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Burchill LJ, Jain CC, Miranda WR. Advancing New Solutions for Adult Congenital Heart Disease-Related Heart Failure. J Am Coll Cardiol 2024; 83:1415-1417. [PMID: 38599717 DOI: 10.1016/j.jacc.2024.03.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Luke J Burchill
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Trovato V, Asada A, Fussner L, Curtis C, Kahwash R. Interleukin-5 Antagonist Monoclonal Antibody Therapy Improves Symptoms and Reduces Steroid Dependence in Eosinophilic Myocarditis Patients. JACC Case Rep 2024; 29:102267. [PMID: 38645295 PMCID: PMC11031656 DOI: 10.1016/j.jaccas.2024.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/23/2024]
Abstract
Eosinophilic myocarditis (EM) is a rare disease associated with significant morbidity and mortality. This case series follows the clinical courses of 3 patients with EM. The use of mepolizumab, an anti-interleukin-5 monoclonal antibody, as an adjunctive treatment was associated with stabilization of cardiac function and improved long-term outcomes.
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Affiliation(s)
- Vincenzo Trovato
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ashlee Asada
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lynn Fussner
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Casey Curtis
- Division of Allergy and Immunology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Agress S, Sheikh JS, Perez Ramos AA, Kashyap D, Razmjouei S, Kumar J, Singh M, Lak MA, Osman A, Zia Ul Haq M. The Interplay of Comorbidities in Chronic Heart Failure: Challenges and Solutions. Curr Cardiol Rev 2024; 20:CCR-EPUB-138415. [PMID: 38347774 DOI: 10.2174/011573403x289572240206112303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Chronic heart failure (HF) is frequently associated with various comorbidities. These comorbid conditions, such as anemia, diabetes mellitus, renal insufficiency, and sleep apnea, can significantly impact the prognosis of patients with HF. OBJECTIVE This review aims to synthesize current evidence on the prevalence, impact, and management of comorbidities in patients with chronic HF. METHODS A comprehensive review was conducted, with a rigorous selection process. Out of an initial pool of 59,030 articles identified across various research modalities, 134 articles were chosen for inclusion. The selection spanned various research methods, from randomized controlled trials to observational studies. RESULTS Comorbidities are highly prevalent in patients with HF and contribute to increased hospitalization rates and mortality. Despite advances in therapies for HF with reduced ejection fraction, options for treating HF with preserved ejection fraction remain sparse. Existing treatment protocols often lack standardization, reflecting a limited understanding of the intricate relationships between HF and associated comorbidities. CONCLUSION There is a pressing need for a multidisciplinary, tailored approach to manage HF and its intricate comorbidities. This review underscores the importance of ongoing research efforts to devise targeted treatment strategies for HF patients with various comorbid conditions.
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Affiliation(s)
| | - Jannat S Sheikh
- CMH Lahore Medical College & Institute of Dentistry, Lahore, Pakistan
| | | | - Durlav Kashyap
- West China Medical School, Sichuan University, Chengdu, China
| | - Soha Razmjouei
- Case Western Reserve University, Cleveland, OH, United States of America
| | - Joy Kumar
- Kasturba Medical College, Manipal, India
| | | | - Muhammad Ali Lak
- Department of Internal Medicine, CMH Lahore Medical College & Institute of Dentistry, Lahore, Pakistan
| | - Ali Osman
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Muhammad Zia Ul Haq
- Department of Epidemiology and Public Health, Emory University Rollins School of Public Health, Atlanta, USA
- Department of Noncommunicable Diseases and Mental Health, World Health Organization, Cairo, Egypt
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Rose SW, Strackman BW, Gilbert ON, Lasser KE, Paasche‐Orlow MK, Lin M, Saylor G, Hanchate AD. Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc 2024; 13:e031021. [PMID: 38166429 PMCID: PMC10926796 DOI: 10.1161/jaha.123.031021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND The extent to which sex, racial, and ethnic groups receive advanced heart therapies equitably is unclear. We estimated the population rate of left ventricular assist device (LVAD) and heart transplant (HT) use among (non-Hispanic) White, Hispanic, and (non-Hispanic) Black men and women who have heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS We used a retrospective cohort design combining counts of LVAD and HT procedures from 19 state inpatient discharge databases from 2010 to 2018 with counts of adults with HFrEF. Our primary outcome measures were the number of LVAD and HT procedures per 1000 adults with HFrEF. The main exposures were sex, race, ethnicity, and age. We used Poisson regression models to estimate procedure rates adjusted for differences in age, sex, race, and ethnicity. In 2018, the estimated population of adults aged 35 to 84 years with HFrEF was 69 736, of whom 44% were women. Among men, the LVAD rate was 45.6, and the HT rate was 26.9. Relative to men, LVAD and HT rates were 72% and 62% lower among women (P<0.001). Relative to White men, LVAD and HT rates were 25% and 46% lower (P<0.001) among Black men. Among Hispanic men and women and Black women, LVAD and HT rates were similar (P>0.05) or higher (P<0.01) than among their White counterparts. CONCLUSIONS Among adults with HFrEF, the use of LVAD and HT is lower among women and Black men. Health systems and policymakers should identify and ameliorate sources of sex and racial inequities.
