trends in place of death for older heart failure decedents with or without comorbid dementia. BMC Med 2022; 20:30. [PMID: 35057803 PMCID: PMC9901524 DOI: 10.1186/s12916-021-02210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Heart failure (HF) is increasingly prevalent in the growing elderly population and commonly associated with cognitive impairment. We compared trends in place of death (PoD) of HF patients with/without comorbid dementia around the implementation period of the Mental Capacity Act (MCA) in October 2007, this legislation supporting patient-centred decision making for those with reduced agency. METHODS Analyses of death certification data for England between January 2001 and December 2018, describing the PoD and sociodemographic characteristics of all people ≥ 65 years registered with HF as the underlying cause of death, with/without a mention of comorbid dementia. We used modified Poisson regression with robust error variance to determine the prevalence ratio (PR) of the outcome in dying at home, in care homes or hospices compared to dying in hospital. Covariates included year of death, age, gender, marital status, comorbidity burden, index of multiple deprivation and urban/rural settings. RESULTS One hundred twenty thousand sixty-eight HF-related death records were included of which 8199 mentioned dementia as a contributory cause. The overall prevalence proportion of dementia was 6.8%, the trend significantly increasing from 5.6 to 8.0% pre- and post-MCA (Cochran-Armitage trend test p < 0.0001). Dementia was coded as unspecified (78.2%), Alzheimer's disease (13.5%) and vascular (8.3%). Demented decedents were commonly older, female, and with more comorbidities. Pre-MCA, PoD for non-demented HF patients was hospital 68.2%, care homes 20.2% and 10.7% dying at home. Corresponding figures for those with comorbid dementia were 47.6%, 48.0% and 4.2%, respectively. Following MCA enforcement, PoD for those without dementia shifted from hospital to home, 62.5% and 17.2%, respectively; PR: 1.026 [95%CI: 1.024-1.029]. While home deaths also rose to 10.0% for those with dementia, with hospital deaths increasing to 50.4%, this trend was insignificant, PR: 1.001 [0.988-1.015]. Care home deaths reduced for all, with/without dementia, PR: 0.959 [0.949-0.969] and PR: 0.996 [0.993-0.998], respectively. Hospice as PoD was rare for both groups with no appreciable change over the study period. CONCLUSIONS Our analyses suggest the MCA did not materially affect the PoD of HF decedents with comorbid dementia, likely reflecting difficulties implementing this legislation in real-life clinical practice.
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Affiliation(s)
- James M Beattie
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK.,School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK.
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16
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Bygdell M, Ohlsson C, Lilja L, Celind J, Martikainen J, Rosengren A, Kindblom JM. Birth weight and young adult body mass index for predicting the risk of developing adult heart failure in men. Eur J Prev Cardiol 2021; 29:971-978. [PMID: 34910135 DOI: 10.1093/eurjpc/zwab186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/09/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022]
Abstract
AIMS Hospitalizations for heart failure among young adults and middle-aged individuals have increased. The aims of the present study were to evaluate the association between birth weight and risk of adult heart failure and the importance of change from low birth weight to overweight/obesity at young adulthood. METHODS AND RESULTS We used the population-based body mass index (BMI) Epidemiology Study cohort Gothenburg (n = 35 659) with birth weight and young adult BMI (20 years) available from child healthcare records, school health records, and military conscription register for men born 1945-1961. The cohort includes all children who finished school, which was mandatory, in Gothenburg, Sweden. Information on heart failure diagnosis was retrieved from the National Patient Register and the Cause of Death Register (n = 415). In cox regression analyses, there was an inverse association between birth weight and risk of heart failure [hazard ratio (HR) 0.83 per standard deviation (SD), 95% confidence interval (CI) 0.76-0.90], and a direct association for young adult BMI (HR 1.48 per SD, 95% CI 1.36-1.61). Of note, individuals with birth weight in the lowest tertile, who were overweight/obese in young adulthood had a five-fold risk of heart failure (HR 4.95, 95% CI 3.36-7.31) compared with individuals in the middle birth weight tertile who were normal weight at 20 years. CONCLUSIONS Birth weight was inversely associated with the risk of hospitalization due to heart failure. The combination of low birth weight and overweight/obesity in young adulthood results in excess risk of heart failure beyond that of low birth weight or young adult overweight/obesity separately. These findings indicate the need of a life course perspective in heart failure prevention and risk assessment.
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Affiliation(s)
- Maria Bygdell
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden.,Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lina Lilja
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care and Kungshöjd Pediatric Clinic, Gothenburg, Sweden
| | - Jimmy Celind
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden
| | - Jari Martikainen
- Bioinformatics Core Facility, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden
| | - Jenny M Kindblom
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Vita stråket 11, 41345 Gothenburg, Sweden.,Pediatric Clinical Research Center, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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17
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Lange SA, Feld J, Kühnemund L, Köppe J, Makowski L, Engelbertz CM, Gerß J, Dröge P, Ruhnke T, Günster C, Freisinger E, Reinecke H. Acute and Long-Term Outcomes of ST-Elevation Myocardial Infarction in Cancer Patients, a 'Real World' Analysis with 175,000 Patients. Cancers (Basel) 2021; 13:cancers13246203. [PMID: 34944823 PMCID: PMC8699199 DOI: 10.3390/cancers13246203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) and cancer are common and serious diseases. As the prognosis and treatment of both diseases has improved, more cancer patients will suffer an AMI. Unfortunately, data on these "double hit" patients is scarce. METHODS From the largest public German health insurance, anonymized data of all patients with pre-existing cancer who were hospitalized due to ST-elevation MI (STEMI) between 2010 and 2017 were analyzed and followed-up until 2018. RESULTS Of 175,262 STEMI patients, 27,213 had pre-existing cancer (15.5%). Most frequent were skin (24.9%), prostate (17.0%), colon (11.0%), breast (10.9%), urinary tract (10.6%), and lung cancer (5.2%). STEMI patients with malignancies were older and presented more often with coronary three-vessel disease, atrial arrhythmias, chronic kidney disease, chronic heart failure, cerebrovascular and peripheral artery disease (PAD, each p < 0.001). They showed more often previous AMI, percutaneous coronary interventions (PCI), cardiac surgery, and stroke (all p < 0.001). Acute PCIs were applied between 2 and 6% less frequently compared to those without cancer. In-hospital adverse events occurred more frequently in cancer. Eight-year survival was 57.3% (95% CI 57.0-57.7%) without cancer and ranged between 41.2% and 19.2% in distinct cancer types. Multivariable Cox regression for all-cause mortality found, e.g., lung cancer (HR 2.04), PAD stage 4-6 (HR 1.78), metastasis (HR 1.72), and previous stroke (HR 1.44) to have the strongest impact (all p < 0.001). CONCLUSION In this large "real world" data, prognosis after STEMI in cancer patients was markedly reduced but differed widely between cancer types. Of note, no withholding of interventional treatments in cancer patients could be observed.
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Affiliation(s)
- Stefan A. Lange
- Cardiol, Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (L.K.); (L.M.); (C.M.E.); (E.F.); (H.R.)
- Correspondence: ; Tel.: +49-2551-8343203; Fax: +49-2551-8353204
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, D-48149 Muenster, Germany; (J.F.); (J.K.); (J.G.)
| | - Leonie Kühnemund
- Cardiol, Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (L.K.); (L.M.); (C.M.E.); (E.F.); (H.R.)
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, D-48149 Muenster, Germany; (J.F.); (J.K.); (J.G.)
| | - Lena Makowski
- Cardiol, Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (L.K.); (L.M.); (C.M.E.); (E.F.); (H.R.)
| | - Christiane M. Engelbertz
- Cardiol, Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (L.K.); (L.M.); (C.M.E.); (E.F.); (H.R.)
