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Graham FJ, Iaconelli A, Sonecki P, Campbell RT, Hunter D, Cleland JGF, Pellicori P. Defining Heart Failure Based on Imaging the Heart and Beyond. Card Fail Rev 2023; 9:e10. [PMID: 37427007 PMCID: PMC10326661 DOI: 10.15420/cfr.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/19/2023] [Indexed: 07/11/2023] Open
Abstract
Water and salt retention, in other words congestion, are fundamental to the pathophysiology of heart failure and are important therapeutic targets. Echocardiography is the key tool with which to assess cardiac structure and function in the initial diagnostic workup of patients with suspected heart failure and is essential for guiding treatment and stratifying risk. Ultrasound can also be used to identify and quantify congestion in the great veins, kidneys and lungs. More advanced imaging methods might further clarify the aetiology of heart failure and its consequences for the heart and periphery, thereby improving the efficiency and quality of care tailored with greater precision to individual patient need.
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Affiliation(s)
- Fraser J Graham
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - Antonio Iaconelli
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | | | - Ross T Campbell
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - David Hunter
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - John GF Cleland
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
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2
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Rossignol P, Silva-Cardoso J, Kosiborod MN, Brandenburg, Cleland JG, Hadimeri H, Hullin R, Makela S, Mörtl D, Paoletti E, Pollock C, Vogt L, Jadoul M, Butler J. Pragmatic Diagnostic and Therapeutic Algorithms to Optimize New Potassium Binder use in Cardiorenal Disease. Pharmacol Res 2022; 182:106277. [PMID: 35662631 DOI: 10.1016/j.phrs.2022.106277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pivotal randomized trials demonstrating efficacy, safety and good tolerance, of two new potassium binders (patiromer and sodium zirconium cyclosilicate) led to their recent approval. A major hurdle to the implementation of these potassium-binders is understanding how to integrate them safely and effectively into the long-term management of cardiovascular and kidney disease patients using renin angiotensin aldosterone system inhibitors (RAASi), the latter being prone to induce hyperkalaemia. METHODS a multidisciplinary academic panel including nephrologists and cardiologists was convened to develop consensus therapeutic algorithm(s) aimed at optimizing the use of the two novel potassium binders (patiromer and sodium zirconium cyclosilicate) in stable adults who require treatment with RAASi and experience(d) hyperkalaemia in a non-emergent setting. RESULTS Two dedicated pragmatic algorithms are proposed. The lowest intervention threshold (i.e. 5.1mmol/L or greater) was the one used in the patiromer and sodium zirconium cyclosilicate) pivotal trials, both drugs being indicated to treat hyperkalaemia in a non -emergent setting. Acknowledging the heterogeneity across specialty guidelines in hyperkalaemia definition and thresholds to intervene when facing hyperkalaemia, we have been mindful to use soft language i.e. "it is to consider", not necessarily "to do". CONCLUSIONS Providing the clinical community with pragmatic algorithms may help optimize the management of high-risk patients by avoiding the risks of both hyper and hypokalaemia and of suboptimal RAASi therapy.
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Affiliation(s)
- P Rossignol
- Université de Lorraine, INSERM CIC Plurithématique 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France.
| | - J Silva-Cardoso
- Heart Failure and Transplant Clinic, Cardiology Service, São João University Hospital Centre, Faculty of Medicine, University of Porto, CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - M N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri; The George Institute for Global Health, and University of New South Wales, Sydney, New South Wales, Australia
| | - Brandenburg
- Department of Cardiology and Nephrology, Rhein-Maas Klinikum, Würselen, Germany
| | - J G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow & National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - H Hadimeri
- Department of Nephrology, Skaraborgs sjukhus, Skövde, Sweden
| | - R Hullin
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Suisse
| | - S Makela
- Department of Internal Medicine, Kidney Unit, Tampere University Hospital, Tampere, Finland
| | - D Mörtl
- Department of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - E Paoletti
- Nephrology, Dialysis, and Transplantation, Policlinico San Martino, Genova, Italy
| | - C Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - L Vogt
- Department of Internal Medicine, section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - M Jadoul
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium;; Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - J Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
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3
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Ho FK, Ferguson LD, Celis-Morales CA, Gray SR, Forrest E, Alazawi W, Gill JMR, Katikireddi SV, Cleland JGF, Welsh P, Pell JP, Sattar N. Association of gamma-glutamyltransferase levels with total mortality, liver-related and cardiovascular outcomes: A prospective cohort study in the UK Biobank. EClinicalMedicine 2022; 48:101435. [PMID: 35706481 PMCID: PMC9112033 DOI: 10.1016/j.eclinm.2022.101435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Gamma-glutamyltransferase (GGT) levels in the blood can be a sensitive marker of liver injury but the extent to which they give insight into risk across multiple outcomes in a clinically useful way remains uncertain. METHODS Using data from 293,667 UK Biobank participants, the relationship of GGT concentrations to self-reported alcohol intake and adiposity markers were investigated. We next investigated whether GGT predicted liver-related, cardiovascular (CV) or all-cause mortality, and potentially improved CV risk prediction. FINDINGS Higher alcohol intake and greater waist circumference (WC) were associated with higher GGT; the association was stronger for alcohol with evidence of a synergistic effect of WC. Higher GGT concentrations were associated with multiple outcomes. Compared to a GGT of 14.5 U/L (lowest decile), values of 48 U/L for women and 60 U/L for men (common upper limits of 'normal') had hazard ratios (HRs) for liver-related mortality of 1.83 (95% CI 1.60-2.11) and 3.25 (95% CI 2.38-4.42) respectively, for CV mortality of 1.21 (95% CI 1.14-1.28) and 1.43 (95% CI 1.27-1.60) and for all-cause mortality of 1.15 (95% CI 1.12-1.18) and 1.31 (95% CI 1.24-1.38). Adding GGT to a risk algorithm for CV mortality reclassified an additional 1.24% (95% CI 0.14-2.34) of participants across a binary 5% 10-year risk threshold. INTERPRETATION Our study suggests that a modest elevation in GGT levels should trigger a discussion with the individual to review diet and lifestyle including alcohol intake and consideration of formal liver disease and CV risk assessment if not previously done. FUNDING British Heart Foundation Centre of Research Excellence Grant (grant number RE/18/6/34217), NHS Research Scotland (grant number SCAF/15/02), the Medical Research Council (grant number MC_UU_00022/2); and the Scottish Government Chief Scientist Office (grant number SPHSU17).
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Affiliation(s)
- Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lyn D Ferguson
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Carlos A Celis-Morales
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Ewan Forrest
- Gastroenterology Unit, Glasgow Royal Infirmary and University of Glasgow, Glasgow, UK
| | - William Alazawi
- Blizard Institute – Faculty of Medicine and Dentistry, Queen Mary University of London, UK
| | - Jason MR Gill
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | | | - John GF Cleland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
- Corresponding author.