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Affiliation(s)
- Scott W. Rose
- Section of Cardiology Medicine, Department of MedicineWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Braden W. Strackman
- Department of Social Sciences and Health Policy, Division of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Olivia N. Gilbert
- Section of Cardiology Medicine, Department of MedicineWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Karen E. Lasser
- Section of General Internal MedicineBoston University School of MedicineBostonMAUSA
| | | | - Meng‐Yun Lin
- Department of Social Sciences and Health Policy, Division of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Georgia Saylor
- Section of Cardiology Medicine, Department of MedicineWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Amresh D. Hanchate
- Department of Social Sciences and Health Policy, Division of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNCUSA
- Section of General Internal MedicineBoston University School of MedicineBostonMAUSA
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Dogan NB, Yasar HY, Kilicaslan B. Cardioprotective Effects of Sodium-Glucose Cotransporter 2 Inhibitors and Their Possible Association With Normalization of the Circadian Index of Heart Rhythm. Tex Heart Inst J 2023; 50:e238196. [PMID: 38083821 PMCID: PMC10751477 DOI: 10.14503/thij-23-8196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Updated recommendations for the treatment of heart failure with reduced ejection fraction (HFrEF) include sodium-glucose cotransporter 2 (SGLT2) inhibitors and other long-established HFrEF therapies. These drugs' mechanisms of action have yet to be fully clarified. OBJECTIVE This study evaluated the effects of SGLT2 inhibitors on the modulation of autonomic function at 1 month beyond conventional HF therapy. METHODS This single-center, observational, prospective study was conducted from January 2020 to December 2022. Patients with type 2 diabetes who had ischemic HFrEF and met the study criteria were considered for SGLT2 inhibitor treatment with empagliflozin or dapagliflozin. Changes in the circadian index were used as the primary outcome to assess the early effects of SGLT2 inhibitors on autonomic function. Changes in functional effort capacity and laboratory findings were also evaluated. Participants' circadian index was measured by a 24-hour rhythm Holter monitoring recorder (BTL-08 Holter H100). A symptom-limited treadmill test assessed patients' effort capacities. Tests were repeated after 1 month of therapy. RESULTS The mean (SD) age of the 151 participants was 56.95 (7.29) years; their mean (SD) left ventricular EF was 35.69% (7.10%), and 95 participants were men (62.9%). From baseline to 1 month, mean (SD) daytime heart rate (80.63 [9.17] vs 77.67 [8.04] beats per minute; P = .004) and nighttime heart rate (76.83 [11.34] vs 73.81 [10.25] beats per minute; P = .03) decreased significantly. Variation in the circadian indexes (mean [SD], 1.04 [0.02] vs 1.10 [0.04]; P < .001) was statistically significant, favoring increased modulation of autonomic function. The increases in exercise duration (mean [SD], 8.88 [3.69] minutes and median [IQR], 8.81 [5.76-12.13] minutes vs 9.72 [3.14] and 9.59 [7.24-12.22] minutes; P = .04) and exercise capacity (mean [SD], 203.38 [65.18] m and median [IQR], 119.22 [149.43-259.15] m vs 335.61 [51.39] and 325.79 [293.59-376.91] m; P < .001] were also significant. CONCLUSION The use of SGLT2 inhibitors during early treatment can favorably affect both autonomic dysfunction and functional effort capacity of patients with type 2 diabetes with ischemic HFrEF.
