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Lambrakos LK, Feigofsky SA, Wang Y, Ahmed FZ, Pachón M, Takata TS, Frazier-Mills CG, Kotschet E, Gravelin LM, Hsu JC. Enhancing patient acceptance of ICD implantation through structured shared decision making: conversation is key. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01850-7. [PMID: 39001909 DOI: 10.1007/s10840-024-01850-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D) are lifesaving treatments for patients at risk for sudden cardiac death. Effective physician-patient communication during the shared decision-making process is essential. Electrophysiologist-patient conversations were targeted to obtain objective data on the interaction, understand the conversation framework, and uncover opportunities for improved communication. METHODS Individuals previously identified as requiring an ICD/CRT-D but declined implantation were recruited for this four-stage interview and survey-based study. Quantitative analysis of surveys and AI analysis of conversation videos was conducted to evaluate patient participant expectations, analyze feedback about the conversations with study physicians, and gauge willingness for device implantation. RESULTS The study included 27 patients (mean age 51 years, 51.9% female) and 9 study physicians. Patients were significantly more willing to undergo ICD/CRT-D implantation after conversing with study physicians compared to their own physicians and pre-conversation surveys (mean scores: 5.0, 3.1, and 4.4 out of 7, respectively; p < 0.001). Patient participants had higher satisfaction with the study conversation, rating study physicians higher in effectiveness of explanations, responsiveness to questions, and overall quality of the conversation compared to their own physicians (all p < 0.001). CONCLUSIONS In a cohort of patients who previously declined ICD/CRT-D implantation, patient satisfaction and willingness to undergo implantation of a guideline-directed device therapy increased significantly following a structured conversation with study physicians. Identified key elements could be integrated into user-friendly tools and educational materials to facilitate these conversations, improving patient engagement with the decision-making process and enhancing informed acceptance of indicated device therapies.
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Affiliation(s)
- Litsa K Lambrakos
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, 1321 NW 14th Street, Suite 510, Miami, FL, 33136, USA.
| | | | | | - Fozia Z Ahmed
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Marta Pachón
- Cardiology Department, Hospital Virgen de La Salud, Toledo, Spain
| | | | - Camille G Frazier-Mills
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Emily Kotschet
- Monash Cardiac Rhythm Management Department, Monash Medical Centre, MonashHeartMelbourne, VIC, Australia
| | | | - Jonathan C Hsu
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
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2
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Sadeghpour Tabaei A, Hashemi P. Intra-operative Risk Factors Affecting Mortality after Heart Transplantation: A Referral Center Experience in Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:359-368. [PMID: 38952641 PMCID: PMC11214675 DOI: 10.30476/ijms.2023.99165.3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 07/03/2024]
Abstract
Background Heart transplantation is the preferred treatment for end-stage heart failure. This study investigated the intra-operative risk factors affecting post-transplantation mortality. Methods This single-center retrospective cohort study examined 239 heart transplant patients over eight years, from 2011-2019, at the oldest dedicated cardiovascular center, Shahid Rajaee Hospital (Tehran, Iran). The primary evaluated clinical outcomes were rejection, readmission, and mortality one month and one year after transplantation. For data analysis, univariate logistic regression analyses were conducted. Results In this study, 107 patients (43.2%) were adults, and 132 patients (56.8%) were children. Notably, reoperation due to bleeding was a significant predictor of one-month mortality in both children (OR=7.47, P=0.006) and adults (OR=172.12, P<0.001). Moreover, the need for defibrillation significantly increased the risk of one-month mortality in both groups (children: OR=38.00, P<0.001; adults: OR=172.12, P<0.001). Interestingly, readmission had a protective effect against one-month mortality in both children (OR=0.02, P<0.001) and adults (OR=0.004, P<0.001). Regarding one-year mortality, the use of extracorporeal membrane oxygenation (ECMO) was associated with a higher risk in both children (OR=7.64, P=0.001) and adults (OR=12.10, P<0.001). For children, reoperation due to postoperative hemorrhage also increased the risk (OR=5.14, P=0.020), while defibrillation was a significant risk factor in both children and adults (children: OR=22.00, P<0.001; adults: OR=172.12, P<0.001). The median post-surgery survival was 22 months for children and 24 months for adults. Conclusion There was no correlation between sex and poorer outcomes. Mortality at one month and one year after transplantation was associated with the following risk factors: the use of ECMO, reoperation for bleeding, defibrillation following cross-clamp removal, and Intensive Care Unit (ICU) stay. Readmission, on the other hand, had a weak protective effect.