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4
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Borlaug BA, Blair J, Bergmann MW, Bugger H, Burkhoff D, Bruch L, Celermajer DS, Claggett B, Cleland JGF, Cutlip DE, Dauber I, Eicher JC, Gao Q, Gorter TM, Gustafsson F, Hayward C, van der Heyden J, Hasenfuß G, Hummel SL, Kaye DM, Komtebedde J, Massaro JM, Mazurek JA, McKenzie S, Mehta SR, Petrie MC, Post MC, Nair A, Rieth A, Silvestry FE, Solomon SD, Trochu JN, Van Veldhuisen DJ, Westenfeld R, Leon MB, Shah SJ. Latent Pulmonary Vascular Disease May Alter the Response to Therapeutic Atrial Shunt Device in Heart Failure. Circulation 2022; 145:1592-1604. [PMID: 35354306 PMCID: PMC9133195 DOI: 10.1161/circulationaha.122.059486] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND In REDUCE LAP-HF II (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients With Heart Failure), implantation of an atrial shunt device did not provide overall clinical benefit for patients with heart failure with preserved or mildly reduced ejection fraction. However, prespecified analyses identified differences in response in subgroups defined by pulmonary artery systolic pressure during submaximal exercise, right atrial volume, and sex. Shunt implantation reduces left atrial pressures but increases pulmonary blood flow, which may be poorly tolerated in patients with pulmonary vascular disease (PVD). On the basis of these results, we hypothesized that patients with latent PVD, defined as elevated pulmonary vascular resistance during exercise, might be harmed by shunt implantation, and conversely that patients without PVD might benefit. METHODS REDUCE LAP-HF II enrolled 626 patients with heart failure, ejection fraction ≥40%, exercise pulmonary capillary wedge pressure ≥25 mm Hg, and resting pulmonary vascular resistance <3.5 Wood units who were randomized 1:1 to atrial shunt device or sham control. The primary outcome-a hierarchical composite of cardiovascular death, nonfatal ischemic stroke, recurrent HF events, and change in health status-was analyzed using the win ratio. Latent PVD was defined as pulmonary vascular resistance ≥1.74 Wood units (highest tertile) at peak exercise, measured before randomization. RESULTS Compared with patients without PVD (n=382), those with latent PVD (n=188) were older, had more atrial fibrillation and right heart dysfunction, and were more likely to have elevated left atrial pressure at rest. Shunt treatment was associated with worse outcomes in patients with PVD (win ratio, 0.60 [95% CI, 0.42, 0.86]; P=0.005) and signal of clinical benefit in patients without PVD (win ratio, 1.31 [95% CI, 1.02, 1.68]; P=0.038). Patients with larger right atrial volumes and men had worse outcomes with the device and both groups were more likely to have pacemakers, heart failure with mildly reduced ejection fraction, and increased left atrial volume. For patients without latent PVD or pacemaker (n=313; 50% of randomized patients), shunt treatment resulted in more robust signal of clinical benefit (win ratio, 1.51 [95% CI, 1.14, 2.00]; P=0.004). CONCLUSIONS In patients with heart failure with preserved or mildly reduced ejection fraction, the presence of latent PVD uncovered by invasive hemodynamic exercise testing identifies patients who may worsen with atrial shunt therapy, whereas those without latent PVD may benefit.
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Affiliation(s)
- Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Dan Burkhoff
- Cardiovascular Research Foundation, New York NY, USA
| | | | | | | | - John GF Cleland
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, Glasgow, and National Heart & Lung Institute, Imperial College London, United Kingdom
| | | | - Ira Dauber
- South Denver Cardiology Associates/Centura Health. Denver, CO, USA
| | | | - Qi Gao
- Baim Clinical Research Institute, Boston, MA
| | - Thomas M. Gorter
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Finn Gustafsson
- Rigshospitalet, University ofCopenhagen, Copenhagen, Denmark
| | | | | | - Gerd Hasenfuß
- Heart Center, University Medical Center, Göttingen, Germany
| | - Scott L Hummel
- University of Michigan, Ann Harbor, MI and VA Ann Arbor Health System, Ann Arbor, MI
| | | | | | | | | | | | - Shamir R. Mehta
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | - Marco C. Post
- Departments of Cardiology, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, The Netherlands
| | | | - Andreas Rieth
- Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany
| | | | | | - Jean-Noël Trochu
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
| | - Dirk J. Van Veldhuisen
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
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5
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Pellicori P, McConnachie A, Carlin C, Wales A, Cleland JGF. Predicting mortality after hospitalisation for COPD using electronic health records. Pharmacol Res 2022; 179:106199. [DOI: 10.1016/j.phrs.2022.106199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
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6
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Zhang J, Pellicori P, Schutte R, Cleland JG. The association between blood groups and COVID-19 infection: a study from the UK Biobank. J Intern Med 2021; 289:747-748. [PMID: 33306225 DOI: 10.1111/joim.13226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- J Zhang
- School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - P Pellicori
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - R Schutte
- Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - J G Cleland
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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7
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Shi C, van der Wal HH, Silljé HHW, Dokter MM, van den Berg F, Huizinga L, Vriesema M, Post J, Anker SD, Cleland JG, Ng LL, Samani NJ, Dickstein K, Zannad F, Lang CC, van Haelst PL, Gietema JA, Metra M, Ameri P, Canepa M, van Veldhuisen DJ, Voors AA, de Boer RA. Tumour biomarkers: association with heart failure outcomes. J Intern Med 2020; 288:207-218. [PMID: 32372544 PMCID: PMC7496322 DOI: 10.1111/joim.13053] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is increasing recognition that heart failure (HF) and cancer are conditions with a number of shared characteristics. OBJECTIVES To explore the association between tumour biomarkers and HF outcomes. METHODS In 2,079 patients of BIOSTAT-CHF cohort, we measured six established tumour biomarkers: CA125, CA15-3, CA19-9, CEA, CYFRA 21-1 and AFP. RESULTS During a median follow-up of 21 months, 555 (27%) patients reached the primary end-point of all-cause mortality. CA125, CYFRA 21-1, CEA and CA19-9 levels were positively correlated with NT-proBNP quartiles (all P < 0.001, P for trend < 0.001) and were, respectively, associated with a hazard ratio of 1.17 (95% CI 1.12-1.23; P < 0.0001), 1.45 (95% CI 1.30-1.61; P < 0.0001), 1.19 (95% CI 1.09-1.30; P = 0.006) and 1.10 (95% CI 1.05-1.16; P < 0.001) for all-cause mortality after correction for BIOSTAT risk model (age, BUN, NT-proBNP, haemoglobin and beta blocker). All tumour biomarkers (except AFP) had significant associations with secondary end-points (composite of all-cause mortality and HF hospitalization, HF hospitalization, cardiovascular (CV) mortality and non-CV mortality). ROC curves showed the AUC of CYFRA 21-1 (0.64) had a noninferior AUC compared with NT-proBNP (0.68) for all-cause mortality (P = 0.08). A combination of CYFRA 21-1 and NT-proBNP (AUC = 0.71) improved the predictive value of the model for all-cause mortality (P = 0.0002 compared with NT-proBNP). CONCLUSIONS Several established tumour biomarkers showed independent associations with indices of severity of HF and independent prognostic value for HF outcomes. This demonstrates that pathophysiological pathways sensed by these tumour biomarkers are also dysregulated in HF.
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Affiliation(s)
- C Shi
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H H van der Wal
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H H W Silljé
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M M Dokter
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - F van den Berg
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - L Huizinga
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Vriesema
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Post
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S D Anker
- Department of Cardiology, Berlin-Brandenburg Center for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) Partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J G Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK.,Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - L L Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - N J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - K Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - F Zannad
- Clinical Investigation Center 1433, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - C C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - P L van Haelst
- F. Hoffmann-La Roche Ltd. Diagnostics Division, Basel, Switzerland
| | - J A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - P Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - D J van Veldhuisen
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A A Voors
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R A de Boer
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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8
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Conrad N, Judge A, Canoy D, Cleland JG, McMurray JJV, Rahimi K. 6129Temporal trends and patterns in cause-specific mortality and hospitalisations after incident heart failure: a longitudinal analysis of 86,000 individuals. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The past two decades have brought considerable improvements in heart failure care. Clinical trials have demonstrated effectiveness of several different treatments in reducing mortality and hospitalisations, and observational studies have shown that these treatments are increasingly being used in many countries. Little is known about whether these changes have been reflected in patient outcomes in routine clinical settings.
