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Stevenson LW, Montgomery JA. Seeking More Time with Synchrony. N Engl J Med 2024; 390:269-270. [PMID: 38231629 DOI: 10.1056/nejme2312419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
| | - Jay A Montgomery
- From the Division of Cardiology, Vanderbilt University Medical Center, Nashville
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2
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Bozkurt B, Ahmad T, Alexander KM, Baker WL, Bosak K, Breathett K, Fonarow GC, Heidenreich P, Ho JE, Hsich E, Ibrahim NE, Jones LM, Khan SS, Khazanie P, Koelling T, Krumholz HM, Khush KK, Lee C, Morris AA, Page RL, Pandey A, Piano MR, Stehlik J, Stevenson LW, Teerlink JR, Vaduganathan M, Ziaeian B. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J Card Fail 2023; 29:1412-1451. [PMID: 37797885 PMCID: PMC10864030 DOI: 10.1016/j.cardfail.2023.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Biykem Bozkurt
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine, Houston, Texas.
| | - Tariq Ahmad
- Heart Failure Program Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kevin M Alexander
- Cardiovascular Medicine, Stanford University, Stanford University School of Medicine, Stanford, California
| | | | - Kelly Bosak
- KU Medical Center, School Of Nursing, Kansas City, Kansas
| | - Khadijah Breathett
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | - Paul Heidenreich
- Cardiovascular Medicine, Stanford University, Stanford University School of Medicine, Stanford, California
| | - Jennifer E Ho
- Advanced Heart Failure and Transplant Cardiology, Beth Israel Deaconess, Boston, Massachusetts
| | - Eileen Hsich
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Nasrien E Ibrahim
- Advanced Heart Failure and Transplant, Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Lenette M Jones
- Department of Health Behavior and Biological Sciences, University of Michigan, School of Nursing, Ann Arbor, Michigan
| | - Sadiya S Khan
- Northwestern University, Cardiology Feinberg School of Medicine, Chicago, Illinois
| | - Prateeti Khazanie
- Advanced Heart Failure and Transplant Cardiology, UC Health, Aurora, Colorado
| | - Todd Koelling
- Frankel Cardiovascular Center. University of Michigan, Ann Arbor, Michigan
| | - Harlan M Krumholz
- Heart Failure Program Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kiran K Khush
- Cardiovascular Medicine, Stanford University, Stanford University School of Medicine, Stanford, California
| | - Christopher Lee
- Boston College William F. Connell School of Nursing, Boston, Massachusetts
| | - Alanna A Morris
- Division of Cardiology, Emory School of Medicine, Atlanta, Georgia
| | - Robert L Page
- Departments of Clinical Pharmacy and Physical Medicine, University of Colorado, Aurora, Colorado
| | - Ambarish Pandey
- Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | | | - Josef Stehlik
- Advanced Heart Failure Section, Cardiology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - John R Teerlink
- Cardiology University of California San Francisco (UCSF), San Francisco, California
| | - Muthiah Vaduganathan
- Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Boback Ziaeian
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
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Siddiqi HK, O'Connor C, Stevenson LW. Curation of Heart Failure Shock With Pulmonary Artery Catheters. J Card Fail 2023; 29:1245-1248. [PMID: 37442221 DOI: 10.1016/j.cardfail.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Hasan Khalid Siddiqi
- Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, TN.
| | | | - Lynne Warner Stevenson
- Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, TN
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Brinkley DM, Stevenson LW. Shifting the Shadow of Death. Circ Heart Fail 2023:e010704. [PMID: 37337894 DOI: 10.1161/circheartfailure.123.010704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- D Marshall Brinkley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lynne Warner Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
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Stevenson LW, Ross HJ, Rathman LD, Boehmer JP. Remote Monitoring for Heart Failure Management at Home. J Am Coll Cardiol 2023; 81:2272-2291. [PMID: 37286258 DOI: 10.1016/j.jacc.2023.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/17/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/09/2023]
Abstract
Early telemonitoring of weights and symptoms did not decrease heart failure hospitalizations but helped identify steps toward effective monitoring programs. A signal that is accurate and actionable with response kinetics for early re-assessment is required for the treatment of patients at high risk, while signal specifications differ for surveillance of low-risk patients. Tracking of congestion with cardiac filling pressures or lung water content has shown most impact to decrease hospitalizations, while multiparameter scores from implanted rhythm devices have identified patients at increased risk. Algorithms require better personalization of signal thresholds and interventions. The COVID-19 epidemic accelerated transition to remote care away from clinics, preparing for new digital health care platforms to accommodate multiple technologies and empower patients. Addressing inequities will require bridging the digital divide and the deep gap in access to HF care teams, who will not be replaced by technology but by care teams who can embrace it.
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Affiliation(s)
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Peter Munk Centre, Toronto, Ontario, Canada
| | - Lisa D Rathman
- PENN Medicine Lancaster General Health, Lancaster, Pennsylvania, USA
| | - John P Boehmer
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Saldivar B, El-Harasis M, Laws L, Wright A, Williams HL, Davogustto G, Anderson K, Wells QS, Kannankeril PJ, Stevenson WG, Stevenson LW, Roden DM, Shoemaker MB. SURVEY OF PROVIDER OPINIONS ON GENETIC EVALUATION OF EARLY ONSET ATRIAL FIBRILLATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00598-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 549] [Impact Index Per Article: 274.5] [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: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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8
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol 2022; 79:1757-1780. [DOI: 10.1016/j.jacc.2021.12.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW, Beckman JA, O'Gara PT, Al-Khatib SM, Armbruster AL, Birtcher KK, Cigarroa JE, de las Fuentes L, Deswal A, Dixon DL, Fleisher LA, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark DB, Mukherjee D, Palaniappan LP, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Wijeysundera DN, Woo YJ. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Card Fail 2022; 28:e1-e167. [DOI: 10.1016/j.cardfail.2022.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 636] [Impact Index Per Article: 318.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e876-e894. [PMID: 35363500 DOI: 10.1161/cir.0000000000001062] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [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: 11/16/2022]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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Affiliation(s)
- Lynne Warner Stevenson
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Jordan R H Hoffman
- Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan N Menachem
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Parrinello G, Greene SJ, Torres D, Alderman M, Bonventre JV, Pasquale PD, Gargani L, Nohria A, Fonarow GC, Vaduganathan M, Butler J, Paterna S, Stevenson LW, Gheorghiade M. Editorial Expression of Concern: Water and sodium in heart failure: a spotlight on congestion. Heart Fail Rev 2021; 26:1529. [PMID: 33913077 DOI: 10.1007/s10741-021-10113-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/29/2022]
Affiliation(s)
- Gaspare Parrinello
- Biomedical Department of Internal and Specialty Medicine, (Di.Bi.M.I.S.), A.O.U.P ''Paolo Giaccone'', University of Palermo, Piazza delle Cliniche 2, 90,127, Palermo, Italy.