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Affiliation(s)
- Ali Sadeghpour Tabaei
- Department of Cardiovascular Surgery, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parham Hashemi
- Department of Cardiovascular Surgery, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Taj J, Taylor EP. End-Stage/Advanced Heart Failure: Geriatric Palliative Care Considerations. Clin Geriatr Med 2023; 39:369-378. [PMID: 37385689 DOI: 10.1016/j.cger.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Heart failure remains a condition with high morbidity and mortality affecting 23 million people globally with a cost burden equivalent to 5.4% of the total health care budget in the United States. These costs include repeated hospitalizations as the disease advances and care that may not align with individual wishes and values. The coincidence of comorbid conditions with advanced heart failure poses significant challenges in the geriatric population. Advance care planning, medication education, and minimizing polypharmacy are primary palliative opportunities leading to specialist palliative care such as symptom management at end of life and timing of referral to hospice.
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Affiliation(s)
- Jabeen Taj
- Division of Hospice and Palliative Medicine, Department of Family Medicine, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322, USA.
| | - Emily Pinto Taylor
- Division of General Internal Medicine, Department of Family Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Drive Southeast, Atlanta, GA 30303, USA; Division of Hospice and Palliative Medicine, Department of Family Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Drive Southeast, Atlanta, GA 30303, USA
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4
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Sawatari H, Chahal AA, Ahmed R, Collinss GB, Deshpande S, Khanji MY, Provedenciae R, Khan H, Wafa SEI, Salloum MN, Karim S, Shenthar J, Cha YM, Hyman M, Brady PA, Somers VK, Padmanabhan D, Nkomo VT. Impact of Cardiac Implantable Electronic Devices on Cost and Length of Stay in Patients With Surgical Aortic Valve Replacement and Transcutaneous Aortic Valve Implantation. Am J Cardiol 2023; 192:69-78. [PMID: 36753975 DOI: 10.1016/j.amjcard.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Abstract
Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in aortic stenosis are associated with arrhythmic complications that can require cardiac implantable electronic device (CIED) implantation, but impact on healthcare-associated cost (HAC) and length of stay (LOS) are unknown. This study aimed to assess differences among SAVR/TAVI patients with CIED implantation on HAC and LOS. Patients hospitalized for SAVR or TAVI between 2011 and 2017 on the National Inpatient Sample database were identified and stratified according to presence/type of CIED implantation. During this period, 95,262 patients were identified; 6,435 (6.8%) patients received CIED (median [interquartile range] age: 74.0 [66.0 to 82.0] years). The median adjusted HAC was $44,271 and LOS was 6 days. CIED implantation was associated with longer LOS and higher adjusted HAC in patients with SAVR and TAVI (p <0.0001). Patients with in-hospital death and complications because of SAVR or TAVI had longer preceding in-hospital days of admission. Male patients admitted to small hospitals and the West region had the highest HAC. In conclusion, CIED implantation for arrhythmias results in higher HAC and longer LOS in patients with aortic stenosis for both SAVR and TAVI.
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Affiliation(s)
- Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia
| | - Raheel Ahmed
- Department of Cardiology, Northumbria Healthcare National Health Service Foundation Trust, Newcastle, New South Wales
| | - George B Collinss
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Saurabh Deshpande
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Rui Provedenciae
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Hassan Khan
- Emory University School of Medicine, Atlanta, Georgia
| | - Syed Emir Irfan Wafa
- Department of Cardiology, Northampton General Hospital, Northampton, Massachusetts
| | - Mohammad N Salloum
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Queens Hospital Center, New York, New York
| | - Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jayaprakash Shenthar
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew Hyman
- Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia
| | - Peter A Brady
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia; Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Engstrom N, Letson HL, Ng K, Dobson GP. Predicting arrhythmias in primary prevention heart failure patients: picking up the fragments. Open Heart 2022. [PMCID: PMC9438052 DOI: 10.1136/openhrt-2022-002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Identifying patients with high-risk heart failure (HF) who would benefit from an implantable cardioverter-defibrillator (ICD) remains controversial. A potential marker for arrhythmic sudden death is fragmented QRS (fQRS). fQRS is the notching and slurring of the QRS complex in a 12-lead ECG and it indicates abnormal ventricular depolarisation and myocardial scarring and fibrosis. However, before fQRS complex can be included into selection criteria for ICD therapy, more complete reporting is required on their association with malignant arrhythmias, left ventricular remodelling and myocardial scarring/fibrosis in patients with HF. The molecular basis of the fQRS-arrhythmia-fibrosis connection in HF also needs to be explored. It is not widely appreciated that changes in the QRS complex and phases 0 and 1 of the ventricular action potential occur before contraction and predetermine Ca2+ release during contraction and later Ca2+ sparks. It is currently not known whether the different zig-zag patterns of the QRS are associated with aberrant Ca2+ cycling and arrhythmogenic sparks in patients with HF.