Methods
We used anonymised electronic health records that link information from primary care, secondary care, and the national death registry to investigate 86,000 individuals with newly diagnosed heart failure between 2002 and 2013 in the UK. We computed all-cause and cause-specific mortality rates and number of hospitalisations in the first year following diagnosis. We used Poisson regression models to calculate category-specific rate ratios and 95% confidence intervals, adjusting for patients' age, sex, region, socioeconomic status and 17 major comorbidities.
Findings
One year after initial heart failure diagnosis, all-cause mortality rates were high (32%) and did not change significantly over the period of study (adjusted rate ratio (RR) 2013 vs 2002: 0.94 [0.88, 1]). Overall rates masked diverging trends in cause-specific outcomes: a decline in cardiovascular mortality (RR: 0.74 [0.68, 0.81]) was offset by an increase in non-cardiovascular mortality (RR: 1.28 [1.17, 1.39]), largely due to infections and chronic respiratory conditions. Sub-group analyses further showed that overall mortality declined among patients under 80 years of age (RR 2013 vs 2002: 0.79 [0.71, 0.88]), although not in older age groups (RR 2013 vs 2002: 0.97 [0.9, 1.06]). After cardiovascular causes (43%), the major causes of death identified in 2013 were neoplasms (15%), respiratory conditions (12%), and infections (11%). Hospital admissions within a year of heart failure diagnosis were common (1.15 hospitalisations per patient-year at risk), changed little over time (RR: 0.96 [0.92, 0.99]), and were largely (60%) due to non-cardiovascular causes.
Interpretation
Despite increased use of life-saving interventions, overall mortality and hospitalisations following a new diagnosis of heart failure have changed little over the past decade. Improved prognosis among young and middle-aged patients marks an important achievement and attests of complex barriers to progress in elderly patients. The shift from cardiovascular to non-cardiovascular causes of death suggest that management of associated comorbidities might offer additional opportunities to improve patients' prognosis.
Acknowledgement/Funding
British Heart Foundation, National Institute for Health Research, UK Research and Innovation.
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Affiliation(s)
- N Conrad
- University of Oxford, Oxford, United Kingdom
| | - A Judge
- University of Oxford, Oxford, United Kingdom
| | - D Canoy
- University of Oxford, Oxford, United Kingdom
| | - J G Cleland
- University of Glasgow, Glasgow, United Kingdom
| | | | - K Rahimi
- University of Oxford, Oxford, United Kingdom
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9
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Affiliation(s)
- Rienzi Diaz-Navarro
- Universidad de Valparaiso; Department of Internal Medicine, School of Medicine; Vina del Mar Chile
| | - Gerard Urrútia
- CIBER Epidemiología y Salud Pública (CIBERESP); Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret, 167 Pavilion 18 (D-53) Barcelona Catalonia Spain 08025
| | - John GF Cleland
- Imperial College London; National Heart and Lung Institute; London UK
| | - Daniel Poloni
- Universidad de Valparaiso; Department of Internal Medicine, School of Medicine; Vina del Mar Chile
| | - Francisco Villagran
- Universidad de Valparaiso; Department of Internal Medicine, School of Medicine; Vina del Mar Chile
| | - Shrikant Bangdiwala
- Collaborative Studies Coordinating Center; Department of Biostatistics, Gillings School of Global Public Health; Suite 203, Bank of America Center 137 E. Franklin Street Chapel Hill North Carolina USA 27514-4145
| | - Gabriel Rada
- Pontificia Universidad Católica de Chile; Department of Internal Medicine and Evidence-Based Healthcare Program, Faculty of Medicine; Lira 44, Decanato Primer piso Santiago Chile
| | - Eva Madrid
- Cochrane Centre School of Medicine Universidad de Valparaiso; Interdisciplinary Centre for Health Studies CIESAL; Viña del Mar Chile
- Universidad de Valparaiso; Chilean Cochrane Centre; Valparaiso Chile
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10
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Koo K, Ferguson C, Ling LH, Cleland JGF, Inglis SC. Implantable device monitoring versus usual care for managing individuals with heart failure. Hippokratia 2019. [DOI: 10.1002/14651858.cd013401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kevin Koo
- University of Technology Sydney; Faculty of Health; Sydney Australia
| | - Caleb Ferguson
- Western Sydney University & Western Sydney Local Health District; Western Sydney Nursing Research Centre; Sydney Australia
| | - Liang-Han Ling
- Alfred Hospital; Cardiology Department; 55 Commercial Road Melbourne Australia
| | - John GF Cleland
- Imperial College London; National Heart and Lung Institute; London UK
| | - Sally C Inglis
- University of Technology Sydney; Faculty of Health; Sydney Australia
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11
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Tromp J, Ouwerkerk W, Demissei BG, Anker SD, Cleland JG, Dickstein K, Filippatos G, van der Harst P, Hillege HL, Lang CC, Metra M, Ng LL, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zannad F, Zwinderman AH, Voors AA, van der Meer P. Novel endotypes in heart failure: effects on guideline-directed medical therapy. Eur Heart J 2018; 39:4269-4276. [DOI: 10.1093/eurheartj/ehy712] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/14/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- J Tromp
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
- National Heart Centre Singapore, 5 Hospital Drive, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore
| | - W Ouwerkerk
- National Heart Centre Singapore, 5 Hospital Drive, Singapore
- Department of Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, Amsterdam, Meibergdreef 9, AZ, The Netherlands
| | - B G Demissei
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - S D Anker
- Division of Cardiology and Metabolism—Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK); Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Charitépl. 1 Berlin, Germany
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), DZHK (German Center for Cardiovascular Research), Robert-Koch-Straße 40, Göttingen, Germany
| | - J G Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, Sydney St, Chelsea, London, UK
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, UK
| | - K Dickstein
- University of Bergen, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, Stavanger, Norway
| | - G Filippatos
- School of Medicine, Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon, National and Kapodistrian University of Athens, 1, Rimini Str, Haidari, Athens Greece
| | - P van der Harst
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - H L Hillege
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - C C Lang
- Division of Molecular & Clinical Medicine, University of Dundee, Dundee, UK
| | - M Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Piazza del Mercato, 15, Brescia, Italy
| | - L L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, UK
| | - P Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Rudolfa Weigla 5, Wroclaw, Poland
- Cardiology Department, Military Hospital, Rudolfa Weigla, Wroclaw, Poland
| | - N J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, UK
| | - D J van Veldhuisen
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - F Zannad
- CHU de Nancy, Inserm CIC 1433, Université de Lorrain, CHRU de Nancy, F-CRIN INI-CRCT Nancy, France
| | - A H Zwinderman
- Department of Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, Amsterdam, Meibergdreef 9, AZ, The Netherlands
| | - A A Voors
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - P van der Meer
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
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Cosmi D, Shen L, Magnoli M, Abrahm WT, Anand IS, Cleland JG, Cohn JN, De Berardis G, Maggioni AP, Masson S, Nicolucci A, Staszewsky L, Tognoni G, Cosmi F, Latini R. 3381Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Cosmi
- Gubbio/Gualdo Tadino Hospital, Cardiology, Gubbio, Italy
| | - L Shen
- University of Glasgow, Glasgow, United Kingdom
| | - M Magnoli
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - W T Abrahm
- Davis Heart & Lung Research Institute, Columbus, United States of America
| | - I S Anand
- University of Minnesota, Minneapolis, United States of America
| | - J G Cleland
- University of Glasgow, Glasgow, United Kingdom
| | - J N Cohn
- University of Minnesota, Minneapolis, United States of America
| | - G De Berardis
- Center for Outcomes Research and clinical Epidemiology srl, Pescara, Italy
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - S Masson
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - A Nicolucci