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, D-48149 Muenster, Germany; (J.F.); (J.K.); (J.G.)
| | - Patrik Dröge
- AOK Research Institute (WIdO), D-10178 Berlin, Germany; (P.D.); (T.R.); (C.G.)
| | - Thomas Ruhnke
- AOK Research Institute (WIdO), D-10178 Berlin, Germany; (P.D.); (T.R.); (C.G.)
| | - Christian Günster
- AOK Research Institute (WIdO), D-10178 Berlin, Germany; (P.D.); (T.R.); (C.G.)
| | - Eva Freisinger
- Cardiol, Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (L.K.); (L.M.); (C.M.E.); (E.F.); (H.R.)
| | - Holger Reinecke
- Cardiol, Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany; (L.K.); (L.M.); (C.M.E.); (E.F.); (H.R.)
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18
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Exploring the Therapeutic Mechanism of Tingli Dazao Xiefei Decoction on Heart Failure Based on Network Pharmacology and Experimental Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6645878. [PMID: 34868332 PMCID: PMC8639272 DOI: 10.1155/2021/6645878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/19/2021] [Indexed: 11/17/2022]
Abstract
Background Tingli Dazao Xiefei decoction (TDXD) has been shown to have a therapeutic effect on heart failure (HF). Nevertheless, its molecular mechanism for treating HF is still unclear. Materials and Methods TDXD and HF targets were collected from the databases, and protein-protein interaction (PPI) analysis and enrichment analysis were performed on the overlapping targets. Then, AutoDock was employed for molecular docking. Finally, we used the left anterior descending coronary artery (LAD) ligation to induce HF model rats for in vivo experiments and verified the effect and mechanism of TDXD on HF. Results Network pharmacological analysis showed that the main active components of TDXD in treating HF were quercetin, kaempferol, beta-carotene, isorhamnetin, and beta-sitosterol, and the core targets were IL-6, VEGFA, TNF, AKT1, and MAPK1. Multiple gene functions and signaling pathways were obtained by enrichment analysis, among which inflammation-related, PI3K/Akt, and MAPK signaling pathways were closely related to HF. Furthermore, the molecular docking results showed that the core targets had good binding ability with the main active components. Animal experiments showed that TDXD could effectively improve left ventricular ejection fraction (EF) and left ventricular fractional shortening (FS), decrease left ventricular internal diastolic diameter (LVIDd) and left ventricular internal systolic diameter (LVIDs), reduce the area of myocardial fibrosis, and decrease serum BNP, LDH, CK-MB, IL-6, IL-1β, and TNF-α levels in HF rats. Meanwhile, TDXD could upregulate the expression of Bcl-2, downregulate the expression of Bax, and reduce cardiomyocyte apoptosis. At the same time, it was verified that TDXD could significantly decrease the expression of PI3K, P-Akt, and P-MAPK. Captopril showed similar effects. Conclusions Combining network pharmacological analysis and experimental validation, this study verified that TDXD could improve cardiac function and protect against cardiac injury by inhibiting the activation of PI3K/Akt and MAPK signaling pathways.
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19
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The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence. J Cardiovasc Nurs 2021; 35:243-252. [PMID: 32084078 DOI: 10.1097/jcn.0000000000000632] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process. OBJECTIVES We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence. METHODS This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects. RESULTS Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management. CONCLUSIONS Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.
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20
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Engelsgjerd EK, Benziger CP, Horne BD. Validation of the Intermountain Risk Score and Get with the Guidelines-Heart Failure Score in predicting mortality. Open Heart 2021; 8:openhrt-2021-001722. [PMID: 34426528 PMCID: PMC8383865 DOI: 10.1136/openhrt-2021-001722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/02/2021] [Indexed: 12/26/2022] Open
Abstract
Objective The Intermountain Risk Score (IMRS) was evaluated for validation as a mortality predictor and compared with the American Heart Association’s Get With The Guidelines—Heart Failure (GWTG-HF) risk score in a rural heart failure (HF) population. Background IMRS predicts mortality in general populations using common, inexpensive laboratory tests, patient age and sex, but requires validation in patients with HF. Methods Individuals were selected from the GWTG-HF registry at Essentia Health. This included consecutive HF inpatients age ≥18 years admitted July 2017–June 2019. IMRS was calculated using sex-specific weightings of the complete blood count, basic metabolic profile, and age. Results A total of 703 individuals (mean age: 74.12, 44.38% female) were studied. The 30-day IMRS predicted 30-day mortality for both sexes (females n=312: OR=1.19 (95% CI 1.08 to 1.32) per +1, p<0.001; males n=391: OR=1.23 (CI 1.12 to 1.36) per +1, p<0.001). The GWTG-HF risk score (only available in n=300, 42.7%) was independent of IMRS for 30-day mortality (OR=1.11 (CI 1.06 to 1.16) per +1, p<0.001). Using thresholds in bivariate modelling, IMRS (high vs low risk, OR=8.25 (CI 2.19 to 31.09), p=0.002) and the GWTG-HF score (tertile 3 vs 1: OR=2.18 (CI 0.84 to 5.68), p=0.11) independently predicted mortality. In multivariable analyses including covariables, IMRS (high vs low risk: OR=6.69 (CI 1.75 to 25.60), p=0.005) and the GWTG-HF score (tertile 3 vs 1: OR=2.62 (CI 0.96 to 7.12), p=0.06) remained predictors of mortality. Results were similar for 1-year mortality. Conclusions The IMRS and GWTG-HF scores predicted mortality of patients with HF in a large rural healthcare system. Future study of these scores as initial clinical risk estimators for evaluating their utility in improving patient health outcomes and increasing cost effectiveness is warranted.
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Affiliation(s)
| | | | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA .,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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21
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Yu B, Roberts MB, Raffield LM, Zekavat SM, Nguyen NQH, Biggs ML, Brown MR, Griffin G, Desai P, Correa A, Morrison AC, Shah AM, Niroula A, Uddin MM, Honigberg MC, Ebert BL, Psaty BM, Whitsel EA, Manson JE, Kooperberg C, Bick AG, Ballantyne CM, Reiner AP, Natarajan P, Eaton CB. Supplemental Association of Clonal Hematopoiesis With Incident Heart Failure. J Am Coll Cardiol 2021; 78:42-52. [PMID: 34210413 PMCID: PMC8313294 DOI: 10.1016/j.jacc.2021.04.085] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Age-related clonal hematopoiesis of indeterminate potential (CHIP), defined as clonally expanded leukemogenic sequence variations (particularly in DNMT3A, TET2, ASXL1, and JAK2) in asymptomatic individuals, is associated with cardiovascular events, including recurrent heart failure (HF). OBJECTIVES This study sought to evaluate whether CHIP is associated with incident HF. METHODS CHIP status was obtained from whole exome or genome sequencing of blood DNA in participants without prevalent HF or hematological malignancy from 5 cohorts. Cox proportional hazards models were performed within each cohort, adjusting for demographic and clinical risk factors, followed by fixed-effect meta-analyses. Large CHIP clones (defined as variant allele frequency >10%), HF with or without baseline coronary heart disease, and left ventricular ejection fraction were evaluated in secondary analyses. RESULTS Of 56,597 individuals (59% women, mean age 58 years at baseline), 3,406 (6%) had CHIP, and 4,694 developed HF (8.3%) over up to 20 years of follow-up. CHIP was prospectively associated with a 25% increased risk of HF in meta-analysis (hazard ratio: 1.25; 95% confidence interval: 1.13-1.38) with consistent associations across cohorts. ASXL1, TET2, and JAK2 sequence variations were each associated with an increased risk of HF, whereas DNMT3A sequence variations were not associated with HF. Secondary analyses suggested large CHIP was associated with a greater risk of HF (hazard ratio: 1.29; 95% confidence interval: 1.15-1.44), and the associations for CHIP on HF with and without prior coronary heart disease were homogenous. ASXL1 sequence variations were associated with reduced left ventricular ejection fraction. CONCLUSIONS CHIP, particularly sequence variations in ASXL1, TET2, and JAK2, represents a new risk factor for HF.