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Müller P, Leow MKS, Dietrich JW. Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence. Front Cardiovasc Med 2022; 9:942971. [PMID: 36046184 PMCID: PMC9420854 DOI: 10.3389/fcvm.2022.942971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
It is well established that thyroid dysfunction is linked to an increased risk of cardiovascular morbidity and mortality. The pleiotropic action of thyroid hormones strongly impacts the cardiovascular system and affects both the generation of the normal heart rhythm and arrhythmia. A meta-analysis of published evidence suggests a positive association of FT4 concentration with major adverse cardiovascular end points (MACE), but this association only partially extends to TSH. The risk for cardiovascular death is increased in both subclinical hypothyroidism and subclinical thyrotoxicosis. Several published studies found associations of TSH and FT4 concentrations, respectively, with major cardiovascular endpoints. Both reduced and elevated TSH concentrations predict the cardiovascular risk, and this association extends to TSH gradients within the reference range. Likewise, increased FT4 concentrations, but high-normal FT4 within its reference range as well, herald a poor outcome. These observations translate to a monotonic and sensitive effect of FT4 and a U-shaped relationship between TSH and cardiovascular risk. Up to now, the pathophysiological mechanism of this complex pattern of association is poorly understood. Integrating the available evidence suggests a dual etiology of elevated FT4 concentration, comprising both ensuing primary hypothyroidism and a raised set point of thyroid function, e. g. in the context of psychiatric disease, chronic stress and type 2 allostatic load. Addressing the association between thyroid homeostasis and cardiovascular diseases from a systems perspective could pave the way to new directions of research and a more personalized approach to the treatment of patients with cardiovascular risk.
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Affiliation(s)
- Patrick Müller
- Department for Electrophysiology, Medical Hospital I, Klinikum Vest, Recklinghausen, NRW, Germany
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Metabolic Disorders Research Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, NRW, Germany
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Hattingen, NRW, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Bochum, NRW, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Ruhr University Bochum, Bochum, NRW, Germany
- *Correspondence: Johannes W. Dietrich
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7
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Willy K, Ellermann C, Reinke F, Rath B, Wolfes J, Eckardt L, Doldi F, Wegner FK, Köbe J, Morina N. The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9080257. [PMID: 36005421 PMCID: PMC9409697 DOI: 10.3390/jcdd9080257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 12/13/2022] Open
Abstract
The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the device may impact quality of life of patients concerned considerably. Therefore we aimed at conducting a systematic search and meta-analysis of trials examining the impact of the implantation of cardiac devices, namely implantable cardioverter-defibrillators (ICD), pacemakers and left-ventricular assist devices (LVAD) on quality of life. After pre-registering the trial with the PROSPERO database, we searched Medline, PsycINFO, Web of Science and the Cochrane databases for relevant publications. Study quality was assessed by two independent reviewers using standardized protocols. A total of 37 trials met our inclusion criteria. Of these, 31 trials were cohort trials while 6 trials used a randomized controlled design. We found large pre-post effect sizes for positive associations between quality of life and all types of devices. The effect sizes for LVAD, pacemaker and ICD patients were g = 1.64, g = 1.32 and g = 0.64, respectively. There was a lack of trials examining the effect of implantation on quality of life relative to control conditions. Trials assessing quality of life in patients with cardiac devices are still scarce. Yet, the existing data suggest beneficial effects of cardiac devices on quality of life. We recommend that clinical trials on cardiac devices routinely assess quality of life or other parameters of psychological well-being as a decisive study endpoint. Furthermore, improvements in psychological well-being should influence decisions about implantations of cardiac devices and be part of patient education and may impact shared decision-making.