- Center for Outcomes Research and clinical Epidemiology srl, Pescara, Italy
| | - L Staszewsky
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - G Tognoni
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - F Cosmi
- Santa Margherita La Fratta Hospital, Cortona, Italy
| | - R Latini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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13
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Lota AS, Wassall R, Scott AD, Gatehouse PD, Wage R, Smith G, Tayal U, Halliday BP, Ware JS, Firmin D, Cook SA, Cleland JG, Pennell DJ, Prasad. SK. 027 T2 mapping in acute and recovered myocarditis: potential role in clinical surveillance. Heart 2017. [DOI: 10.1136/heartjnl-2017-311399.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Halliday BP, Gulati A, Ali A, Guha K, Newsome S, Arzanausikaite M, Vassiliou VS, Lota A, Tayal U, Khalique Z, Izgi C, Alpendurada F, Cleland JGF, Pennell DJ, Prasad SK. 002 Sudden cardiac death risk stratification in patients with mild dilated cardiomyopathy. Heart 2017. [DOI: 10.1136/heartjnl-2017-311399.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Salvi D, Ottaviano M, Muuraiskangas S, Martínez-Romero A, Vera-Muñoz C, Triantafyllidis A, Cabrera Umpiérrez MF, Arredondo Waldmeyer MT, Skobel E, Knackstedt C, Liedes H, Honka A, Luprano J, Cleland JGF, Stut W, Deighan C. An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise. J Telemed Telecare 2017; 24:303-316. [DOI: 10.1177/1357633x17697501] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease. However, their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies. We developed a mobile health system designed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring, guidance, motivational feedback, and educational content. Methods Our multi-disciplinary approach is based on mapping “desired behaviours” into specific system’s specifications, borrowing concepts from Fogg’s Persuasive Systems Design principles. A randomised controlled trial was conducted to compare mobile-based rehabilitation (55 patients) versus standard care (63 patients). Results Some technical issues related to connectivity, usability and exercise sessions interrupted by safety algorithms affected the trial. For those who completed the rehabilitation (19 of 55), results show high levels of both user acceptance and perceived usefulness. Adherence in terms of started exercise sessions was high, but not in terms of total time of performed exercise or drop-outs. Educational level about heart-related health improved more in the intervention group than the control. Exercise habits at 6 months follow-up also improved, although without statistical significance. Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits, but further studies would be needed to confirm these indications.
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Affiliation(s)
- Dario Salvi
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Biongeniería, Universidad Politécnica de Madrid, Madrid, Spain
| | - Manuel Ottaviano
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Biongeniería, Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | - Cecilia Vera-Muñoz
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Biongeniería, Universidad Politécnica de Madrid, Madrid, Spain
| | - Andreas Triantafyllidis
- Laboratory of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Fernanda Cabrera Umpiérrez
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Biongeniería, Universidad Politécnica de Madrid, Madrid, Spain
| | - Maria Teresa Arredondo Waldmeyer
- Life Supporting Technologies, Departamento de Tecnología Fotónica y Biongeniería, Universidad Politécnica de Madrid, Madrid, Spain
| | - Erik Skobel
- Clinic for Cardiac and Pulmonary Rehabilitation, Rosenquelle, Aachen, Germany
| | - Christian Knackstedt
- Department of Cardiology, RWTH Aachen University, Aachen, Germany
- Maastricht University Medical Centre, Dept. of Cardiology, Maastricht, The Netherlands
| | - Hilkka Liedes
- VTT Technical Research Centre of Finland Ltd, Tampere, Finland
| | - Anita Honka
- VTT Technical Research Centre of Finland Ltd, Tampere, Finland
| | - Jean Luprano
- Centre Suisse d’Electronique et de Microtechnique SA, Neuchatel, Switzerland
| | | | - Wim Stut
- Philips Research, Eindhoven, The Netherlands
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Cleland JGF, Freemantle N, Eastaugh J, Young PJ, Harrison J, Heran BS, Taylor RS. Beta-blockers for heart failure. Hippokratia 2016. [DOI: 10.1002/14651858.cd002131.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- John GF Cleland
- Imperial College London; National Heart and Lung Institute; London UK
| | - Nick Freemantle
- University of Birmingham; Department of Primary Care and General Practice; Edgbaston Birmingham UK BI5 2TT
| | - Joanne Eastaugh
- University of York; Medicines Evaluation Group, Centre for Health; Heslington York UK YO10 5DD
| | - Phillip J Young
- University of York; Health Sciences and Clinical Evaluation; Alcuin College HESLINGTON York Yorkshire UK YO10 5DD
| | - Jane Harrison
- University of York; Medicines Evaluation Group, Centre for Health; Heslington York UK YO10 5DD
| | - Balraj S Heran
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
| | - Rod S Taylor
- University of Exeter Medical School; Institute of Health Research; Exeter UK EX2 4SG
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17
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Cleland JGF, Freemantle N, Eastaugh J, Young PJ, Mason J, Harrison J. Beta-blockers for myocardial infarction. Hippokratia 2016. [DOI: 10.1002/14651858.cd002129.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- John GF Cleland
- Imperial College London; National Heart and Lung Institute; London UK
| | - Nick Freemantle
- University of Birmingham; Department of Primary Care and General Practice; Edgbaston Birmingham UK BI5 2TT
| | - Joanne Eastaugh
- University of York; Medicines Evaluation Group, Centre for Health; Heslington York UK YO10 5DD
| | - Phillip J Young
- University of York; Health Sciences and Clinical Evaluation; Alcuin College HESLINGTON York Yorkshire UK YO10 5DD
| | - James Mason
- University of Warwick; Warwick Medical School - Health Sciences; Gibbet Hill Campus Coventry UK CV4 7AL
| | - Jane Harrison
- University of York; Medicines Evaluation Group, Centre for Health; Heslington York UK YO10 5DD
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18
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Pellicori P, Joseph AC, Zhang J, Lukaschuk E, Sherwi N, Bourantas CV, Loh H, Clark AL, Cleland JGF. The relationship of QRS morphology with cardiac structure and function in patients with heart failure. Clin Res Cardiol 2015; 104:935-45. [DOI: 10.1007/s00392-015-0861-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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19
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Dierckx R, Cleland JGF, Pellicori P, Zhang J, Goode K, Putzu P, Boyalla V, Clark AL. If home telemonitoring reduces mortality in heart failure, is this just due to better guideline-based treatment? J Telemed Telecare 2015; 21:331-9. [DOI: 10.1177/1357633x15574947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/02/2015] [Indexed: 11/17/2022]
Abstract
To investigate, in a ‘real-world’ setting, the impact of home telemonitoring (HTM) compared to usual care on achieved dose of guideline-recommended medication, hospitalisation rate and mortality in patients with heart failure (HF). Methods: We retrospectively analyzed data on 333 patients with HF referred to a HTM service supported by a nurse-specialist (mean age 71±12 years, mean left ventricular ejection fraction (LVEF) 36 ± 11% and median N-Terminal pro B-type Natriuretic Peptide (NT-proBNP) 2,972 ng/L (interquartile range (IQR): 1,447–7,801 ng/L)). Most patients (n = 278) accepted HTM (HTM-group) but 55 refused and received usual care (UC-group). In the HTM-group, weight, heart rate, blood pressure and symptom severity were measured daily. Results: At referral, respectively 90%, 90%, 67% and 94% of patients with LVEF ≤40% (n = 229) were treated with β-blockers (BB), angiotensin converting enzyme-inhibitors (ACE-I) or angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA) and diuretics, with rates similar between groups. After 6 months, prescription of BB (92% vs 83%), ACE-I/ARB (92% vs 90%) and MRA (68% vs 67%) did not differ significantly between groups. The proportions of patients who achieved ≥50% and ≥100% of target doses of BB, ACE-I/ARB and MRA were also similar in each group. However, during a median follow-up of 1094 days (IQR 767–1419) fewer patients who chose HTM died (33% vs 49%; P = 0.002). Conclusion: Patients who choose HTM have a better prognosis than those who do not but this does not appear to be mediated through greater prescription of key HF medications.