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Affiliation(s)
- Bing Yu
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mary B Roberts
- Center for Primary Care and Prevention, Brown University, Pawtucket, Rhode Island, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Seyedeh Maryam Zekavat
- Yale School of Medicine, New Haven, Connecticut, USA; Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Ngoc Quynh H Nguyen
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mary L Biggs
- Department of Biostatistics, University of Washington, Seattle, Washington, USA; Department of Epidemiology, Gillings School of Global Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael R Brown
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gabriel Griffin
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Pinkal Desai
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, New York, USA
| | - Adolfo Correa
- Department of Pediatric and Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Alanna C Morrison
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Abhishek Niroula
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Md Mesbah Uddin
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Michael C Honigberg
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin L Ebert
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Howard Hughes Medical Institute, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - JoAnn E Manson
- Harvard Medical School, Boston, Massachusetts, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charles Kooperberg
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alex P Reiner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Pradeep Natarajan
- Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Disease Initiative of the Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.
| | - Charles B Eaton
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA; Care New England, Center for Primary Care and Prevention, Pawtucket, Rhode Island, USA; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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22
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Jaffuel D, Nogue E, Berdague P, Galinier M, Fournier P, Dupuis M, Georger F, Cadars MP, Ricci JE, Plouvier N, Picard F, Puel V, Mallet JP, Suehs CM, Molinari N, Bourdin A, Roubille F. Sacubitril-valsartan initiation in chronic heart failure patients impacts sleep apnea: the ENTRESTO-SAS study. ESC Heart Fail 2021; 8:2513-2526. [PMID: 34102018 PMCID: PMC8318447 DOI: 10.1002/ehf2.13455] [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: 02/05/2021] [Revised: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Optimizing medical cardiac treatment for sleep apnoea (SA) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is an expert Grade C recommendation based on six studies encompassing a total of 67 patients only. Whether sacubitril–valsartan (SV), a cornerstone of HFrEF medical treatment, impacts SA is unknown and requires evaluation. Methods and results The ENTRESTO‐SAS trial is a six‐centre, prospective, open‐label real‐life cohort study (NCT02916160). Ambulatory patients eligible for SV (i.e. HFrEF adults who remain symptomatic despite optimal treatment) were evaluated before and after 3 months of SV (including nocturnal ventilatory polygraphy); 118 patients were final analysed [median age was 66 (IQ25–75: 56–73) years, 81.4% male, 36.5% New York Heart Association III–IV, N‐terminal pro‐B‐type natriuretic peptide level of 1564 (701–3376) ng/L, left ventricular ejection fraction of 30 (25–34)%, 60.7% ischaemic HFrEF, 97.5% initially treated with angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers, 83.9% with beta‐blockers, 64.4% with mineralocorticoid receptor antagonists, and 74.6% with diuretics]. Three groups were defined according to initial central/obstructive apnoea–hypopnoea indices (AHIs): G1 (n = 49, AHIcentral ≥ 5/h and AHIobstructive < 15/h); G2 (n = 27, AHIobstructive ≥ 15/h); and G3 (n = 42, AHIcentral < 5/h and AHIobstructive < 15/h). At 3 months, the AHI (main predefined outcome) decreased significantly by −7.10/h (IQ25–75: −16.10 to 0.40; P < 0.001) in G1 + G2 without positive airway pressure treatment (45 patients, median initial AHI of 24.20 (IQ25–75: 16.40–43.50)/h). Of these, 24.4% presented an AHI decrease ≥50% and 37.78% had a final AHI < 15/h (tendency for improvement from an initial value of 20%: P = 0.0574). For G1 patients (n = 37), AHI significantly decreased from a median of 22.90 (16.00–43.50)/h to 19.20 (12.70–31.10)/h (P = 0.002). For G2 patients (n = 8), AHI decreased from a median of 30.10 (26.40–47.60)/h to 22.75 (14.60–36.90)/h (statistically non‐significant, P = 0.059). Conclusions In this real‐life population, SV treatment for 3 months in SA patients is associated with a significant decrease in AHI. These results support the current guidelines that recommend first an optimization of the HFrEF treatment in patients with HFrEF and central SA. A potential positive airway pressure sparing effect merits further investigation.
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Affiliation(s)
- Dany Jaffuel
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Erika Nogue
- Department of Medical Information, Montpellier University Hospital, IMAG UMR 5149, Montpellier University, Montpellier, France
| | - Philippe Berdague
- Department of Cardiology, Béziers Hospital, Béziers, France.,MSP de Béziers, Pôle médical spécialisé, Béziers, France
| | - Michel Galinier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
| | - Marion Dupuis
- Department of Pneumology, Respiratory Tracts Center, Hôpital Larrey, Toulouse, France
| | | | - Marie-Pierre Cadars
- Centre Médecine du Sommeil et Assistance respiratoire, Béziers Hospital, Béziers, France
| | | | - Nathalie Plouvier
- Department of Pneumology, University Hospital Caremeau, Nîmes, France
| | | | - Vincent Puel
- PEAS, Nouvelle Clinique Bel-Air, Bordeaux, France
| | - Jean-Pierre Mallet
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Carey M Suehs
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Department of Medical Information, Montpellier University Hospital, IMAG UMR 5149, Montpellier University, Montpellier, France
| | - Nicolas Molinari
- Department of Medical Information, Montpellier University Hospital, IMAG UMR 5149, Montpellier University, Montpellier, France
| | - Arnaud Bourdin
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Department of Cardiology, Regional University Hospital of Montpellier, Montpellier, France
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23
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Singh GK, Ferguson C, Davidson PM, Newton PJ. Attitudes and practices towards palliative care in chronic heart failure: a survey of cardiovascular nurses and physicians. Contemp Nurse 2021; 57:113-127. [PMID: 33970800 DOI: 10.1080/10376178.2021.1928522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Heart failure is a chronic condition with various implications for individuals and families. Although the importance of implementing palliative care is recommended in best practice guidelines, implementation strategies are less clear. AIMS This study sought to; (1) determine Australian and New Zealand cardiovascular nurses and physicians' end of life care attitudes and specialist palliative care referral in heart failure and; (2) determine self-reported delivery of supportive care and attitudes towards service names. METHODS An electronic survey was emailed to members of four peak bodies and professional networks. Participants were also recruited through social media. Paper-based versions of the survey were completed by attendees of the 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, August 2018. FINDINGS There were 113 completed responses included in the analyses. Participants were nurses (n = 75), physicians (n = 32) and allied health professionals (n = 4). Most (67%) reported they were comfortable with providing end of life care; however, fewer respondents agreed they received support for their dying patients and one-third experienced a sense of failure when heart failure progressed. Most (84-100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name 'supportive care' than to 'palliative care'. CONCLUSION Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name 'supportive care' and further research focusing on primary palliative team-based approach is required to improve palliative care access. IMPACT STATEMENT Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.