| | - Stephen J Greene
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Daniele Torres
- Biomedical Department of Internal and Specialty Medicine, (Di.Bi.M.I.S.), A.O.U.P ''Paolo Giaccone'', University of Palermo, Piazza delle Cliniche 2, 90,127, Palermo, Italy
| | - Michael Alderman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, USA
| | | | | | - Luna Gargani
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Muthiah Vaduganathan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Javed Butler
- Division of Cardiology, Emory University, Atlanta, USA
| | - Salvatore Paterna
- Biomedical Department of Internal and Specialty Medicine, (Di.Bi.M.I.S.), A.O.U.P ''Paolo Giaccone'', University of Palermo, Piazza delle Cliniche 2, 90,127, Palermo, Italy
| | - Lynne Warner Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, USA
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Varma N, Bourge RC, Stevenson LW, Costanzo MR, Shavelle D, Adamson PB, Ginn G, Henderson J, Abraham WT. Remote Hemodynamic-Guided Therapy of Patients With Recurrent Heart Failure Following Cardiac Resynchronization Therapy. J Am Heart Assoc 2021; 10:e017619. [PMID: 33626889 PMCID: PMC8174266 DOI: 10.1161/jaha.120.017619] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Patients with recurring heart failure (HF) following cardiac resynchronization therapy fare poorly. Their management is undecided. We tested remote hemodynamic‐guided pharmacotherapy. Methods and Results We evaluated cardiac resynchronization therapy subjects included in the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Class III Heart Failure Patients) trial, which randomized patients with persistent New York Heart Association Class III symptoms and ≥1 HF hospitalization in the previous 12 months to remotely managed pulmonary artery (PA) pressure‐guided management (treatment) or usual HF care (control). Diuretics and/or vasodilators were adjusted conventionally in control and included remote PA pressure information in treatment. Annualized HF hospitalization rates, changes in PA pressures over time (analyzed by area under the curve), changes in medications, and quality of life (Minnesota Living with Heart Failure Questionnaire scores) were assessed. Patients who had cardiac resynchronization therapy (n=190, median implant duration 755 days) at enrollment had poor hemodynamic function (cardiac index 2.00±0.59 L/min per m2), high comorbidity burden (67% had secondary pulmonary hypertension, 61% had estimated glomerular filtration rate <60 mL/min per 1.73 m2), and poor Minnesota Living with Heart Failure Questionnaire scores (57±24). During 18 months randomized follow‐up, HF hospitalizations were 30% lower in treatment (n=91, 62 events, 0.46 events/patient‐year) versus control patients (n=99, 93 events, 0.68 events/patient‐year) (hazard ratio, 0.70; 95% CI, 0.51–0.96; P=0.028). Treatment patients had more medication up‐/down‐titrations (847 versus 346 in control, P<0.001), mean PA pressure reduction (area under the curve −413.2±123.5 versus 60.1±88.0 in control, P=0.002), and quality of life improvement (Minnesota Living with Heart Failure Questionnaire decreased −13.5±23 versus −4.9±24.8 in control, P=0.006). Conclusions Remote hemodynamic‐guided adjustment of medical therapies decreased PA pressures and the burden of HF symptoms and hospitalizations in patients with recurring Class III HF and hospitalizations, beyond the effect of cardiac resynchronization therapy. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00531661.
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Hylind R, Beauséjour-Ladouceur V, Plovanich ME, Helms A, Smith E, Joyce E, Granter S, Stevenson LW, Cirino AL, McDonough BA, Mostaghimi A, Abrams DJ, Lakdawala NK. Cardiocutaneous Features of Autosomal Dominant Desmoplakin-Associated Arrhythmogenic Cardiomyopathy. Circ Genom Precis Med 2020; 13:e003081. [PMID: 33191767 DOI: 10.1161/circgen.120.003081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robyn Hylind
- Inherited Cardiac Arrhythmia Program, Children's Hospital Boston (R.H., V.B.-L., D.J.A.)
| | - Virginie Beauséjour-Ladouceur
- Inherited Cardiac Arrhythmia Program, Children's Hospital Boston (R.H., V.B.-L., D.J.A.).,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Molly Elizabeth Plovanich
- Department of Dermatology (M.E.P., A.M.), Brigham and Women's Hospital.,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Adam Helms
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan Medical Center, Ann Arbor, MI (A.D., E.S.)
| | - Eric Smith
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan Medical Center, Ann Arbor, MI (A.D., E.S.)
| | - Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, Dublin, Ireland (E.J.)