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Affiliation(s)
- Riet Dierckx
- Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull
| | - John GF Cleland
- National Heart & Lung Institute and National Institute of Health Research, Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London
| | - Pierpaolo Pellicori
- Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull
| | - Jufen Zhang
- Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull
| | - Kevin Goode
- Faculty of Health and Social Care, University of Hull, Kingston-upon-Hull
| | - Paola Putzu
- Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull
| | - Vennela Boyalla
- Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull
| | - Andrew L Clark
- Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull
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Hutchinson K, Pellicori P, Dierckx R, Cleland JGF, Clark AL. Remote telemonitoring for patients with heart failure: might monitoring pulmonary artery pressure become routine? Expert Rev Cardiovasc Ther 2014; 12:1025-33. [DOI: 10.1586/14779072.2014.935340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fazlalizadeh H, Pellicori P, Kazmi S, Zhang J, Clark A, Saveliych B, Warden J, Byass T, Henderson C, Freeman R, Cleland JGF. 45 Role of Natriuretic Peptides in Screening of Cardiac Dysfunction in Older Patients with Type-2 Dibetes Mellitus. A Report from Sica-diabetes Study (FP7/2007–2013/241558). Heart 2014. [DOI: 10.1136/heartjnl-2014-306118.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Summary In this study retrospective data from the 1975 Pakistan Fertility Survey are used to examine the effects of birth spacing on infant and child mortality. The length of the preceding interval between live births emerges as a major determinant of mortality. The effect persists for rural and urban families, for children of uneducated and educated mothers, for both boys and girls, and for large and small families. The possibility that this relationship is the spurious consequence of data defects or of a common cause, such as early weaning, is examined but rejected. Once the length of the preceding interval is controlled, the average spacing of earlier births is found to be unrelated to survivorship. However, the length of the succeeding interval is significantly related to survivorship during the second year of life.
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Keshavarzi F, Hoye A, Clark AL, Oliver R, Cleland JG, Alamgir F. 079 “MitraClip, a summit well worth reaching for”. Outcome of transcatheter mitral valve clip for the management of mitral regurgitation in high risk group patients unsuitable for surgical intervention. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mathur G, Karalis D, Clark AL, Cleland JG. Abstract P359: Both High and Low Total Cholesterol Levels Are Associated With Poor Prognosis in Patients With Left Ventricular Systolic Dysfunction. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_1.ap359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM
To assess the influence of total cholesterol level on prognosis in patients with left ventricular systolic dysfunction (LVSD).
METHODS
Patients presenting to a HF clinic (2000-2006) were screened. Those with LVSD were divided into 3 groups based on tertiles of total cholesterol level. All-cause mortality data was used for Kaplan-Meier curve and Cox regression analysis to assess the prognostic significance of total cholesterol level in these patients.
RESULTS
Of 2901 patients screened, 1342 had some degree of LVSD on echocardiogram, classified as mild (EF=41-50%; N = 478), moderate (EF=31-40%; N = 513), and severe (EF≤30%; N = 351). Median age was 72 (interquartile range 65-78) yrs, 71% (952 of 1342) were men. Mean follow-up was 37.6 months, during which 340 deaths occurred. Kaplan-Meier curves were generated for the 3 groups based on tertiles of serum cholesterol level (cut-off points 162 and 197 mg/dL) (Figure 1). Patients in the lower and upper tertiles had similar prognosis, which was significantly worse than the middle tertile (log rank=0.004). On multivariate analysis, age (p=0.001), ischemic etiology (p=0.003), NYHA class (p=0.001) and total cholesterol levels below 162 and above 197 mg/dL (p = 0.026) were independent predictors of poor prognosis in patients with LVSD. Though the 3 cholesterol groups were evenly matched for NYHA Class and severity of LVSD, NT pro-BNP levels were significantly higher in the lowest tertile group (p=0.005).
CONCLUSION
In patients with LVSD, both high and low cholesterol levels are associated with poor prognosis. Low cholesterol may be a marker of severity of disease and cardiac cachexia in patients with LVSD, accounting for their poor prognosis.
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Affiliation(s)
| | | | - AL Clark
- Univ of Hull, Hull, United Kingdom
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25
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Bourantas CV, Nikitin NP, Loh HP, Lukaschuk EI, Sherwi N, de Silva R, Tweddel AC, Alamgir MF, Wong K, Gupta S, Clark AL, Cleland JGF. Prevalence of scarred and dysfunctional myocardium in patients with heart failure of ischaemic origin: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2011; 13:53. [PMID: 21936915 PMCID: PMC3190338 DOI: 10.1186/1532-429x-13-53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 09/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can provide unique data on the transmural extent of scar/viability. We assessed the prevalence of dysfunctional myocardium, including partial thickness scar, which could contribute to left ventricular contractile dysfunction in patients with heart failure and ischaemic heart disease who denied angina symptoms. METHODS We invited patients with ischaemic heart disease and a left ventricular ejection fraction < 50% by echocardiography to have LGE CMR. Myocardial contractility and transmural extent of scar were assessed using a 17-segment model. RESULTS The median age of the 193 patients enrolled was 70 (interquartile range: 63-76) years and 167 (87%) were men. Of 3281 myocardial segments assessed, 1759 (54%) were dysfunctional, of which 581 (33%) showed no scar, 623 (35%) had scar affecting ≤50% of wall thickness and 555 (32%) had scar affecting > 50% of wall thickness. Of 1522 segments with normal contractile function, only 98 (6%) had evidence of scar on CMR. Overall, 182 (94%) patients had ≥1 and 107 (55%) patients had ≥5 segments with contractile dysfunction that had no scar or ≤50% transmural scar suggesting viability. CONCLUSIONS In this cohort of patients with left ventricular systolic dysfunction and ischaemic heart disease, about half of all segments had contractile dysfunction but only one third of these had > 50% of the wall thickness affected by scar, suggesting that most dysfunctional segments could improve in response to an appropriate intervention.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Nikolay P Nikitin
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Huan P Loh
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Elena I Lukaschuk
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Nassar Sherwi
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Ramesh de Silva
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Ann C Tweddel
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Mohamed F Alamgir
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Kenneth Wong
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Sanjay Gupta
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
| | - John GF Cleland
- Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK
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Cleland JG, Buga L, Ghosh J, Nasir M. Applying evidence-based device care in cardiovascular patients: which patient with heart failure and what device? J R Coll Physicians Edinb 2011; 40:229-39. [PMID: 21127768 DOI: 10.4997/jrcpe.2010.311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In terms of engineering, clinical understanding and application, device therapy remains in its infancy. In clinical trials, implantable cardiac defibrillators (ICDs) have greatly reduced the rate of sudden death and had a modest impact on mortality in a relatively broad range of patients. They do not generally improve symptoms and may make them worse. Cardiac resynchronisation therapy (CRT) devices have been used more selectively - probably far too selectively - and have shown substantial improvement in symptoms and a large reduction in mortality both by reducing sudden death and death due to heart failure. These effects are not explained solely by improved ventricular function, and the clinical response to therapy has so far not been predicted well by any method of assessing cardiac function or dyssynchrony. Reduction in brady-arrhythmia-triggered sudden death may be an underestimated benefit of biventricular pacing. In recent trials, heart failure patients implanted with a device have had a remarkably low mortality. This forces the clinical community to contemplate universal device use for patients with heart failure, except in those who have irremediable, life-limiting, non-cardiac disease. For most patients this should be CRT or a combination of CRT and an ICD (CRT-D).