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Affiliation(s)
- Gursharan K Singh
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Caleb Ferguson
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.,Western Sydney Local Health District, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Patricia M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Phillip J Newton
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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24
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Sazzad F, Kuzemczak M, Loh E, Wu W, Kofidis T. Targeted Myocardial Restoration with Injectable Hydrogels-In Search of The Holy Grail in Regenerating Damaged Heart Tissue. Biomedicines 2021; 9:biomedicines9060595. [PMID: 34073912 PMCID: PMC8225139 DOI: 10.3390/biomedicines9060595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022] Open
Abstract
A 3-dimensional, robust, and sustained myocardial restoration by means of tissue engineering remains an experimental approach. Prolific protocols have been developed and tested in small and large animals, but, as clinical cardiac surgeons, we have not arrived at the privilege of utilizing any of them in our clinical practice. The question arises as to why this is. The heart is a unique organ, anatomically and functionally. It is not an easy target to replicate with current techniques, or even to support in its viability and function. Currently, available therapies fail to reverse the loss of functional cardiac tissue, the fundamental pathology remains unaddressed, and heart transplantation is an ultima ratio treatment option. Owing to the equivocal results of cell-based therapies, several strategies have been pursued to overcome the limitations of the current treatment options. Preclinical data, as well as first-in-human studies, conducted to-date have provided important insights into the understanding of injection-based approaches for myocardial restoration. In light of the available data, injectable biomaterials suitable for transcatheter delivery appear to have the highest translational potential. This article presents a current state-of-the-literature review in the field of hydrogel-based myocardial restoration therapy.
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Affiliation(s)
- Faizus Sazzad
- Myocardial Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (F.S.); (E.L.); (W.W.)
| | - Michał Kuzemczak
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland;
- Department of Medical Rescue, Poznan University of Medical Sciences, 60-806 Poznań, Poland
| | - Engracia Loh
- Myocardial Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (F.S.); (E.L.); (W.W.)
| | - Wellington Wu
- Myocardial Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (F.S.); (E.L.); (W.W.)
| | - Theo Kofidis
- Myocardial Experimental Laboratory, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (F.S.); (E.L.); (W.W.)
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore 119228, Singapore
- Correspondence: ; Tel.: +65-6772-6505
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25
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Wang LC, Chen HM, Chen JH, Lin YC, Ko Y. An evaluation of the healthcare costs associated with adverse events in patients with breast cancer. Int J Health Plann Manage 2021; 36:1465-1475. [PMID: 33914358 DOI: 10.1002/hpm.3184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Despite the increasing prevalence and costs of breast cancer (BC), little is known about its adverse event (AE)-related costs in Asia. This study aimed to estimate the healthcare expenditures of AEs in patients with BC in Taiwan. METHODS This is a retrospective claims database analysis. The medical costs associated with BC AEs during the first-line treatment period were estimated by use of both a matching method and the generalized linear model (GLM). RESULTS A total of 50,010 patients diagnosed with breast cancer were identified. Using the case-control matching method, pneumonitis/pneumonia was the AE associated with the greatest total healthcare costs (NT$ 66,889), followed by arthralgia (NT$55,380). In the GLM, the estimated costs ranged from NT$ 1,045 for fatigue to NT$ 116,652 for left heart failure. Moreover, the estimated total healthcare incremental cost increased with the number of AEs (NT$18,157 for 1 AE, NT$33,827 for 2 AEs, NT$39,052 for 3 AEs, NT$53,348 for 4 AEs, and NT$54,215 for 5 AEs and above). CONCLUSIONS The findings indicate that AEs among patients with BC were associated with a substantial economic burden, and healthcare expenditure rose significantly as the number of AEs increased.
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Affiliation(s)
- Lin-Chien Wang
- Department of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan, ROC
| | - Hsuan-Ming Chen
- Department of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan, ROC
| | - Jin-Hua Chen
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.,Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan.,Biostatistics Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Lin
- Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Yu Ko
- Department of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan, ROC.,Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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26
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Bakogiannis C, Tsarouchas A, Mouselimis D, Lazaridis C, Theofillogianakos EK, Billis A, Tzikas S, Fragakis N, Bamidis PD, Papadopoulos CE, Vassilikos VP. A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study. JMIR Mhealth Uhealth 2021; 9:e24271. [PMID: 33847599 PMCID: PMC8080140 DOI: 10.2196/24271] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/05/2020] [Accepted: 03/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate. Results A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%. Conclusions The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.
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Affiliation(s)
- Constantinos Bakogiannis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Antonios Billis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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27
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Coats AJS, Rosano G. Treatments delayed lead to lives lost. Eur J Heart Fail 2021; 23:511. [PMID: 33686776 DOI: 10.1002/ejhf.2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK
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28
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Lindmark K, Boman K, Stålhammar J, Olofsson M, Lahoz R, Studer R, Proudfoot C, Corda S, Fonseca AF, Costa-Scharplatz M, Levine A, Törnblom M, Castelo-Branco A, Kopsida E, Wikström G. Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study. ESC Heart Fail 2021; 8:2144-2153. [PMID: 33751806 PMCID: PMC8120394 DOI: 10.1002/ehf2.13296] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden. Methods and results Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all‐cause mortality were evaluated. A time‐dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction‐based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient‐years of follow‐up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all‐cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all‐cause mortality increased approximately six‐fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24–7.48] and 5.59 [4.70–6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities. Conclusions There is a strong association between recurrent HFHs and CV and all‐cause mortality, with the risk increasing progressively with each recurrent HFH.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, S-901 87, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | | | | | | | | | | | | | | | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
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29
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30
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Bansal A, Padappayil RP, Gopal S, Garg M, Joshi R. Practice patterns in the management of congestive heart failure and post-discharge quality of life: A hospital-based cross-sectional study. J Family Med Prim Care 2021; 9:5592-5596. [PMID: 33532400 PMCID: PMC7842451 DOI: 10.4103/jfmpc.jfmpc_218_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/13/2020] [Accepted: 09/06/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of the study is to identify the etiology, risk factors, frequency of major and minor components of the Framingham criteria for heart failure, discharge medications, mortality, and quality of life after discharge from the hospital, for patients who were admitted to the in-patient unit of a tertiary care hospital in central India, with a diagnosis of congestive heart failure (CHF). Methods: This hospital-based cross-sectional study involved retrospective chart review of patients who were admitted to the in-patient unit with a diagnosis of CHF. These patients were then attempted to reach via their telephone numbers listed in the medical records and their current quality of life was assessed using Euro-QoL 5D questionnaire. Results: In the 69 patients who were admitted to the hospital with congestive cardiac failure during the pre-defined period, ischemic heart disease was the most common etiology and smoking was the most common risk factor for the development of CHF. The most common findings based on Framingham criteria were dyspnea on mild exertion, rales and bilateral ankle edema. It was determined that one-fourth of the individuals were non-compliant to the medical treatment and more than half of the patients had a poor health score. Conclusion: Smoking remains to be a major risk factor for patients to develop ischemic heart disease and subsequent CHF. Patients with congestive cardiac failure also had severe deterioration in their quality of life after discharge from the hospital, implying the need for improving efforts toward prevention and better management.
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Affiliation(s)
- Agam Bansal
- Department of Internal Medicine, Cleveland Clinic Foundation, Ohio, USA
| | - Rana P Padappayil
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shwetha Gopal
- Department of Internal Medicine, Affiliation, St Barnabas Medical Centre, Livingston, New Jersey, USA
| | - Mohil Garg
- All India Institute of Medical Sciences, India
| | - Rajnish Joshi
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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31
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Shuvy M, Zwas DR, Keren A, Gotsman I. Prevalence and impact of concomitant malignancy on outcomes among ambulatory heart failure population. Eur J Clin Invest 2021; 51:e13373. [PMID: 32780431 DOI: 10.1111/eci.13373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Heart failure (HF) and cancer are medical conditions with a rising prevalence resulting in increased co-occurrence. We assessed the impact of cancer on clinical outcome in patients with HF and the prognostic impact of specific types of cancers on different HF subpopulations. METHODS All patients with HF were evaluated for the occurrence of malignant neoplasm at a health maintenance organization and were followed for cardiac-related hospitalizations and death. RESULTS The study cohort included 7106 HF patients, 1564 of them (22%) had a diagnosis of malignant neoplasm. HF patients with concomitant cancer were older, had more comorbidities and were more likely to have NYHA class III/IV (42% vs. 37%, P < .01), compared with patients with no malignancy. The overall 2-year mortality rate of the entire HF cohort was 23.2%. Survival rate by Kaplan-Meier analysis demonstrated that the presence of a malignancy was directly associated with reduced survival: 67.2 ± 1.2% vs 79.5 ± 0.5%, P < .001. Malignancy was associated with an increase in mortality with a hazard ratio (HR) of 1.36, 95% confidence interval (CI) 1.21-1.54, P < .001. The strongest impact of malignancy on outcomes was related to age; among patients <70 years old, the increase in the risk of mortality was the highest with a HR of 2.07, 95% CI 1.54-2.80, P < .001. CONCLUSIONS Malignancy is common among patients with HF. Patients with concomitant HF and malignancies have poor outcomes, and the impact of cancer on outcome is stronger among young patients.