| | - Scott Granter
- Department of Pathology (S.C.), Brigham and Women's Hospital
| | | | - Allison L Cirino
- Department of Cardiovascular Medicine (A.L.C., N.K.L.), Brigham and Women's Hospital
| | - Barbara A McDonough
- Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Arash Mostaghimi
- Department of Dermatology (M.E.P., A.M.), Brigham and Women's Hospital.,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Children's Hospital Boston (R.H., V.B.-L., D.J.A.).,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Neal K Lakdawala
- Department of Cardiovascular Medicine (A.L.C., N.K.L.), Brigham and Women's Hospital.,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
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Snipelisky D, Fudim M, Perez A, Nayor M, Lever NM, Raymer DS, Rosenbaum AN, AbouEzzeddine O, Hernandez AF, Stevenson LW, Gilstrap LG. Expected vs Actual Outcomes of Elective Initiation of Inotropic Therapy During Heart Failure Hospitalization. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2020; 4:529-536. [PMID: 33083701 PMCID: PMC7557209 DOI: 10.1016/j.mayocpiqo.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To describe the intent and early outcomes of elective inotrope use during heart failure hospitalization. Patients and Methods A prospective multisite design was used to collect data for hemodynamically stable patients started electively on inotrope therapy between January 1 and August 31, 2018. We prospectively recorded data when intravenous inotropic therapy was initiated, including survey of the attending cardiologists regarding expectations for the clinical course. Patients were followed up for events through hospital discharge and an additional survey was administered at the end of hospitalization. Results For the 92 patients enrolled, average age was 60 years and ejection fraction was 24%±12%. At the time of inotrope initiation, attending heart failure cardiologists predicted that 50% (n=46) of the patients had a “high or very high” likelihood of becoming dependent on intravenous inotropic therapy and 58% (n=53) had a “high” likelihood of death, transplant, or durable ventricular assist device placement within the next 6 months. Provider predictions regarding death/hospice or need for continued home infusions were accurate only 51% (47 of 92) of the time. Only half the patients (n=47) had goals-of-care conversations before inotrope treatment initiation. Conclusion More than half the patients (51 of 92) electively started on inotrope treatment without present or imminent cardiogenic shock ultimately required home inotrope therapy, died during admission, or were discharged with hospice. Heart failure clinicians could not reliably identify those patients at the time of inotrope therapy initiation and goals-of-care discussions were not frequently performed.
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Affiliation(s)
- Zachary L Cox
- Lipscomb University College of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Lynne Warner Stevenson
- Advanced Heart Disease, Division of Cardiology, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
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Madelaire C, Gustafsson F, Stevenson LW, Kristensen SL, Køber L, Andersen J, D'Souza M, Biering-Sørensen T, Andersson C, Torp-Pedersen C, Gislason G, Schou M. One-Year Mortality After Intensification of Outpatient Diuretic Therapy. J Am Heart Assoc 2020; 9:e016010. [PMID: 32662300 PMCID: PMC7660734 DOI: 10.1161/jaha.119.016010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 12/11/2022]
Abstract
Background Mortality is increased following a hospitalization for decompensated heart failure (HF), during which diuretics are usually intensified. It is unclear how risk is affected after outpatient intensification of diuretic therapy for HF. Methods and Results From nationwide administrative registers, we identified all Danish patients who were diagnosed with HF from 2001 to 2016 and received angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker and β blocker within 120 days. Subsequent follow‐up tracked progressive events of diuretic intensification and HF hospitalization. Intensification events were defined as new addition or doubling of loop diuretic or addition of thiazide to loop diuretic. These events were included in multivariable Cox regression models, calculating 1‐year mortality hazard after each year since inclusion. Patients with an intensification event or hospitalization were risk set matched to 2 nonworsened HF controls and absolute 1‐year mortality risks were calculated using Kaplan‐Meier estimates. We included 74 990 patients, their median age was 71 years, and 36% were women. Intensification events were associated with significantly increased mortality at all times during follow‐up. One‐year mortality was 18.0% after an intensification event, 22.6% after HF hospitalization, and 10.4% for matched controls with neither. In a multivariable Cox model adjusted for age, sex, ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease, and diabetes mellitus, the hazard ratio for 1‐year death after an intensification event was 1.75 (95% CI, 1.66–1.85), and it was 2.28 (95% CI, 2.16–2.41) after HF hospitalization. Conclusions In a nationwide cohort of patients with HF, outpatient intensification events were associated with almost 2‐fold risk of mortality during the next year. Although HF hospitalization was associated with a higher risk, the need to intensify diuretics in the outpatient setting is a signal to review and intensify efforts to improve HF outcomes.
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Affiliation(s)
- Christian Madelaire
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
| | - Finn Gustafsson
- The Heart Centre Rigshospitalet University of Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Denmark
| | | | | | - Lars Køber
- The Heart Centre Rigshospitalet University of Copenhagen Denmark
| | | | - Maria D'Souza
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
| | - Charlotte Andersson
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark.,Section of Cardiology Department of Medicine Boston Medical Center Boston MA
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research Nordsjaellands Hospital Hilleroed Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Gunnar Gislason
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark.,Danish Heart Foundation Copenhagen Denmark
| | - Morten Schou
- Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark
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Al-Khatib SM, Benjamin EJ, Albert CM, Alonso A, Chauhan C, Chen PS, Curtis AB, Desvigne-Nickens P, Ho JE, Lam CS, Link MS, Patton KK, Redfield MM, Rienstra M, Rosenberg Y, Schnabel R, Spertus JA, Stevenson LW, Hills MT, Voors AA, Cooper LS, Go AS. Advancing Research on the Complex Interrelations Between Atrial Fibrillation and Heart Failure: A Report From a US National Heart, Lung, and Blood Institute Virtual Workshop. Circulation 2020; 141:1915-1926. [PMID: 32511001 PMCID: PMC7291844 DOI: 10.1161/circulationaha.119.045204] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The interrelationships between atrial fibrillation (AF) and heart failure (HF) are complex and poorly understood, yet the number of patients with AF and HF continues to increase worldwide. Thus, there is a need for initiatives that prioritize research on the intersection between AF and HF. This article summarizes the proceedings of a virtual workshop convened by the US National Heart, Lung, and Blood Institute to identify important research opportunities in AF and HF. Key knowledge gaps were reviewed and research priorities were proposed for characterizing the pathophysiological overlap and deleterious interactions between AF and HF; preventing HF in people with AF; preventing AF in individuals with HF; and addressing symptom burden and health status outcomes in AF and HF. These research priorities will hopefully help inform, encourage, and stimulate innovative, cost-efficient, and transformative studies to enhance the outcomes of patients with AF and HF.