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Affiliation(s)
- J G Cleland
- Hull and York Medical School, Kingston upon Hull, UK.
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Cleland JGF. Long-term aspirin for coronary artery disease: are we being deceived by a biased presentation of the evidence? Future Cardiol 2010; 6:141-6. [DOI: 10.2217/fca.10.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- John GF Cleland
- Department of Cardiology, Castle Hill Hospital, Hull and York Medical School, University of Hull, Kingston-upon-Hull, HU6 5JQ, UK
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Abstract
Over recent years, telehealth has increasingly demonstrated its value in supporting the delivery of cardiovascular healthcare. From teletriage services as a portal into healthcare through to telemonitoring of heart failure patients, technology is already increasing the ability of practitioners to provide care remotely, empower patients and improve clinical outcomes. In the future, telehealth services have the potential to have an even greater impact on the provision of cardiovascular care. Embedding telehealth services into mainstream cardiac care, the development of more sophisticated devices and the utilisation of technology in a wider range of clinical contexts will help to accelerate the adoption of telehealth throughout healthcare. This article evaluates the current state of the art in telehealth provision and explores some of the areas for future development in this fast-moving and exciting area of clinical practice.
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Verheugt FW, Becker RC, Bertrand ME, Bode C, Chesebro JH, Cleland JG, Conti R, Hillis WS, Klein W, Maseri A, Turpie AG, Wallentin L, Waters DD. Management strategies in unstable coronary artery disease--current problems and future directions. The UCAD Council. Clin Cardiol 2009; 22:551-3. [PMID: 10486693 PMCID: PMC6655658 DOI: 10.1002/clc.4960220903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Unstable coronary artery disease continues to pose a major challenge to clinicians. The advent of new therapies, such as percutaneous transluminal coronary angioplasty, low-molecular-weight heparins, and glycoprotein IIb/IIIa inhibitors, provides new management options for this indication but also raises new questions with regard to optimal management. Prospective randomized trials with well-defined, long-term outcome measures and a means of identifying which patients will derive most benefit from each treatment, together with a means of rapid and clear dissemination of study results and implications, are required in order to advance the management of unstable coronary artery disease.
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Affiliation(s)
- F W Verheugt
- Department of Cardiology, Academic Hospital Nijmegen St Radboud, The Netherlands
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Bourantas CV, Loh HP, de Silva R, Lukaschuk E, Nicoslon T, Eadington D, Thackray S, Thackray AC, Clark AL, Nikitin NP, Cleland JGF. 157 Renal artery stenosis: independent predictor of increased mortality in patients with heart failure. A Magnetic Resonance Imaging study. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bourantas CV, Loh HP, de Silva R, Witte K, Lukaschuk EI, Nicoslon T, Thackray S, Tweddel AC, Clark AL, Nikitin NP, Cleland JGF. 2065 Prevalence and prognostic signficance of atherosclerotic disease of the aorta and its side branches in patients with chronic heart failure. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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33
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Cleland JGF. The Central Role of the Kidney in the Pathogenesis of Heart Failure. J Card Fail 2008. [DOI: 10.1016/j.cardfail.2008.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shelton RJ, Goode K, Cleland JG. Natriuretic peptides in patients with atrial fibrillation and advanced chronic heart failure: determinants and prognostic value of (NT-)ANP and (NT-pro) BNP. Europace 2007; 9:147; author reply 148. [PMID: 17227813 DOI: 10.1093/europace/eul147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cleland JGF, Kubanek M, Goode K. Prognostic Significance of NTproBNP in Patients with a Clinical Diagnosis of Heart Failure and Preserved Left Ventricular Systolic Function. Eur Cardiol 2007. [DOI: 10.15420/ecr.2007.0.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Cleland JGF. Papel de los ARA-II en el tratamiento de la insuficiencia cardiaca: ¿qué dicen las guías de práctica clínica? Rev Esp Cardiol 2006. [DOI: 10.1157/13092035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Seymour AL, Sample J, Cleland JGF. Decrease in fatty acid oxidation increases tolerance of the ageing heart to ischaemic injury. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jessica Sample
- Biological SciencesUniversity of HullCottingham RoadHullHU6 7RXUnited Kingdom
| | - John GF Cleland
- Academic Dept of CardiologyUniversity of HullCastle Hill HospitalCottinghamHullHU16 5JQUnited Kingdom
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Abstract
Chronic heart failure is characterised by excess adrenergic activity that augurs a poor prognosis. The reasons for increased adrenergic activity are complex and incompletely understood. The circumstantial evidence relating increased activity to adverse outcome is powerful, but not yet conclusive. In normal subjects, autonomic control of the circulation is predominantly under the control of sympatho-inhibitory inputs from the arterial and cardiopulmonary baroreceptors, with a small input from the excitatory ergo- and chemo-receptors. In heart failure, the situation is reversed, with loss of the restraining input from the baroreceptors and an increase in the excitatory inputs, resulting in excessive adrenergic activity. The circumstantial evidence linking neuroendocrine activation with poor outcome coupled with the clinical success of inhibition of the renin-angiotensin-aldosterone system has long suggested that inhibition of adrenergic activity might be beneficial in heart failure. There is a number of potential ways of achieving this. Improved treatment of heart failure itself may reduce sympathetic drive. There is an interplay between angiotensin II, aldosterone and the sympathetic nervous system, and thus RAAS antagonists, such as angiotensin converting enzyme inhibitors and spironolactone could directly reduce sympathetic activation. Exercise rehabilitation may similarly reduce sympathetic activity.Recently, beta-adrenergic receptor antagonists have been conclusively shown to improve symptoms, reduce hospitalisations and increase survival. However, the demonstration that central reduction of sympathetic activity with agents such as moxonidine increases morbidity and mortality suggests that we do not properly understand the role of sympathetic activation in the pathophysiology of heart failure.