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Affiliation(s)
- Mony Shuvy
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Tel Aviv, Israel
| | - Donna R Zwas
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Tel Aviv, Israel
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Tel Aviv, Israel
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Tel Aviv, Israel
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32
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Bose CN, Saboonchi F, Persson H, Björling G, Elfström ML. Adaptation of Coping Effectiveness Training for Patients With Heart Failure and Patient-Reported Experience of the Intervention. J Patient Exp 2021; 7:1054-1061. [PMID: 33457545 PMCID: PMC7786735 DOI: 10.1177/2374373520916012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Although patients with chronic heart failure (CHF) often experience psychological distress, psychosocial aspects are not an integral part of their treatment and care. The aim is to describe the adaptation of Coping Effectiveness Training for patients with CHF and the participants’ reported experiences. The intervention workbook and manual were translated into Swedish and adapted for patients with CHF. Patient-reported experience from 33 of 35 participants, that had completed the psychosocial intervention, was measured with an evaluation form consisting of closed and open-ended questions. Most participants thought they benefited from the intervention, were pleased with the structure and did not want to add anything to the program. The benefits experienced were learning how to cope with the illness and meeting other people to share and discuss experiences. There was a variation concerning the group process of how much direction should be given during the discussions. Overall, unique data from patient-reported experience measure showed that the participants were satisfied with the psychosocial intervention, applied for the first time to patients with CHF.
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Affiliation(s)
- Catarina Nahlén Bose
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Administration, Karolinska Institutet, Stockholm, Sweden
| | - Hans Persson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Gunilla Björling
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Magnus L Elfström
- Mälardalen University, School of Health, Care and Social Welfare, Eskilstuna, Sweden
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Fonseca AF, Lahoz R, Proudfoot C, Corda S, Loefroth E, Jackson J, Cotton S, Studer R. Burden and Quality of Life Among Female and Male Patients with Heart Failure in Europe: A Real-World Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1693-1706. [PMID: 34354345 PMCID: PMC8331086 DOI: 10.2147/ppa.s312200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To characterize symptoms, clinical burden, and health-related quality of life (HRQoL) among women and men with heart failure (HF) with a left ventricular ejection fraction (LVEF) of ≤60% in Europe. PATIENTS AND METHODS A real-world cross-sectional study was conducted in France, Germany, Italy, Spain, and United Kingdom from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive patients with HF. The same patients were invited to complete a questionnaire comprising patient-reported outcomes: the Minnesota Living with Heart Failure Questionnaire (MLHFQ), five-level five-dimension EuroQol questionnaire (EQ-5D-5L), Visual Analogue Scale (VAS), and Work Productivity and Activity Impairment questionnaire. RESULTS The mean age of 804 patients (men, n=517; women, n=287) was 68.6 years (men, 67.8 years; women, 70.2 years; p=0.0022). The mean LVEF was 44.7% (men, 43.6%; women, 46.8%; p<0.0001). Patients reported dyspnoea when active (overall, 55.7%; men, 56.0%; women, 55.3%), fatigue/weakness/faintness (34.5%; men, 32.9%; women, 37.2%), and oedema (20.3%; men, 18.7%; women, 23.1%) as the most troublesome HF symptoms. Overall, 54.1% of patients reported low mood/depression (men, 50.8%; women, 60.1%). The overall MLHFQ mean score was higher (ie, poorer HRQoL) among women vs men (37.9 vs 34.6; p=0.0481). MLHFQ was consistently higher (ie, poorer HRQoL) for women vs men across the physical (18.6 vs 16.6; p=0.0041) and emotional (9.4 vs 7.9; p=0.0021) scoring domains. Mean EQ-5D utility (0.69 vs 0.75; p=0.0046) and VAS scores (55.4 vs 61.3; p<0.0001) were lower among women compared with men. Overall, 23.4% of patients were hospitalized owing to HF in the previous year (men, 22.7%; women, 24.6%). Patients reported 43.2% activity impairment due to HF (men, 41.6%; women, 46.4%; p=0.01). CONCLUSION HF causes a substantial burden on patients, with a greater burden among women vs men. This gender-related difference is consistent with other HF studies, warranting further research to understand the underlying reasons.
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Affiliation(s)
- Ana Filipa Fonseca
- Novartis Pharma AG, Basel, Switzerland
- Correspondence: Ana Filipa Fonseca Real World Evidence Group, Cardio-Renal-Metabolic Franchise, Novartis Pharma AG, Novartis Campus, Basel, CH-4002, Switzerland Tel: +41 (0) 793489979 Email
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34
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Stewart S, Playford D, Scalia GM, Currie P, Celermajer DS, Prior D, Codde J, Strange G. Ejection fraction and mortality: a nationwide register-based cohort study of 499 153 women and men. Eur J Heart Fail 2020; 23:406-416. [PMID: 33150657 DOI: 10.1002/ejhf.2047] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS We investigated the sex-based risk of mortality across the spectrum of left ventricular ejection fraction (LVEF) in a large cohort of patients in Australia. METHODS AND RESULTS Quantified levels of LVEF from 237 046 women (48.1%) and 256 109 men undergoing first-time, routine echocardiography (2000-2019) were linked to 119 232 deaths (median 5.6 years of follow-up). Overall, 17.6% of men vs. 8.3% of women had an LVEF <50%. An LVEF <40% was associated with the highest crude cardiovascular-related and all-cause mortality at 5 years (∼20-30% and ∼ 40-50%, respectively). Thereafter, actual cardiovascular-related and all-cause mortality at 5 years in both sexes steeply improved to a nadir LVEF of 65.0-69.9% (reference group). Below this LVEF level, the adjusted hazard ratio (HR) for cardiovascular-related mortality for a LVEF of 55.0-59.9% was 1.36 [95% confidence interval (CI) 1.16-1.59; P < 0.001] in women and 1.21 (95% CI 1.05-1.39; P = 0.008) in men. In women, an LVEF of 60.0-64.9% was also associated with a HR 1.33 (95% CI 1.16-1.52; P < 0.001) for cardiovascular-related mortality. These associations were most striking in women and men aged <65 years and were replicated in those with suspected heart failure (32 403 cases aged 65.2 ± 16.1 years, 57.0% women). For pre-existing heart failure (33 738 cases aged 67.6 ± 16.9 years, 46.5% women), the specific threshold of increased mortality was at and below 50.0-54.9%. CONCLUSIONS Among patients investigated for suspected or established cardiovascular disease, we found clinically relevant sex-based differences in the distribution and mortality associated with an LVEF <65.0-69.9%. Specifically, they suggest a greater risk of mortality at higher LVEF levels among women.