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Affiliation(s)
- Sana M. Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710
| | - Emelia J. Benjamin
- Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118
| | - Christine M. Albert
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30307
| | | | - Peng-Sheng Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46278
| | - Anne B. Curtis
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Jennifer E. Ho
- Corrigan Minehan Heart Center, Cardiovascular Research Center and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke-National University of Singapore
| | - Mark S. Link
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390
| | | | | | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Yves Rosenberg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Renate Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck
| | - John A. Spertus
- Cardiovascular Division, Saint Luke’s Mid America Heart Institute/UMKC, Kansas City, MO 64111
| | | | | | - Adriaan A. Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612. Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA 94143. Departments of Medicine, Health Research and Policy, Stanford University, Stanford, CA 94305
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20
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Shah AS, Stevenson LW. The 4 Dimensions of Heart Allocation in an Increasingly Complex Universe. J Am Coll Cardiol 2020; 75:2917-2920. [DOI: 10.1016/j.jacc.2020.04.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
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21
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Stevenson LW, Naftilan AJ. Changing the Stage Directions for Heart Failure? J Am Coll Cardiol 2020. [PMID: 32216912 DOI: 10.3969/j.issn.1674-4055.2020.12.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lynne Warner Stevenson
- Division of Cardiology, Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Allen J Naftilan
- Division of Cardiology, Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
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22
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Madelaire C, Gustafsson F, Kristensen SL, Stevenson LW, Koeber L, Torp-Pedersen C, D'Souza M, Andersen J, Gislason G, Biering-Sorensen T, Andersson C, Schou M. P765One-year mortality risk after intensification of outpatient diuretics. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0365] [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: 11/14/2022] Open
Abstract
Abstract
Background
Mortality is increased following a hospitalization for heart failure (HF). It is not clear whether outpatient intensification of diuretic confers the same increased risk in the general population with heart failure
Purpose
This study sought to assess 1-year mortality risk after worsening HF, defined either as hospitalization due to HF or as intensified diuretic therapy in an outpatient setting, in a complete nationwide cohort of patients with HF on angiotensin converting enzyme inhibitors/ angiotensin receptor blocker and beta blockers.
Methods
From nationwide administrative registers, we identified all patients in Denmark diagnosed with HF in 2001–2016 and prescribed angiotensin converting enzyme inhibitor/ angiotensin receptor blocker and beta blocker within 120 days. During follow-up we defined worsening HF by the following events: Inpatient worsening (HF readmission) and outpatient worsening (intensified diuretic therapy, defined as the first event of new addition or doubled dosage of loop diuretic therapy or new onset addition of thiazide to loop diuretic therapy). Patients with a worsening event were risk set matched to two HF controls each at time of the event – based on age, sex and calendar year. One-year mortality risk was estimated with Kaplan-Meier and multivariable Cox regression models.
Results
We included 74,990 patients, median age 71 years (interquartile range: 62–79), 36% women. During five years of follow up, 8,727 patients had an inpatient worsening event, and 12,290 had an outpatient worsening event as first event. Absolute risk of 1-year mortality was 22.6% (95%-confidence interval (95%-CI): 21.7%-23.5%) after inpatient worsening, 18.0% (95%-CI: 17.3%-18.7%) after outpatient worsening compared to 9.8% (95%-CI: 9.5%-10.1%) for the matched controls. In a multivariable Cox model adjusted ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease and diabetes, the hazard ratio for mortality among patients experiencing inpatient worsening was 2.46 (95%-CI: 2.33–2.60) and for outpatient worsening was 1.87 (95%-CI: 1.77–1.97), compared with the matched HF controls as reference (figure 1). Among patients who had an outpatient worsening as first event, 1,245 (10.1%) had a subsequent HF readmission within one year.
Conclusion
In a nationwide cohort of patients with HF, outpatient worsening defined by a diuretic intensification was associated with almost 2-fold risk of mortality during the next year. Although HF hospitalization is associated with a higher risk, the need to intensify diuretics in the outpatient setting is a signal to review and intensify efforts to improve HF outcomes.
Acknowledgement/Funding
The Danish Heart Foundation, (grant number 17-R116-A7610-22048)
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Affiliation(s)
- C Madelaire
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - L W Stevenson
- Vanderbilt University, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, United States of America
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Department of cardiology, Aalborg, Denmark
| | - M D'Souza
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - J Andersen
- The Danish Heart Foundation, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - C Andersson
- Herlev Hospital, Department of cardiology, Herlev, Denmark
| | - M Schou
- Herlev Hospital, Department of cardiology, Herlev, Denmark
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23
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Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Peterson PN, Reed BN, Roy CL, Storrow AB. 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2019; 74:1966-2011. [PMID: 31526538 DOI: 10.1016/j.jacc.2019.08.001] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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24
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Greenberg B, Fang J, Mehra M, Stevenson LW. Advanced heart failure: Trans-Atlantic perspectives on the Heart Failure Association of the European Society of Cardiology position statement. Eur J Heart Fail 2018; 20:1536-1539. [DOI: 10.1002/ejhf.1313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/03/2018] [Accepted: 08/09/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Barry Greenberg
- Cardiology Department, Sulpizio Family Cardiovascular Center; University of California; San Diego, La Jolla CA USA
| | - James Fang
- Division of Cardiovascular Medicine; University of Utah Health Sciences Center; Salt Lake City UT USA
| | - Mandeep Mehra
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School; Boston MA USA
| | - Lynne Warner Stevenson
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville TN USA
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25
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Affiliation(s)
- Lynne Warner Stevenson
- From the Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (L.W.S.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (R.B.D.).
| | - Roger B Davis
- From the Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (L.W.S.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (R.B.D.)
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27
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O'Gara PT, Grayburn PA, Badhwar V, Afonso LC, Carroll JD, Elmariah S, Kithcart AP, Nishimura RA, Ryan TJ, Schwartz A, Stevenson LW. 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017; 70:2421-2449. [PMID: 29055505 DOI: 10.1016/j.jacc.2017.09.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mitral regurgitation (MR) is a complex valve lesion that can pose significant management challenges for the cardiovascular clinician. This Expert Consensus Document emphasizes that recognition of MR should prompt an assessment of its etiology, mechanism, and severity, as well as indications for treatment. A structured approach to evaluation based on clinical findings, precise echocardiographic imaging, and when necessary, adjunctive testing, can help clarify decision making. Treatment goals include timely intervention by an experienced heart team to prevent left ventricular dysfunction, heart failure, reduced quality of life, and premature death.