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Affiliation(s)
- A L Clark
- Department of Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull, HU16 5JQ
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Cleland JG, Baksh A, Louis A. Polypharmacy (or polytherapy) in the treatment of heart failure. Heart Fail Monit 2003; 1:8-13. [PMID: 12634876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
There is now conclusive evidence that most patients with heart failure due to left ventricular systolic dysfunction should be treated with angiotensin converting enzyme (ACE) inhibitors and beta-blockers. They will also need diuretics for the control of fluid retention. There is also a powerful case for adding spironolactone to the treatment of patients with more severe symptoms. Many doctors would also use digoxin and, especially if coronary disease is present, aspirin or warfarin. Most patients also have other chronic diseases, such as diabetes, arthritis, depression and dyspepsia, and each of these may provoke the prescription of yet another agent. Many patients will receive prescriptions to treat the side-effects of their therapy. Finding a sure path through the morass of pharmacotherapy is a daunting task. Polypharmacy is having a negative impact on new drug research in an area where there are in fact remarkably few really effective treatments and the therapeutic problem is only partially solved. This paper discusses some of the issues surrounding polypharmacy in heart failure and how to resolve them, using an illustrative case history. It highlights the potential benefits of polypharmacy with effective drugs and the gross over-use of ineffective treatments in heart failure. The major problem with polypharmacy in heart failure is not the heart failure treatment itself, but the drugs for other concomitant conditions, the effectiveness of which is often not supported by an appropriate evidence base and for which alternative, less noxious management strategies often exist. Polypharmacy may be deleterious not only because of the increased potential for side-effects and drug interactions but also because taking unnecessary therapy reduces compliance with effective drugs.
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Affiliation(s)
- J G Cleland
- Department of Cardiology, University of Hull, UK
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41
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Ali MM, Babiker AG, Cleland JG. Analysis of failure time hierarchical data in the presence of competing risks with application to oral contraceptive pill use in Egypt. Stat Med 2001; 20:3611-24. [PMID: 11746341 DOI: 10.1002/sim.1090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Problems of practical interest in the analysis of data on contraceptive use, from Demographic and Health Surveys (DHS), include the estimation of the cause-specific probability of discontinuation by time t (the cumulative incidence function), in the presence of other competing causes and the evaluation of the effect of covariates on the cause-specific hazards of discontinuation. Methods of analysis of failure time data with competing risks are by now fairly well developed in the case of a simple random sample. However, the data from the DHS are clustered by geographical areas and include multiple episodes per woman. For a marginal (population average) approach, we propose using methods developed for simple random samples with standard errors calculated using a double bootstrap to take account of the clustered hierarchical nature of the data. In the conditional approach, the cause-specific hazards are modelled as log-linear functions of the covariates conditional on random effects of clusters and women, using a three-level multinomial discrete-time logit model. The methods are applied to data from Egypt 1992 DHS on the oral contraceptive pill use.
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Affiliation(s)
- M M Ali
- Centre for Population Studies, London School of Hygiene & Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, UK.
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42
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Coletta AP, Cleland JG. Clinical trials update: highlights of the scientific sessions of the XXIII Congress of the European Society of Cardiology--WARIS II, ESCAMI, PAFAC, RITZ-1 and TIME. Eur J Heart Fail 2001; 3:747-50. [PMID: 11738228 DOI: 10.1016/s1388-9842(01)00210-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article continues a series of reports updating recent research developments of particular interest to personnel involved in the treatment and management of patients with heart failure. This is a summary of selected presentations made at the Scientific Sessions of the XXIII Annual Congress of the European Society of Cardiology. Summaries of the following clinical studies are included: WARIS-II, ESCAMI, PAFAC, RITZ-I and TIME.
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Affiliation(s)
- A P Coletta
- Department of Academic Cardiology, Castle Hill Hospital, Cottingham, HU16 5JQ, Kingston upon Hull, UK
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Cleland JG. ACE inhibitors for 'diastolic' heart failure? reasons not to jump to premature conclusions about the efficacy of ACE inhibitors among older patients with heart failure. Eur J Heart Fail 2001; 3:637-9. [PMID: 11738214 DOI: 10.1016/s1388-9842(01)00211-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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McGowan JH, Martin W, Burgess MI, McCurrach G, Ray SG, McDonagh TA, Cleland JG. Validation of an echocardiographic wall motion index in heart failure due to ischaemic heart disease. Eur J Heart Fail 2001; 3:731-7. [PMID: 11738226 DOI: 10.1016/s1388-9842(01)00199-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS The echocardiographic assessment of left ventricular ejection fraction (LVEF) by geometric methods is limited in many patients because of inadequate views and also in the presence of regional wall motion abnormalities due to ischaemic heart disease (IHD). This study aimed to examine the application of a wall motion index (WMI) method, using a nine-segment LV model in patients with chronic heart failure (CHF) due to IHD. METHODS AND RESULTS Echocardiography was performed in 71 consecutive subjects with CHF due to IHD. WMI could be derived in 70 subjects (99%). The inter-observer variability (repeatability coefficient) of WMI was 0.66, i.e. LVEF+/-20%. In 66 subjects, LVEF was measured, within 4 weeks, using radionuclide ventriculography (RNV-EF). The inter-observer variability of RNV-EF was +/-3.1%. Using the mean of two observations for each method, the Bland-Altman range of agreement for LVEF was 26% (+/-13%). CONCLUSION WMI is a widely applicable echocardiographic method for assessing LV systolic function and has moderate agreement with RNV-EF. Unlike RNV-EF, however, WMI is not likely to be a suitable method for the measurement of small, but prognostically important, changes in LV function that may occur in CHF.
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Affiliation(s)
- J H McGowan
- Department of Medical and Nuclear Cardiology, Glasgow Royal Infirmary, G31 2ER, Glasgow, UK.
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45
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Affiliation(s)
- P J Cowburn
- Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton, Hants, UK
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46
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Cleland JG, Thygesen K, Uretsky BF, Armstrong P, Horowitz JD, Massie B, Packer M, Poole-Wilson PA, Rydén L. Cardiovascular critical event pathways for the progression of heart failure; a report from the ATLAS study. Eur Heart J 2001; 22:1601-12. [PMID: 11492990 DOI: 10.1053/euhj.2000.2570] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS To determine the sequence of critical cardiovascular events in the progression of heart failure, and whether aetiology or high-dose vs low-dose lisinopril affected these pathways. METHODS AND RESULTS This was a post-hoc investigation of the ATLAS database, which comprised 3164 patients with chronic heart failure, randomized to low- (2.5-5.0 mg. day(-1)) or high-dose (32.5-35.0 mg. day(-1)) lisinopril, followed up for a median of 46 months. Two-thirds (64.3%) of patients had heart failure attributed to ischaemic heart disease. During the study, most patients (61.1%) had at least one cardiovascular hospitalization and 42.5% of all patients died: most deaths (88.2%) were cardiovascular. Nearly half (49.7%) of the cardiovascular deaths were considered sudden and 45.2% of cardiovascular deaths occurred as the first cardiovascular event. A third (30.2%) of deaths resulted from heart failure and were generally preceded by hospitalization, either for heart failure (85.5%), myocardial ischaemic events (21.7%) or arrhythmias (18.0%). Compared with low-dose, high-dose lisinopril was associated with a lower risk of death or hospitalization for any reason (P=0.002) and death or hospitalization with worsening heart failure (P<0.001). High-dose lisinopril delayed the time to all-cause mortality and hospitalization for chronic heart failure by 7.1 months. CONCLUSIONS Vascular and arrhythmic events may not only be important precipitants of sudden death, but were also seen to contribute to the progression of heart failure. A reduction in vascular events, as well as benefits on ventricular remodelling, could account for the decrease in death or hospitalization with high-dose lisinopril.