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Affiliation(s)
- Kevin Willy
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
- Department of Psychology, University of Münster, 48149 Münster, Germany
- Correspondence: ; Tel.: +49-251-83-44949; Fax: +49-251-83-52980
| | - Christian Ellermann
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Reinke
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Felix K. Wegner
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Nexhmedin Morina
- Department of Psychology, University of Münster, 48149 Münster, Germany
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8
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Abstract
BACKGROUND Pain is a common but understudied symptom among patients with heart failure (HF) transported by emergency medical services (EMS). The aims were to determine explanatory factors of a primary complaint of pain and pain severity, and characterize pain among patients with HF transported by EMS. METHODS Data from electronic health records of patients with HF transported by EMS within a midwestern United States county from 2009 to 2017 were analyzed. Descriptive statistics, χ 2 , analysis of variance, and logistic and multiple linear regression analyses were used. RESULTS The sample (N = 4663) was predominantly women (58.1%) with self-reported race as Black (57.7%). The mean age was 64.2 ± 14.3 years. Pain was the primary complaint in 22.2% of the sample, with an average pain score of 6.8 ± 3.1 out of 10. The most common pain complaint was chest pain (68.1%). Factors associated with a primary pain complaint were younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96-0.97), history of myocardial infarction (OR, 1.96; 95% CI, 1.55-2.49), and absence of shortness of breath (OR, 0.67; 95% CI, 0.58-0.77). Factors associated with higher pain severity were younger age ( b = -0.05, SE = 0.013), being a woman ( b = 1.17, SE = 0.357), and White race ( b = -1.11, SE = 0.349). CONCLUSIONS Clinical and demographic factors need consideration in understanding pain in HF during EMS transport. Additional research is needed to examine these factors to improve pain management and reduce transports due to pain.
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9
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OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 21:677-686. [DOI: 10.1093/eurjcn/zvab135] [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: 01/13/2021] [Revised: 06/24/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
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Gajjela H, Kela I, Kakarala CL, Hassan M, Belavadi R, Gudigopuram SVR, Raguthu CC, Modi S, Sange I. Milestones in Heart Failure: How Far We Have Come and How Far We Have Left to Go. Cureus 2021; 13:e20359. [PMID: 35028235 PMCID: PMC8751580 DOI: 10.7759/cureus.20359] [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] [Accepted: 12/11/2021] [Indexed: 12/20/2022] Open
Abstract
Heart failure is a clinically complex syndrome that results due to the failure of the ventricles to function as pump and oxygenate end organs. The repercussions of inadequate perfusion are seen in the form of sympathetic overactivation and third spacing, leading to clinical signs of increased blood pressure, dyspnea, fatigue, palpitations, etc. This article provided a brief overview of the clinical syndrome of heart failure; its epidemiology, risk factors, symptoms, and staging; and the mechanisms involved in disease progression. This article also described several landmark trials in heart failure that tested the efficacy of first-line drugs such as beta-blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and the latest drugs in the field of heart failure: angiotensin receptor neprilysin inhibitors. Most studies described in this article were guideline-setting trials that revolutionized the practice of medicine and cardiology.
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Affiliation(s)
- Harini Gajjela
- Research, Our Lady of Fatima University College of Medicine, Valenzuela, PHL
| | - Iljena Kela
- Family Medicine, Jagiellonian University Medical College, Krakow, POL
| | - Chandra L Kakarala
- Internal Medicine, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, IND
| | - Mohammad Hassan
- Internal Medicine, Mohiuddin Islamic Medical College, Mirpur, PAK
| | - Rishab Belavadi
- Surgery, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, IND
| | | | | | - Srimy Modi
- Research, K. J. Somaiya Medical College, Mumbai, IND
| | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Research, K. J. Somaiya Medical College, Mumbai, IND
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Jankauskas SS, Kansakar U, Varzideh F, Wilson S, Mone P, Lombardi A, Gambardella J, Santulli G. Heart failure in diabetes. Metabolism 2021; 125:154910. [PMID: 34627874 PMCID: PMC8941799 DOI: 10.1016/j.metabol.2021.154910] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
Heart failure and cardiovascular disorders represent the leading cause of death in diabetic patients. Here we present a systematic review of the main mechanisms underlying the development of diabetic cardiomyopathy. We also provide an excursus on the relative contribution of cardiomyocytes, fibroblasts, endothelial and smooth muscle cells to the pathophysiology of heart failure in diabetes. After having described the preclinical tools currently available to dissect the mechanisms of this complex disease, we conclude with a section on the most recent updates of the literature on clinical management.