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28
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Stevenson LW, Schneiweiss S, Gilstrap L. Propensity to match or mismatch patients and therapies? Eur J Heart Fail 2017; 20:355-358. [DOI: 10.1002/ejhf.983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/21/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | - Lauren Gilstrap
- Cardiovascular Division; Brigham and Women's Hospital; Boston MA USA
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29
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30
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Adamson PB, Abraham WT, Stevenson LW, Desai AS, Lindenfeld J, Bourge RC, Bauman J. Pulmonary Artery Pressure-Guided Heart Failure Management Reduces 30-Day Readmissions. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002600. [PMID: 27220593 DOI: 10.1161/circheartfailure.115.002600] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 10/20/2015] [Accepted: 04/27/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study examines the impact of pulmonary artery pressure-guided heart failure (HF) care on 30-day readmissions in Medicare-eligible patients. METHODS AND RESULTS The CardioMicroelectromechanical system (CardioMEMS) Heart Sensor Allows Monitoring of Pressures to Improve Outcomes in New York Heart Association Class III Heart Failure Patients (CHAMPION) Trial included 550 patients implanted with a permanent MEMS-based pressure sensor in the pulmonary artery. Subjects were randomized to a treatment group (uploaded pressures were made available to investigators) or a control group (uploaded pressures were not made available to investigators). This analysis focuses on the 245 Medicare-eligible subjects for whom compliance with daily transmissions was 93% compared with 88% for the overall population. Medications were changed more often in the treatment group using pressure information compared with the control group using symptoms and daily weights alone. During the 515 days follow-up after implant, the overall rate of HF hospitalizations was 49% lower in the treatment group (60 HF hospitalizations, 0.34 events/patient-year) compared with control (117 HF hospitalizations, 0.67 events/patient-year; hazard ratio 0.51, 95% confidence interval 0.37-0.70; P<0.0001). Of the 177 HF hospitalizations, 155 qualified as an index HF hospitalization. All-cause 30-day readmissions were 58% lower in the treatment group (0.07 events/patient-year) compared with 0.18 events/patient-year in the control group (hazard ratio 0.42, 95% confidence interval 0.22-0.80; P=0.0080). CONCLUSIONS Pulmonary artery pressure-guided HF management in Medicare-eligible patients led to a 49% reduction in total HF hospitalizations and a 58% reduction in all-cause 30-day readmissions. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT00531661.
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Affiliation(s)
- Philip B Adamson
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.).
| | - William T Abraham
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Lynne Warner Stevenson
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Akshay S Desai
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - JoAnn Lindenfeld
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Robert C Bourge
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
| | - Jordan Bauman
- From the St Jude Medical, Inc, Austin, TX (P.B.A., J.B.); Wexner Medical Center, The Ohio State University, Columbus (W.T.A.); Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S., A.S.D.); Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.); and The University of Alabama at Birmingham (R.C.B.)
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Zile MR, Bennett TD, El Hajj S, Kueffer FJ, Baicu CF, Abraham WT, Bourge RC, Warner Stevenson L. Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor: Relationship to Mortality in Patients With Chronic Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003594. [PMID: 28062538 DOI: 10.1161/circheartfailure.116.003594] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [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: 08/05/2016] [Accepted: 12/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this analysis was to examine whether implantable hemodynamic monitor-derived baseline estimated pulmonary artery diastolic pressure (ePAD) and change from baseline ePAD were independent predictors of all-cause mortality in patients with chronic heart failure. METHODS AND RESULTS Retrospective analysis used data from 3 studies (n=790 patients; 216 deaths). Baseline ePAD was related to mortality using a multivariable model including baseline and demographic data. Changes in ePAD defined as change from baseline to 6 months and from baseline to 14 days before death or exit from study were related to subsequent mortality, and analysis was adjusted for baseline ePAD. Area under the pressure versus time curve during 180 days before death or exit from study was related to mortality. Baseline ePAD, independent of other covariates, was a significant predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.09; P<0.0001). Change in ePAD was an independent predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.100; P=0.0008). Increased ePAD of 3, 4, or 5 mm Hg from baseline to 6 months was associated with increased mortality risk of 23.8%, 32.9%, or 42.8%. Change in ePAD from baseline to 14 days before death or exit from study was higher in patients who died (3.0±8 versus 1.7±10 mm Hg; P=0.003). Area under the pressure versus time curve in the final 180 days before death or exit from study was higher in patients who died versus those alive at end of study (185±668 versus 17±482 mm Hg.days; P=0.006). CONCLUSIONS Implantable hemodynamic monitor-derived baseline ePAD and change from baseline ePAD were independent predictors of mortality in chronic heart failure patients.
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Affiliation(s)
- Michael R Zile
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.).
| | - Tom D Bennett
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Stephanie El Hajj
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Fred J Kueffer
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Catalin F Baicu
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - William T Abraham
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Robert C Bourge
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Lynne Warner Stevenson
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
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Gelfman LP, Bakitas M, Warner Stevenson L, Kirkpatrick JN, Goldstein NE. The State of the Science on Integrating Palliative Care in Heart Failure. J Palliat Med 2017; 20:592-603. [PMID: 29493362 DOI: 10.1089/jpm.2017.0178] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a chronic progressive illness associated with physical and psychological burdens, high morbidity, mortality, and healthcare utilization. Palliative care is interdisciplinary care that aims to relieve suffering and improve quality of life for persons with serious illness and their families. It is offered simultaneously with disease-oriented care, unlike hospice or end-of-life care. Despite the demonstrated benefits of palliative care in other populations, evidence for palliative care in the HF population is limited. OBJECTIVE The objective of this article is to describe the current evidence and the gaps in the evidence that will need to be improved to demonstrate the benefits of integrating palliative care into the care of patients with advanced HF and their family caregivers. METHODS We reviewed the literature to examine the state of the science and to identify gaps in palliative care integration for persons with HF and their families. We then convened an interdisciplinary working group at an NIH/NPCRC sponsored workshop to review the evidence base and develop a research agenda to address these gaps. RESULTS We identified four key research priorities to improve palliative care for patients with HF and their families: (1) to better understand patients' uncontrolled symptoms, (2) to better characterize and address the needs of the caregivers of advanced HF patients, (3) to improve patient and family understanding of HF disease trajectory and the importance of advance care planning, and (4) to determine the best models of palliative care, including models for those who want to continue life-prolonging therapies. CONCLUSIONS The goal of this research agenda is to motivate patient, provider, policy, and payor stakeholders, including funders, to identify the key research topics that have the potential to improve the quality of care for patients with HF and their families.