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Affiliation(s)
- J G Cleland
- Department of Cardiology, Castle Hill Hospital, Castle Road, University of Hull, Kingston upon Hull, HU16 5JQ, U.K
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47
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Cleland JG, John J, Houghton T. Does aspirin attenuate the effect of angiotensin-converting enzyme inhibitors in hypertension or heart failure? Curr Opin Nephrol Hypertens 2001; 10:625-31. [PMID: 11496056 DOI: 10.1097/00041552-200109000-00012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a wealth of data that suggests an important interaction between aspirin and angiotensin-converting enzyme inhibitors in patients with chronic stable cardiovascular disease. The interaction is less obvious in the postinfarction setting, possibly reflecting the fact that many patients stop their aspirin therapy within a few months of such an event. An interaction is biologically plausible, because there is considerable evidence that angiotensin-converting enzyme inhibitors exert important effects through increasing the production of vasodilator prostaglandins, whereas aspirin blocks their production through inhibition of cyclooxygenase, even at low doses. There is some evidence that low-dose aspirin may raise systolic and diastolic blood pressure. There is also considerable evidence that aspirin may entirely neutralize the clinical benefits of angiotensin-converting enzyme inhibitors in patients with heart failure. In addition, aspirin may have an adverse effect on outcome in patients with heart failure that is independent of any interaction with angiotensin-converting enzyme inhibitors, possibly by blocking endogenous vasodilator prostaglandin production and enhancing the vasoconstrictor potential of endothelin. The evidence is not sufficient to justify advising long-term aspirin therapy for patients with cardiovascular disease in general, and for those with heart failure in particular. Thus, the lack of evidence of benefit with aspirin in patients with heart failure and coronary disease, along with growing evidence that aspirin is directly harmful in patients with heart failure and that aspirin may negate the benefits of angiotensin-converting enzyme inhibitors suggest that, unless there is an opportunity to randomize the patient into a study of antithrombotic strategies, then aspirin should be withdrawn or possibly substituted with an anticoagulant or an antiplatelet agent that does not block cyclooxygenase. In contrast, there is fairly robust evidence for a benefit of both aspirin and angiotensin-converting enzyme inhibitors during the first 5 weeks after a myocardial infarction, with little evidence of an interaction. The combination of aspirin and angiotensin-converting enzyme inhibitors is warranted during this period, after which discontinuation or substitution of aspirin with another agent should be considered.
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Affiliation(s)
- J G Cleland
- Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston upon Hull, UK.
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Abstract
Whether the link, found in Benin, between postnatal abstinence and husbands' extramarital contacts can be generalized to other West African countries is assessed in this study. Data from the 1994 Demographic and Health Survey, Côte d'Ivoire, obtained from monogamous husbands concerning their extramarital sexual behavior in the two months preceding the survey were linked to data reported by wives concerning postnatal abstinence over the same time period. Logistic regression was applied to assess the link between these two factors, net of the effects of possible confounders. A significant effect of postnatal abstinence on the probability that the husband reported at least one extramarital partner was found. Unprotected extramarital sex was two times more common among men who observed conjugal abstinence than it was among other men. Other predictors of extramarital sex were urban-rural residence, region, education, and whether or not husband and wife had the same religious affiliation. Because condom use is low in this population, the protective effect of marital abstinence is offset by an increased probability that husbands will seek extramarital partners during the postpartum period. The results confirm the earlier findings for Benin and can likely be generalized to most of West Africa.
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Affiliation(s)
- M M Ali
- London School of Hygiene & Tropical Medicine, Department of Epidemiology and Population Health, 49-51 Bedford Square, London WC1B3DP
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49
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Dare OO, Oladepo O, Cleland JG, Badru OB. Reproductive health needs of young persons in markets and motor parks in south west Nigeria. Afr J Med Med Sci 2001; 30:199-205. [PMID: 14510129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The aim of the study was to assess the reproductive health needs of out-of-school males and females aged 12-26 years working in markets and motor parks in Ibadan using Focus Group Discussions (FGD) and a survey questionnaire. Result revealed that sexual experience was higher among males (80%) compared to females (66%). Multiple concurrent sexual partnerships were found to be common among unmarried young men (71%) than women (51%) but means to prevent pregnancy or sexually transmitted disease (STD) were rarely employed. The knowledge of HIV was high (70%) though very few (12%) were aware that an infected individual would remain asymtomatic. Moreover, 36.5% thought that condoms make sex less enjoyable. Between 6 and 9% used a method for disease prevention within marriage or regular partnerships compared to 16% in casual contacts. Despite high exposure to risk, the prevalence of STDs was low as only 4% of the sexually experienced males and 9% of females were infected with Candida Albicans, Chlamydia trachomatis and Trichomonas vaginitis or Neisseria gonorrhea. The ready availability of antibiotics may account for this apparent discrepancy. These findings suggest that out of school adolescents working in motor parks needs sexuality education and counseling backed up with clinical services.
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Affiliation(s)
- O O Dare
- Center Health Sciences Training, Research and Development, 29, Aare Avenue, New Bodjia Estate, U.I.P.O. Box 21633, Ibadan, Nigeria
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Louis A, Cleland JG, Crabbe S, Ford S, Thackray S, Houghton T, Clark A. Clinical Trials Update: CAPRICORN, COPERNICUS, MIRACLE, STAF, RITZ-2, RECOVER and RENAISSANCE and cachexia and cholesterol in heart failure. Highlights of the Scientific Sessions of the American College of Cardiology, 2001. Eur J Heart Fail 2001; 3:381-7. [PMID: 11378012 DOI: 10.1016/s1388-9842(01)00149-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This is a synopsis of presentations made at the American College of Cardiology (ACC) in 2001 summarising recent research developments relating to heart failure. Clinical studies of particular interest to physicians with an interest in heart failure and its prevention are reviewed. The COPERNICUS trial lends further support to the use of the beta-blocker, carvedilol, in severe heart failure and the CAPRICORN trial to its use in patients with post-infarction left ventricular systolic dysfunction. The MIRACLE study reinforces the evidence from three smaller trials that cardiac resynchronisation therapy is an effective treatment for the relief of symptoms in patients with severe heart failure and cardiac dyssynchrony. The STAF trial casts further doubt on the wisdom of cardioversion as a routine strategy for the management of chronic atrial fibrillation. The RITZ-2 trial suggests that an intravenous, non-selective endothelin antagonist is effective in improving haemodynamics and symptoms and possibly in reducing morbidity in severe heart failure. Observational studies in heart failure suggest that a moderate excess of body fat and elevated blood cholesterol may be desirable in patients with heart failure, challenging the current non-evidenced-based vogue for cholesterol lowering therapy in heart failure. The RENAISSANCE and RECOVER outcome studies of etanercept, a tumour necrosis factor (TNF) receptor analogue that blocks the effect of TNF, were stopped because of lack of evidence of benefit shortly after the ACC.
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Affiliation(s)
- A Louis
- Academic Unit of Cardiology, University of Hull, School of Medicine, Castle Hill Hospital, HU 16 5JQ, Kingston Upon Hull, UK
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