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Affiliation(s)
- Stanislovas S Jankauskas
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Urna Kansakar
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Fahimeh Varzideh
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Scott Wilson
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Pasquale Mone
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Angela Lombardi
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Jessica Gambardella
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA; International Translational Research and Medical Education (ITME), Department of Advanced Biomedical Science, "Federico II" University, 80131 Naples, Italy
| | - Gaetano Santulli
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA; International Translational Research and Medical Education (ITME), Department of Advanced Biomedical Science, "Federico II" University, 80131 Naples, Italy.
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12
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Alansari W, Mohammed A, Aljohani R, Bakhashwain S, Manlangit JJS, Al-Husayni F, Anajreah N, Almehmadi F, Zagzoog A, AlQubbany A. The Quality of Life in Patients With Implantable Cardiac Devices: A Single-Center Cross-Sectional Study. Cureus 2021; 13:e18542. [PMID: 34765337 PMCID: PMC8575321 DOI: 10.7759/cureus.18542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/05/2022] Open
Abstract
Background Cardiovascular diseases (CVDs) and their complications are one of the most common causes of death worldwide. Implantable cardiac assistive devices (CADs) play a significant role in preventing dreadful outcomes, and the complication rate of these implanting procedures is minimal. These cardiac devices require some adaptation and could affect the patients' quality of life psychosocially and financially. This study is aimed to identify the impact of implantable cardiac assistive devices on patients' quality of life in the National Guard Hospital, Jeddah, Saudi Arabia. Methods This is an observational cross-sectional questionnaire-based study. It was conducted on patients who underwent cardiac assistive device implantation in National Guard Hospital. The patients were interviewed face-to-face and were requested to fill the Implanted Device Adjustment Scale (IDAS). Descriptive statistics were carried out. Chi-square test for independence was conducted to examine the associations between qualitative variables with the level of significance was taken as p-value <0.05. Results There was a statistically significant association between IDAS score and gender (p=0.03), monthly income (p=0.009), and type of cardiac implantation device (p=0.041). Females with an implantable cardiac defibrillator (ICD) and individuals with low socioeconomic status reported alongside divorced participants have higher IDAS scores, which correlates to worse adjustment. However, most of our patients scored 21-50 in IDAS score, which indicates a mild psychosocial effect after the cardiac assistive device implantation. Conclusion This study confirmed that most individuals adjust positively to implanted devices. It showed a significant association of gender, type of device, monthly income, and duration. Attention must be drawn to females and divorced patients in regards to psychological and emotional support.
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Affiliation(s)
- Wasna Alansari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Asmaa Mohammed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rahaf Aljohani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Shahad Bakhashwain
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Juan Jr S Manlangit
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Faisal Al-Husayni
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU.,Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Nesreen Anajreah
- Nursing, King Faisal Cardiac Center, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Fahad Almehmadi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Amin Zagzoog
- Cardiology, King Faisal Cardiac Center, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Atif AlQubbany
- Cardiology, King Faisal Cardiac Center, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
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13
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Anagnostopoulos I, Kousta M, Kossyvakis C, Lakka E, Paraskevaidis NT, Schizas N, Alexopoulos N, Deftereos S, Giannopoulos G. The prognostic role of late gadolinium enhancement on cardiac magnetic resonance in patients with nonischemic cardiomyopathy and reduced ejection fraction, implanted with cardioverter defibrillators for primary prevention. A systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 63:523-530. [PMID: 34218421 DOI: 10.1007/s10840-021-01027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with arrhythmic events in patients with nonischemic cardiomyopathy (NICM), while others have questioned the role of left ventricular ejection fraction (LVEF) as a sole predictor of future events. OBJECTIVES To evaluate the role of LGE on CMR in identifying patients with NICM and reduced LVEF for whom a benefit from defibrillator implantation for primary prevention is not anticipated, thus they are mainly exposed to potential risks. METHODS Major electronic databases were searched for studies reporting the incidence of appropriate device therapy (ADT), sudden cardiac death (SCD), and cardiac death based on the presence of LGE on CMR, among patients with NICM and reduced LVEF, implanted with a cardioverter defibrillator for primary prevention. RESULTS Eleven studies (1652 patients, 947 with LGE) were included in the final analysis. LGE presence was strongly associated with ADT (logOR: 1.95, 95%CI: 1.21-2.69) and cardiac death (logOR: 0.91, 95%CI: 0.14-1.68), but not with SCD (logOR: 0.26, 95%CI: -1.09-1.6). Diagnostic accuracy analysis demonstrated that contrast enhancement is a sensitive marker of future ADT and cardiac death (93%, 95%CI: 85.8-96.7%; 82.9%, 95%CI: 70.6-90.7%; respectively), with moderate specificity ( 44%, 95%CI: 27.2-62.6%; 37.7%, 95%CI: 23.4-54.6%; respectively). CONCLUSION LGE is a highly sensitive predictor of ADT and cardiac death in NICM patients implanted with a defibrillator for primary prevention. However, due to moderate specificity, derivation of a cutoff with adequate predictive values and probably a multifactorial approach are needed to improve discrimination of patients who will not benefit from ICDs.