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Affiliation(s)
- Simon Stewart
- Torrens University Australia, Adelaide, Australia/University of Glasgow, Glasgow, UK
| | | | | | | | | | | | - Jim Codde
- The University of Notre Dame, Fremantle, Australia
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Alhakak AS, Sengeløv M, Jørgensen PG, Bruun NE, Johnsen C, Abildgaard U, Iversen AZ, Hansen TF, Teerlink JR, Malik FI, Solomon SD, Gislason G, Biering-Sørensen T. Left ventricular systolic ejection time is an independent predictor of all-cause mortality in heart failure with reduced ejection fraction. Eur J Heart Fail 2020; 23:240-249. [PMID: 33034122 DOI: 10.1002/ejhf.2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/16/2020] [Accepted: 10/07/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS Colour tissue Doppler imaging (TDI) M-mode through the mitral leaflet is an easy and precise method to obtain cardiac time intervals including isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT) and systolic ejection time (SET). The myocardial performance index (MPI) is defined as [(IVCT + IVRT)/SET]. Whether cardiac time intervals obtained by the TDI M-mode method can be used to predict outcome in patients with heart failure with reduced ejection fraction (HFrEF) remains unknown. METHODS AND RESULTS A total of 997 patients with HFrEF (mean age 67 ± 11 years, 74% male) underwent an echocardiographic examination including TDI. During a median follow-up of 3.4 years (interquartile range 1.9-4.8 years), 165 (17%) patients died. The risk of mortality increased by 9% per 10 ms decrease in SET [per 10 ms decrease: hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.06-1.13; P < 0.001]. The association remained significant even after multivariable adjustment for clinical and echocardiographic parameters (per 10 ms decrease: HR 1.06, 95% CI 1.01-1.11; P = 0.030). The MPI was a significant predictor in an unadjusted model (per 0.1 increase: HR 3.06, 95% CI 1.16-8.06; P = 0.023). However, the association did not remain significant after multivariable adjustment. No significant associations between IVCT or IVRT and mortality were found in unadjusted nor adjusted models. Additionally, SET provided incremental prognostic information with regard to predicting mortality when added to established clinical predictors of mortality in patients with HFrEF. CONCLUSION In patients with HFrEF, SET provides independent and incremental prognostic information regarding all-cause mortality.
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Affiliation(s)
- Alia S Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sengeløv
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter G Jørgensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Johnsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Allan Z Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas F Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, CA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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36
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Soofi MA, Jafery Z, AlSamadi F. Impact of a Social Support Program Supervised by a Multidisciplinary Team on Psychosocial Distress and Knowledge About Heart Failure Among Heart Failure Patients. J Saudi Heart Assoc 2020; 32:456-463. [PMID: 33299791 PMCID: PMC7721446 DOI: 10.37616/2212-5043.1046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022] Open
Abstract
Background Heart failure drains significant financial resources with morbidity and mortality higher than cancer. Social support is defined as the care provided by the family members, friends and health care workers to the patients. Absence of social support and poor perceived social support will create stress, anxiety, depression and anger which further deteriorate the underlying disease and worsen quality of life. Discussion in group creates better understanding of the disease which helps the patients improving their skills in managing their condition. Objective To evaluate the impact of multidisciplinary team supervised social support program on components of psychosocial distress and knowledge about heart failure among heart failure patients. Methods Adult patients with heart failure attending King Fahad Medical City as inpatient or outpatient were enrolled in this prospective cohort study. Patients were given questionnaire to assess their perception of social support they have at their disposal, quality of life, knowledge regarding heart failure and self-care behavior. They then had interactive education in groups supervised by multidisciplinary team members about the pathogenesis of their disease with management strategies, dietary restriction, importance of exercise and healthy life style pattern. Patients shared their experiences in the group and had opportunity to learn from each other. Patients were assessed regarding their perceived social support, quality of life, knowledge regarding heart failure and self-care behavior immediately after the session and at 1 month interval. Results There were total 500 patients participated in the study. Among the study participants 62% were male and majority was living with the family. Components of psychosocial distress were present in up to 40% of study participants and only 36% considered knowledgeable regarding heart failure. After the interactive social support group meeting components of psychosocial distress were significantly reduced with significant improvement in knowledge about heart failure. At 1 month follow up participants reported persistent improvement in quality of life, improvement in self-care behavior, perceived social support and wanted to continue in social group program. Conclusion Social support program supervised by multidisciplinary team providing education and social support improved knowledge, self-care behavior, perceived social support and quality of life among heart failure patients.
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Affiliation(s)
| | - Zainab Jafery
- Adult Cardiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal AlSamadi
- Adult Cardiology, King Fahad Medical City, Riyadh, Saudi Arabia
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37
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Brito D, Bettencourt P, Carvalho D, Ferreira J, Fontes-Carvalho R, Franco F, Moura B, Silva-Cardoso JC, de Melo RT, Fonseca C. Sodium-Glucose Co-transporter 2 Inhibitors in the Failing Heart: a Growing Potential. Cardiovasc Drugs Ther 2020; 34:419-436. [PMID: 32350793 PMCID: PMC7242490 DOI: 10.1007/s10557-020-06973-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new drug class designed to treat patients with type 2 diabetes (T2D). However, cardiovascular outcome trials showed that SGLT2i also offer protection against heart failure (HF)-related events and cardiovascular mortality. These benefits appear to be independent of glycaemic control and have recently been demonstrated in the HF population with reduced ejection fraction (HFrEF), with or without T2D. This comprehensive, evidence-based review focuses on the published studies concerning HF outcomes with SGLT2i, discussing issues that may underlie the different results, along with the impact of these new drugs in clinical practice. The potential translational mechanisms behind SGLT2i cardio-renal benefits and the information that ongoing studies may add to the already existing body of evidence are also reviewed. Finally, we focus on practical management issues regarding SGLT2i use in association with other T2D and HFrEF common pharmacological therapies. Safety considerations are also highlighted. Considering the paradigm shift in T2D management, from a focus on glycaemic control to a broader approach on cardiovascular protection and event reduction, including the potential for wide SGLT2i implementation in HF patients, with or without T2D, we are facing a promising time for major changes in the global management of cardiovascular disease.
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Affiliation(s)
- Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal. .,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal.
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital CUF Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar, Universitário de São João, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Espinho, Portugal.,Department of Surgery and Physiology, Cardiovascular Investigation Unit, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Fátima Franco
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Brenda Moura
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Department of Cardiology, Hospital das Forças Armadas-Pólo do Porto, Porto, Portugal.,CINTESIS-Cardiocare, Center for Health Technology and Services Research, Porto, Portugal
| | - José Carlos Silva-Cardoso
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,CINTESIS-Cardiocare, Center for Health Technology and Services Research, Porto, Portugal.,Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Cândida Fonseca
- Heart Failure Clinic, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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Cavanagh CE, Rosman L, Spatz ES, Fried T, Gandhi PU, Soucier RJ, Burg MM. Dying to know: prognosis communication in heart failure. ESC Heart Fail 2020; 7:3452-3463. [PMID: 32969195 PMCID: PMC7754721 DOI: 10.1002/ehf2.12941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 12/31/2022] Open
Abstract
Prognosis communication in heart failure is often narrowly defined as a discussion of life expectancy, but as clinical guidelines and research suggest, these discussions should provide a broader understanding of the disease, including information about disease trajectory, the experiences of living with heart failure, potential burden on patients and families, and mortality. Furthermore, despite clinical guidelines recommending early discussions, evidence suggests that these discussions occur infrequently or late in the disease trajectory. We review the literature concerning patient, caregiver, and clinician perspectives on discussions of this type, including the frequency, timing, desire for, effects of, and barriers to their occurrence. We propose an alternate view of prognosis communication, in which the patient and family/caregiver are educated about the nature of the disease at the time of diagnosis, and a process of engagement is undertaken so that the patient's full participation in their care is marshalled, and the care team engages the patient in the informed decision making that will guide care throughout the disease trajectory. We also identify and discuss evidence gaps concerning (i) patient preferences and readiness for prognosis information along the trajectory; (ii) best practices for communicating prognosis information; and (iii) effects of prognosis communication on patient's quality of life, mental health, engagement in critical self‐care, and clinical outcomes. Research is needed to determine best practices for engaging patients in prognosis communication and for evaluating the effects of this communication on patient engagement and clinical outcomes.