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Affiliation(s)
- Laura P Gelfman
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center , Bronx, New York
| | - Marie Bakitas
- 3 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
| | - Lynne Warner Stevenson
- 4 Division of Cardiovascular Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - James N Kirkpatrick
- 5 Division of Cardiology, Department of Bioethics and Humanities, University of Washington Medical Center , Seattle, Washington
| | - Nathan E Goldstein
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center , Bronx, New York
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 2017; 136:e137-e161. [PMID: 28455343 DOI: 10.1161/cir.0000000000000509] [Citation(s) in RCA: 1813] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Biykem Bozkurt
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Javed Butler
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Donald E Casey
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Monica M Colvin
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Mark H Drazner
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Gerasimos S Filippatos
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Gregg C Fonarow
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Michael M Givertz
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Steven M Hollenberg
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - JoAnn Lindenfeld
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Frederick A Masoudi
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Patrick E McBride
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Pamela N Peterson
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Lynne Warner Stevenson
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Cheryl Westlake
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail 2017; 23:628-651. [PMID: 28461259 DOI: 10.1016/j.cardfail.2017.04.014] [Citation(s) in RCA: 419] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 2017; 70:776-803. [PMID: 28461007 DOI: 10.1016/j.jacc.2017.04.025] [Citation(s) in RCA: 1300] [Impact Index Per Article: 185.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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El-Jawahri A, Paasche-Orlow MK, Matlock D, Stevenson LW, Lewis EF, Stewart G, Semigran M, Chang Y, Parks K, Walker-Corkery ES, Temel JS, Bohossian H, Ooi H, Mann E, Volandes AE. Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure. Circulation 2016; 134:52-60. [PMID: 27358437 PMCID: PMC4933326 DOI: 10.1161/circulationaha.116.021937] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult. This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure. METHODS This was a multisite, randomized, controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of >50% within 2 years. Intervention participants received a verbal description for goals of care (life-prolonging care, limited care, and comfort care) and CPR/intubation plus a 6-minute video depicting the 3 levels of care, CPR/intubation, and an advance care planning checklist. Control subjects received only the verbal description. The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention. Secondary outcomes were CPR/intubation preferences and knowledge (6-item test; range, 0-6) after intervention. RESULTS In the intervention group, 27 (22%) chose life-prolonging care, 31 (25%) chose limited care, 63 (51%) selected comfort care, and 2 (2%) were uncertain. In the control group, 50 (41%) chose life-prolonging care, 27 (22%) selected limited care, 37 (30%) chose comfort care, and 8 (7%) were uncertain (P<0.001). Intervention participants (compared with control subjects) were more likely to forgo CPR (68% versus 35%; P<0.001) and intubation (77% versus 48%; P<0.001) and had higher mean knowledge scores (4.1 versus 3.0; P<0.001). CONCLUSIONS Patients with heart failure who viewed a video were more informed, more likely to select a focus on comfort, and less likely to desire CPR/intubation compared with patients receiving verbal information only. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01589120.
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Affiliation(s)
- Areej El-Jawahri
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
| | - Michael K Paasche-Orlow
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Dan Matlock
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Lynne Warner Stevenson
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Eldrin F Lewis
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Garrick Stewart
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Marc Semigran
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Yuchiao Chang
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Kimberly Parks
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Elizabeth S Walker-Corkery
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Jennifer S Temel
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Hacho Bohossian
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Henry Ooi
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Eileen Mann
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
| | - Angelo E Volandes
- From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.)
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Affiliation(s)
- James E. Udelson
- From Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.); and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA (L.W.S.)
| | - Lynne Warner Stevenson
- From Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.); and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA (L.W.S.)
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos G, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 2016; 68:1476-1488. [PMID: 27216111 DOI: 10.1016/j.jacc.2016.05.011] [Citation(s) in RCA: 473] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos G, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 2016; 134:e282-93. [PMID: 27208050 DOI: 10.1161/cir.0000000000000435] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Stevenson LW, Kormos RL, Young JB, Kirklin JK, Hunt SA. Major advantages and critical challenge for the proposed United States heart allocation system. J Heart Lung Transplant 2016; 35:547-9. [PMID: 27197770 DOI: 10.1016/j.healun.2016.04.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/17/2022] Open
Abstract
The proposed new United States allocation system incorporates extensive research into an elegant plan designed to reduce wait list mortality while preserving post-transplant outcomes. All architects are to be congratulated. However, the future cannot be reliably modeled from the past as listing practices will evolve in response to new criteria. The new system should provide a major advance if and only if it is combined with a commitment to limit the number of listed patients overall and within each high priority status to the number that could reasonably undergo timely transplantation.