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Affiliation(s)
- Ioannis Anagnostopoulos
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece.
| | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
| | - Charalampos Kossyvakis
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
| | - Eleni Lakka
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
| | | | - Nikolaos Schizas
- Department of Cardiothoracic Surgery, Evangelismos Hospital, Athens, Greece
| | | | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Giannopoulos
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
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14
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Abstract
Despite constant breakthroughs in heart failure (HF) therapy, the population of HF patients resume to grow and is linked to increased mortality and morbidity. Ventricular arrhythmias (VA) are one of the leading causes of mortality in HF subjects. Implantable cardioverter-defibrillators (ICDs) are currently the gold standard in treatment, preventing arrhythmic sudden cardiac death (SCD) episodes. However, the death rates related to HF remain elevated, as not all HF subjects benefit equally. Cardiac resynchronization therapy (CRT) has emerged as a novel approach for HF patients. These devices have been thoroughly investigated in major randomized controlled studies but continue to be underutilized in various countries. This review discusses the use of ICD
in HF populations on top of treatments.
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15
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Karamichalakis N, Ikonomidis I, Parissis J, Simitsis P, Filippatos G. Association of ventricular-arterial interaction with the response to cardiac resynchronization therapy. Eur J Heart Fail 2021; 23:1238-1240. [PMID: 33837617 DOI: 10.1002/ejhf.2186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Ignatios Ikonomidis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
| | - John Parissis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
| | - Panagiotis Simitsis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
| | - Gerasimos Filippatos
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
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16
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Abi-Gerges N, Miller PE, Ghetti A. Human Heart Cardiomyocytes in Drug Discovery and Research: New Opportunities in Translational Sciences. Curr Pharm Biotechnol 2019; 21:787-806. [PMID: 31820682 DOI: 10.2174/1389201021666191210142023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/14/2019] [Accepted: 10/28/2019] [Indexed: 12/28/2022]
Abstract
In preclinical drug development, accurate prediction of drug effects on the human heart is critically important, whether in the context of cardiovascular safety or for the purpose of modulating cardiac function to treat heart disease. Current strategies have significant limitations, whereby, cardiotoxic drugs can escape detection or potential life-saving therapies are abandoned due to false positive toxicity signals. Thus, new and more reliable translational approaches are urgently needed to help accelerate the rate of new therapy development. Renewed efforts in the recovery of human donor hearts for research and in cardiomyocyte isolation methods, are providing new opportunities for preclinical studies in adult primary cardiomyocytes. These cells exhibit the native physiological and pharmacological properties, overcoming the limitations presented by artificial cellular models, animal models and have great potential for providing an excellent tool for preclinical drug testing. Adult human primary cardiomyocytes have already shown utility in assessing drug-induced cardiotoxicity risk and helping in the identification of new treatments for cardiac diseases, such as heart failure and atrial fibrillation. Finally, strategies with actionable decision-making trees that rely on data derived from adult human primary cardiomyocytes will provide the holistic insights necessary to accurately predict human heart effects of drugs.
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Affiliation(s)
- Najah Abi-Gerges
- AnaBios Corporation, 3030 Bunker Hill St., Suite 312, San Diego, CA 92109, United States
| | - Paul E Miller
- AnaBios Corporation, 3030 Bunker Hill St., Suite 312, San Diego, CA 92109, United States
| | - Andre Ghetti
- AnaBios Corporation, 3030 Bunker Hill St., Suite 312, San Diego, CA 92109, United States
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