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Affiliation(s)
- Casey E Cavanagh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lindsey Rosman
- Department of Medicine-Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA
| | - Terri Fried
- VA Connecticut Healthcare System, West Haven, CT, USA.,Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Parul U Gandhi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Richard J Soucier
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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de Miguel-Díez J, Jiménez-García R, Méndez-Bailón M, Muñoz-Rivas N, Hernández-Barrera V, Puente-Maestu L, de Miguel-Yanes JM, Perez-Farinos N, López-de-Andrés A. National trends in mechanical ventilation among patients hospitalized with heart failure: a population-based study in Spain (2001-2017). Eur J Intern Med 2020; 78:76-81. [PMID: 32327318 DOI: 10.1016/j.ejim.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/16/2020] [Accepted: 04/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We evaluated seventeen years' trends (2001-2017) in the utilization of non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or both types of ventilator support (NIV+IMV) among patients hospitalized for heart failure (HF). METHODS Observational retrospective epidemiological study using the Spanish National Hospital Discharge Database. RESULTS Over a total of 3,634,044 HF hospitalized patients, we identified 164,815 who were treated with ventilator support. 70.5% received NIV, 24.9% IMV and 4.6% both procedures. Patients receiving NIV were the oldest and had the highest mean value for Charlson comorbidity index (CCI) score. For all types of ventilation values of CCI≥3 increased significantly over the study period (all p<0.001). Patients who received IMV had the highest IHM (48.1%) followed by those with NIV+IMV (44.7%) and NIV (19.9%). The in hospital mortality (IHM) decreased significantly in patients with NIV+IMV and NIV and remained stable in those with IMV. Compared to admissions without ventilation, the probability of receiving NIV and NIV+IMV increased significantly over time, however IMV decreased significantly. Factors associated with a greater probability of receiving NIV vs not being ventilated included higher age, higher CCI and suffering pneumonia whereas male sex reduced the probability. For IMV and NIV+IMV the factors are the same than for NIV, except male sex that increased the probability for IMV and NIV+IMV. CONCLUSIONS We found a significant change in ventilator strategy in hospitalized HF patients over time. Even if the clinical profile is worsening IHM decreased significantly over time, but only in HF patients who received NIV and NIV+IMV.
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Affiliation(s)
- Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain
| | | | - Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid 28031, Spain
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid 28922, Spain
| | - Luis Puente-Maestu
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Napoleón Perez-Farinos
- Department of Public Health and Psychiatry, Faculty of Medicine, Universidad de Málaga, Boulevard Louis Pasteur, 32, Málaga, 28071, Spain.
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid 28922, Spain
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40
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Shepel RN, Drapkina OM. Angiogenesis in Patients with Chronic Heart Failure: Focus on Endothelial Vascular Growth Factor, Pentraxin-3 and Transforming Growth Factor Beta. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-05-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic heart failure (CHF) is considered the leading cause of death in patients with established cardiovascular (CVD) and metabolic diseases. Although the current treatment strategy has improved survival and clinical outcomes, the prevalence of CHF shows an increase. Current clinical guidelines for the treatment and prevention of CVD note the role of biological markers as a fairly simple and powerful tool for diagnosing, stratifying risk and predicting CHF. However, it is unclear whether all of these biological markers are equally capable of predicting cardiovascular mortality and heart failure related outcomes in patients with acute and chronic heart failure, as well as in different phenotypes of heart failure. However, the results of numerous studies demonstrate scientific interest in the processes of angiogenesis among patients with CHF. There is an impressive body of evidence linking CHF to the level of markers such as vascular endothelial growth factor, pentraxin-3, and transforming growth factor beta. The review presents the data of domestic and foreign clinical studies devoted to the study of the level of angiogenesis markers among patients with CHF.
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Affiliation(s)
- R. N. Shepel
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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41
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Estany ER, Campos Vera N, Barrera Sarduy J, Hernández García S, Valdés Martín A, Peña Bofill V, Prendes Lago E. Evaluación funcional de un programa de entrenamiento físico en pacientes infartados con disfunción sistólica severa del ventrículo izquierdo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Björck L, Lundberg C, Schaufelberger M, Lissner L, Adiels M, Rosengren A. Body mass index in women aged 18 to 45 and subsequent risk of heart failure. Eur J Prev Cardiol 2019; 27:1165-1174. [PMID: 31684761 DOI: 10.1177/2047487319882510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of heart failure (HF) is decreasing in older ages, but increasing rates have been observed among younger persons in Sweden. Therefore, we investigated the relationship between risk of hospitalization for HF and body mass index (BMI). METHODS This was a prospective registry-based cohort study. We included 1,374,031 women aged 18-45 years (mean age 27.9 years) who gave birth during 1982-2014, and were registered in the Medical Birth Register. Information on hospitalization because of HF was collected through linkage to the National Inpatient Register. RESULTS Compared to women with a BMI of 20-<22.5 kg/m2, women with a BMI of 22.5-<25.0 had a hazard ratio (HR) of 1.24 (95% confidence interval (CI), 1.10-1.39) for HF after adjustment for age, year, parity, baseline disorders, smoking, and education. The HR (95% CI) increased to 1.56 (1.36-1.78), 2.39 (2.05-2.78), 2.82 (2.43-3.28), and 4.51 (3.63-5.61) in women with a BMI of 25-<27.5, 27.5-<30, 30-<35, and ≥35 kg/m2, respectively. The multiple-adjusted HRs (95% CI) associated with risk of HF per one-unit increase in BMI in women with a BMI ≥ 22.5 kg/m2 ranged from 1.01 (0.97-1.06) for HF related to valvular disease to 1.14 (1.12-1.15) for coronary heart disease, diabetes, or hypertension. CONCLUSION Increasing body weight was strongly associated with the risk of early HF in women. Compared with lean women, the risk for HF started to increase at high-normal BMI levels, and was nearly five-fold in women with a BMI ≥ 35 kg/m2.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Christina Lundberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
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Cardiac wall mechanics analysis in hypertension-induced heart failure rats with preserved ejection fraction. J Biomech 2019; 98:109428. [PMID: 31653505 DOI: 10.1016/j.jbiomech.2019.109428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 11/21/2022]
Abstract
Although cardiac wall mechanics is of importance for understanding heart failure with preserved ejection fraction (HFpEF), there is a lack of relevant mechanics studies. The aim of this study was to analyze the changes in stress and strain in the left ventricle (LV) in hypertension-induced HFpEF rats. Based on experimental measurements in DSS rats fed with high-salt (HS) and low-salt (LS) diets, LV stress and strain were computed throughout the cardiac cycle using Continuity software. HS-feeding increased myofiber stress and strain along both the transmural and longitudinal directions at the end-diastolic state but resulted in a lower absolute value of strain and relatively unchanged stress at the end-systolic state. Moreover, the end-diastolic stress and strain decreased with increasing radial position from the endocardial towards the epicardial walls despite negligible changes along the longitudinal direction. The changes in LV wall mechanics characterized the elevated diastolic LV stiffness and slow LV relaxation in HS-fed rats of HFpEF. These findings denote that a vicious cycle of increased stress and strain and diastolic dysfunction can prompt the development of HFpEF.