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Affiliation(s)
- Lynne Warner Stevenson
- Advanced Heart Disease Section, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Robert L Kormos
- Artificial Heart Program, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James B Young
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sharon A Hunt
- Post Heart Transplant Program, Stanford University, Stanford, California
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Affiliation(s)
- Sean P Pinney
- From the Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.P.P.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.).
| | - Lynne Warner Stevenson
- From the Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.P.P.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
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Dyrda K, Roy D, Leduc H, Talajic M, Stevenson LW, Guerra PG, Andrade J, Dubuc M, Macle L, Thibault B, Rivard L, Khairy P. Treatment Failure With Rhythm and Rate Control Strategies in Patients With Atrial Fibrillation and Congestive Heart Failure: An AF-CHF Substudy. J Cardiovasc Electrophysiol 2015; 26:1327-32. [PMID: 26332293 DOI: 10.1111/jce.12828] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/16/2015] [Accepted: 07/26/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rate and rhythm control strategies for atrial fibrillation (AF) are not always effective or well tolerated in patients with congestive heart failure (CHF). We assessed reasons for treatment failure, associated characteristics, and effects on survival. METHODS AND RESULTS A total of 1,376 patients enrolled in the AF-CHF trial were followed for 37 ± 19 months, 206 (15.0%) of whom failed initial therapy leading to crossover. Rhythm control was abandoned more frequently than rate control (21.0% vs. 9.1%, P < 0.0001). Crossovers from rhythm to rate control were driven by inefficacy, whereas worsening heart failure was the most common reason to crossover from rate to rhythm control. In multivariate analyses, failure of rhythm control was associated with female sex, higher serum creatinine, functional class III or IV symptoms, lack of digoxin, and oral anticoagulation. Factors independently associated with failure of rate control were paroxysmal (vs. persistent) AF, statin therapy, and presence of an implantable cardioverter-defibrillator. Crossovers were not associated with cardiovascular mortality (hazard ratio [HR] 1.11 from rhythm to rate control; 95% confidence interval [95% CI, 0.73-1.73]; P = 0.6069; HR 1.29 from rate to rhythm control; 95% CI, 0.73-2.25; P = 0.3793) or all-cause mortality (HR 1.16 from rhythm to rate control, 95% CI [0.79-1.72], P = 0.4444; HR 1.15 from rate to rhythm control, 95% [0.69, 1.91], P = 0.5873). CONCLUSIONS Rhythm control is abandoned more frequently than rate control in patients with AF and CHF. The most common reasons for treatment failure are inefficacy for rhythm control and worsening heart failure for rate control. Changing strategies does not impact survival.
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Affiliation(s)
- Katia Dyrda
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Denis Roy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Hugues Leduc
- Montreal Heart Institute Coordinating Center (MHICC), Montreal, QC, Canada
| | - Mario Talajic
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | | | - Peter G Guerra
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Jason Andrade
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Marc Dubuc
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Bernard Thibault
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Lena Rivard
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal
| | - Paul Khairy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal.,Montreal Heart Institute Coordinating Center (MHICC), Montreal, QC, Canada
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Abstract
The number of heart transplants performed in the United States was 2177 in 1994 and 2166 in 2014. However, the number of transplant centers has increased, and the criteria for transplants have broadened to include patients 65 years or older, those with a body mass index greater than 30, and more comorbid conditions, such as diabetes mellitus and a history of smoking. As the transplant waiting list has become longer and waiting times have increased, the major route to heart transplants has become deterioration to the most urgent priority status, which accounts for 10% of patients on the waiting list but two-thirds of transplants. Many heart transplant candidates develop life-threatening complications of a ventricular assist device implanted to avert death while waiting. Some affluent patients, however, can afford to temporarily relocate and obtain a transplant in regions where the waiting times are shorter without prior surgery to implant a ventricular assist device. The ethics of allocating hearts for transplant have always recalled the classic lifeboat dilemma of how many people can be allowed to board an already overcrowded lifeboat without sinking the ship and everyone on board. As transplant physicians, we advocate with the best intentions on behalf of our own patients rather than denying transplants to those less likely to benefit. In recognizing our responsibilities as stewards of scarce donor hearts, we should reduce new listings for heart transplants, thus restoring balance to the waiting list and keeping the lifeboat afloat.
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Affiliation(s)
- Lynne Warner Stevenson
- Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts
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Stevenson LW, Udelson JE. Forum for Early Career Clinical Investigation: New Section for Circulation: Heart Failure. Circ Heart Fail 2015. [PMID: 26199306 DOI: 10.1161/circheartfailure.115.002445] [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: 11/16/2022]
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Chen CY, Stevenson LW, Stewart GC, Bhatt DL, Desai M, Seeger JD, Williams L, Jalbert JJ, Setoguchi S. Real world effectiveness of primary implantable cardioverter defibrillators implanted during hospital admissions for exacerbation of heart failure or other acute co-morbidities: cohort study of older patients with heart failure. BMJ 2015; 351:h3529. [PMID: 26174233 PMCID: PMC4501450 DOI: 10.1136/bmj.h3529] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the effectiveness of primary implantable cardioverter defibrillators (ICDs) in elderly patients receiving the device during a hospital admission for exacerbation of heart failure or other acute co-morbidities, with an emphasis on adjustment for early mortality and other factors reflecting healthy candidate bias rather than the effect of the ICD. DESIGN Retrospective cohort study. SETTING Linked data from the Centers for Medicare and Medicaid Services and American College of Cardiology-National Cardiovascular Data Registry ICD registry, nationwide heart failure registry, and Medicare claims data 2004-09. POPULATION 23,111 patients aged ≥ 66 who were admitted to hospital for exacerbation of heart failure or other acute co-morbidities and eligible for primary ICDs. MAIN OUTCOME MEASURES All cause mortality and sudden cardiac death. Latency analyses with Cox regression were used to derive crude hazard ratios and hazard ratios adjusted for high dimension propensity score for outcomes after 180 days from index implantation or discharge. RESULTS Patients who received an ICD during a hospital admission had lower crude mortality risk than patients who did not receive an ICD (40% v 60% at three years); however, with conditioning on 180 day survival and with adjustment for high dimension propensity score, the apparent benefit with ICD was no longer evident for sudden cardiac death (adjusted hazard ratio 0.95, 95% confidence interval 0.78 to 1.17) and had a diminished impact on total mortality (0.91, 0.82 to 1.00). There were trends towards a benefit with ICD in reducing mortality or sudden cardiac death in patients who had had a myocardial infarction more than 40 days previously, left bundle branch block, or low serum B type natriuretic peptide; however, these trends did not reach significance. CONCLUSION After adjustment for healthy candidate bias and confounding, the benefits of primary ICD therapy seen in pivotal trials were not apparent in patients aged 66 or over who received ICDs during a hospital admission for exacerbation of heart failure or other acute co-morbidities. Future research is warranted to further identify subgroups of elderly patients who are more likely to benefit from ICDs. Recognition of those patients whose dominant risk factors are from decompensated heart failure and non-cardiac co-morbidities will allow better focus on ICDs in those patients for whom the device offers the most benefit and provides meaningful prolonging of life.