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44
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Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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45
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Ouwerkerk W, Zwinderman AH, Ng LL, Demissei B, Hillege HL, Zannad F, van Veldhuisen DJ, Samani NJ, Ponikowski P, Metra M, Ter Maaten JM, Lang CC, van der Harst P, Filippatos G, Dickstein K, Cleland JG, Anker SD, Voors AA. Biomarker-Guided Versus Guideline-Based Treatment of Patients With Heart Failure: Results From BIOSTAT-CHF. J Am Coll Cardiol 2019; 71:386-398. [PMID: 29389354 DOI: 10.1016/j.jacc.2017.11.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart failure guidelines recommend up-titration of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blockers (ARBs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) to doses used in randomized clinical trials, but these recommended doses are often not reached. Up-titration may, however, not be necessary in all patients. OBJECTIVES This study sought to establish the role of blood biomarkers to determine which patients should or should not be up-titrated. METHODS Clinical outcomes of 2,516 patients with worsening heart failure from the BIOSTAT-CHF (BIOlogy Study to Tailored Treatment in Chronic Heart Failure) were compared between 3 theoretical treatment scenarios: scenario A, in which all patients are up-titrated to >50% of recommended doses; scenario B, in which patients are up-titrated according to a biomarker-based treatment selection model; and scenario C, in which no patient is up-titrated to >50% of recommended doses. The study conducted multivariable Cox regression using 161 biomarkers and their interaction with treatment, weighted for treatment-indication bias to estimate the expected number of deaths or heart failure hospitalizations at 24 months for all 3 scenarios. RESULTS Estimated death or hospitalization rates in 1,802 patients with available (bio)markers were 16%, 16%, and 26%, respectively, in the ACE inhibitor/ARB up-titration scenarios A, B, and C. Similar rates for beta-blocker and MRA up-titration scenarios A, B, and C were 23%, 19%, and 24%, and 12%, 11%, and 24%, respectively. If up-titration was successful in all patients, an estimated 9.8, 1.3, and 12.3 events per 100 treated patients could be prevented at 24 months by ACE inhibitor/ARB, beta-blocker, and MRA therapy, respectively. Similar numbers were 9.9, 4.7, and 13.1 if up-titration treatment decision was based on a biomarker-based treatment selection model. CONCLUSIONS Up-titrating patients with heart failure based on biomarker values might have resulted in fewer deaths or hospitalizations compared with a hypothetical scenario in which all patients were successfully up-titrated.
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Affiliation(s)
- Wouter Ouwerkerk
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Biniyam Demissei
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Hans L Hillege
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Faiez Zannad
- Inserm CIC 1433, Université de Lorraine, CHU de Nancy, Nancy, France
| | | | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Cardiology Department, Military Hospital, Wroclaw, Poland
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Chim C Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Gerasimos Filippatos
- Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Kenneth Dickstein
- Department of Cardiology, University of Stavanger, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - John G Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center, Göttingen, Göttingen, Germany
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
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Trends in the prevalence of malignancy among patients admitted with acute heart failure and associated outcomes: a nationwide population-based study. Heart Fail Rev 2019; 24:989-995. [PMID: 31175492 DOI: 10.1007/s10741-019-09808-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cancer is the second leading cause of death in the USA, and cardiovascular disease is the second leading cause of morbidity and mortality among cancer survivors. Cancer survivors share common risk factors for cardiovascular disease with non-cancer patients. With improved survival, cancer patients become susceptible to treatment-related toxicity often involving the heart. The impact of concurrent malignancy on outcomes particularly among heart failure patients is an area of active research. We studied the trends in the prevalence of a concurrent diagnosis of breast, prostate, colorectal, and lung cancer among admissions for acute heart failure and the associated trends for in-hospital mortality. Patients aged ≥ 18 years who were admitted with a primary diagnosis of "congestive heart failure" (CCS codes 99 and 108) from years 2003 to 2014 were included. We analyzed the rate of admission and in-hospital mortality among patients who had a concurrent diagnosis for either lung cancer, colorectal cancer, breast cancer (among females), or prostate cancer (among males). We performed a multivariate analysis to assess the role of a concurrent diagnosis of any cancer in predicting in-hospital mortality among HF admissions. From 2003 to 2014 across over 12 million HF admissions, ≈ 7% had a concurrent diagnosis of either lung, breast, colorectal, or prostate cancer. The prevalence was highest for breast cancer (2.3%) followed by prostate cancer (2.1%) and colorectal cancer (1.5%) and lowest with lung cancer (1.1%). The prevalence of cancer increased over the duration of study among all four cancer types with the largest increase in prevalence of breast cancer. Baseline comorbidities including hypertension, diabetes, smoking, chronic kidney disease, and coronary artery disease increased over time among patients with and without cancer. In-hospital mortality was higher among those with a diagnosis of lung cancer (5.9%) followed by colorectal cancer (4.0%), prostate cancer (3.5%), no diagnosis of cancer (3.3%), and breast cancer (3.2%). In-hospital mortality declined across HF admissions with and without a cancer diagnosis from 2003 to 2014. Decline in such mortality among heart failure was highest for patients with lung cancer (8.1 to 4.6% from 2003 to 2014; p < 0.001). Multivariate analysis showed that a concurrent diagnosis of cancer was associated with a marginally lower hospital mortality compared with controls (adjusted odds ratio 0.95, 95% confidence interval 0.94-0.96; p < 0.001). Among HF admissions, the prevalence of a concurrent cancer diagnosis increased over time for breast, lung, colorectal, and prostate cancer. Baseline in-hospital mortality was higher among HF admissions with either lung cancer, colorectal cancer, or prostate cancer and lower with breast cancer compared with controls without a cancer diagnosis. Adjusted analysis revealed no evidence for higher hospital mortality among HF admissions with any accompanying cancer diagnosis.
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48
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Lindmark K, Boman K, Olofsson M, Törnblom M, Levine A, Castelo-Branco A, Schlienger R, Bruce Wirta S, Stålhammar J, Wikström G. Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clin Epidemiol 2019; 11:231-244. [PMID: 30962724 PMCID: PMC6435223 DOI: 10.2147/clep.s170873] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden. Methods Adults with incident HF (≥2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005-2013) and electronic medical records (cohort 2, 2010-2015; primary/secondary care patients from Uppsala and Västerbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed. Results Baseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged ≥85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06-1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02-1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997-2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time). Conclusion The annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine and Heart Centre, Umeå University Hospital, Umeå, Sweden,
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Aaron Levine
- Real-World & Analytics Solutions, IQVIA, Solna, Sweden
| | | | - Raymond Schlienger
- Quantitative Safety & Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | - Sara Bruce Wirta
- Global RWE Cardio-Metabolics, Novartis Sweden AB, Stockholm, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Gerhard Wikström
- Department for Medical Sciences, Uppsala University, Uppsala, Sweden
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Liu H, Zhou X, Yu G, Sun X. The effects of the
PRISMA
statement to improve the conduct and reporting of systematic reviews and meta‐analyses of nursing interventions for patients with heart failure. Int J Nurs Pract 2019; 25:e12729. [DOI: 10.1111/ijn.12729] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/25/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Haihua Liu
- Department of Epidemiology and Health Statistics, School of Public HealthQingdao University Qingdao China
| | - Xiaobin Zhou
- Department of Epidemiology and Health Statistics, School of Public HealthQingdao University Qingdao China
| | - Guoyi Yu
- Editorial Board of Acta Medicine Academiae Qingdao UniversityQingdao University Qingdao China
| | - Xiao Sun
- Department of Epidemiology and Health Statistics, School of Public HealthQingdao University Qingdao China
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50
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Al-Omary MS, Mcivor D, Sverdlov AL. Predicting Events in Heart Failure Patients: An Ongoing Challenge. Heart Lung Circ 2019; 28:195-197. [PMID: 30654943 DOI: 10.1016/j.hlc.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mohammed S Al-Omary
- The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn Mcivor
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Aaron L Sverdlov
- The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
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