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Affiliation(s)
- Chih-Ying Chen
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Lynne Warner Stevenson
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - John D Seeger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Lauren Williams
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Jessica J Jalbert
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
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Stevenson LW, O’Donnell A. Advanced Care Planning. JACC: Heart Failure 2015; 3:122-6. [DOI: 10.1016/j.jchf.2014.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
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Parrinello G, Greene SJ, Torres D, Alderman M, Bonventre JV, Di Pasquale P, Gargani L, Nohria A, Fonarow GC, Vaduganathan M, Butler J, Paterna S, Stevenson LW, Gheorghiade M. Water and sodium in heart failure: a spotlight on congestion. Heart Fail Rev 2015; 20:13-24. [PMID: 24942806 PMCID: PMC4405162 DOI: 10.1007/s10741-014-9438-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite all available therapies, the rates of hospitalization and death from heart failure (HF) remain unacceptably high. The most common reasons for hospital admission are symptoms related to congestion. During hospitalization, most patients respond well to standard therapy and are discharged with significantly improved symptoms. Post-discharge, many patients receive diligent and frequent follow-up. However, rehospitalization rates remain high. One potential explanation is a persistent failure by clinicians to adequately manage congestion in the outpatient setting. The failure to successfully manage these patients post-discharge may represent an unmet need to improve the way congestion is both recognized and treated. A primary aim of future HF management may be to improve clinical surveillance to prevent and manage chronic fluid overload while simultaneously maximizing the use of evidence-based therapies with proven long-term benefit. Improvement in cardiac function is the ultimate goal and maintenance of a "dry" clinical profile is important to prevent hospital admission and improve prognosis. This paper focuses on methods for monitoring congestion, and strategies for water and sodium management in the context of the complex interplay between the cardiac and renal systems. A rationale for improving recognition and treatment of congestion is also proposed.
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Affiliation(s)
- Gaspare Parrinello
- Biomedical Department of Internal and Specialty Medicine (Di.Bi.M.I.S.), A.O.U.P "Paolo Giaccone", University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy,
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Adamson PB, Abraham WT, Bourge RC, Costanzo MR, Hasan A, Yadav C, Henderson J, Cowart P, Stevenson LW. Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Heart Fail 2014; 7:935-44. [PMID: 25286913 DOI: 10.1161/circheartfailure.113.001229] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [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: 12/11/2022]
Abstract
BACKGROUND No treatment strategies have been demonstrated to be beneficial for the population for patients with heart failure (HF) and preserved ejection fraction (EF). METHODS AND RESULTS The CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) trial was a prospective, single-blinded, randomized controlled clinical trial testing the hypothesis that hemodynamically guided HF management decreases decompensation leading to hospitalization. Of the 550 patients enrolled in the study, 119 had left ventricular EF ≥40% (average, 50.6%), 430 patients had low left ventricular EF (<40%; average, 23.3%), and 1 patient had no documented left ventricular EF. A microelectromechanical system pressure sensor was permanently implanted in all participants during right heart catheterization. After implant, subjects were randomly assigned in single-blind fashion to a treatment group in whom daily uploaded pressures were used in a treatment strategy for HF management or to a control group in whom standard HF management included weight-monitoring, and pressures were uploaded but not available for investigator use. The primary efficacy end point of HF hospitalization rate >6 months for preserved EF patients was 46% lower in the treatment group compared with control (incidence rate ratio, 0.54; 95% confidence interval, 0.38-0.70; P<0.0001). After an average of 17.6 months of blinded follow-up, the hospitalization rate was 50% lower (incidence rate ratio, 0.50; 95% confidence interval, 0.35-0.70; P<0.0001). In response to pulmonary artery pressure information, more changes in diuretic and vasodilator therapies were made in the treatment group. CONCLUSIONS Hemodynamically guided management of patients with HF with preserved EF reduced decompensation leading to hospitalization compared with standard HF management strategies. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00531661.
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Affiliation(s)
- Philip B Adamson
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.).
| | - William T Abraham
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Robert C Bourge
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Maria Rosa Costanzo
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Ayesha Hasan
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Chethan Yadav
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - John Henderson
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Pam Cowart
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
| | - Lynne Warner Stevenson
- From the Heart Failure Institute, Oklahoma Heart Hospital, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (W.T.A., A.H.); Department of Medicine, University of Alabama at Birmingham (R.C.B.); Advocate Medical Group-Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs, Edward Hospital Center for Advanced Heart Failure, Naperville, IL (M.R.C.); CardioMEMS, Inc, Atlanta, GA (C.Y., J.H., P.C.); and Advanced Heart Disease Section, Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA (L.W.S.)
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Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, Hohnloser SH, Indik J, Lee R, Mehra MR, Menon V, Page RL, Shen WK, Slotwiner DJ, Stevenson LW, Varosy PD, Welikovitch L. HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials. J Am Coll Cardiol 2014; 64:1143-77. [DOI: 10.1016/j.jacc.2014.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, Hohnloser SH, Indik J, Lee R, Mehra MR, Menon V, Page RL, Shen WK, Slotwiner DJ, Stevenson LW, Varosy PD, Welikovitch L. HRS/ACC/AHA expert consensus statement on the use of implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trials. Circulation 2014; 130:94-125. [PMID: 24815500 DOI: 10.1161/cir.0000000000000056] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Fred M Kusumoto
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Hugh Calkins
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - John Boehmer
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Alfred E Buxton
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Mina K Chung
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Michael R Gold
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Stefan H Hohnloser
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Julia Indik
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Richard Lee
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Mandeep R Mehra
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Venu Menon
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Richard L Page
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Win-Kuang Shen
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - David J Slotwiner
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Lynne Warner Stevenson
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Paul D Varosy
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Lisa Welikovitch
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
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