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Affiliation(s)
- Nazile Bilgin Dogan
- Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hamiyet Yilmaz Yasar
- Department of Endocrinology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Baris Kilicaslan
- Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Ye Q, Zha K. SGLT2i‑treated heart failure patients with a reduced ejection fraction: A meta‑analysis. Exp Ther Med 2023; 26:548. [PMID: 37928504 PMCID: PMC10623217 DOI: 10.3892/etm.2023.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of this study was to investigate the effects of SGLT2 inhibitors (SGLT2i) on patients with heart failure (HF) and reduced ejection fraction, with or without diabetes. A systematic review of randomized controlled trials (RCTs) was conducted, comparing SGLT2i to a placebo for HF patients. Relevant studies from PubMed, Web of Science, and EMBASE were searched from inception to July 2021, without any language restrictions. The pooled effect was estimated using the odds ratio (OR) and 95% confidence interval (CI). Depending on the heterogeneity test results, either random effects or fixed effects models were selected to estimate the pooled effects. Sensitivity analysis was conducted by gradually removing each study to evaluate the results' stability. A total of 5 RCT studies were included in the analysis. The fixed-effects model demonstrated that the patients in the SGLT2i group had a lower risk of hospitalization for HF/cardiovascular death (OR=0.72; 95% CI, 0.67-0.78), P<0.0001; I2=0.0%, P=0.966), cardiovascular death (OR=0.84, 95% CI (0.77, 0.93), P<0.0001; I2=0.0%, P=0.633), hospitalization for HF (OR=0.69, 95% CI (0.63, 0.75), P<0.0001; I2=0.0%, P=0.933), and all-cause mortality (OR=0.79, 95% CI (0.71, 0.89), P<0.0001; I2=3.3%, P=0.376) compared to the placebo group. Sensitivity analysis showed that the pooled effect value remained stable within the corresponding range, even after each study was gradually removed. In conclusion, SGLT2i can reduce the risk of HF hospitalization, cardiovascular death, and all-cause mortality in patients with HF and a reduced ejection fraction, regardless of the presence or absence of diabetes.
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Affiliation(s)
- Qiang Ye
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Kelan Zha
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Kamel I, Salah A, Esteghamati S, Dietzuis H. Rapid Recovery From Cocaine-Induced Cardiomyopathy: A Case Report. Cureus 2023; 15:e49793. [PMID: 38045631 PMCID: PMC10691507 DOI: 10.7759/cureus.49793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 12/05/2023] Open
Abstract
A 33-year-old male presented with shortness of breath and altered mental status. The urine toxicology test was positive for cocaine and fentanyl. The patient underwent a 2D echocardiogram showing severely reduced ejection fraction (EF) and global hypokinesia. He was diagnosed with cocaine-induced cardiomyopathy, which markedly improved four days later.
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Affiliation(s)
- Ibrahim Kamel
- Internal Medicine, Steward Carney Hospital, Dorchester, USA
| | - Amr Salah
- Internal Medicine, Yale University, New Haven, USA
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Supriyana DS, Prasetyawati AE, Arifianto H. Combination Electroacupuncture and Guidelines Directed Medical Therapy Maintained Stability of Heart Rate and Mean Arterial Pressure in Heart Failure with Reduced Ejection Fraction. Med Acupunct 2023; 35:296-304. [PMID: 38162549 PMCID: PMC10753942 DOI: 10.1089/acu.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Clinical studies have shown that electroacupuncture (EA) has therapeutic and modulatory effects on managing heart failure (HF) risk factors. Objective This study aimed to determine the impact of combination drugs and EA on chronic HF patients with reduced ejection fraction (HFrEF) to maintain a stable heart rate (HR) and mean arterial pressure (MAP). Materials and Methods This single-blind clinical randomized controlled trial included 42 patients with chronic HFrEF. The patients were divided into 3 groups: patients taking drugs and EA, patients taking drugs and sham EA (sham acupuncture [SA]), and patients taking drugs without EA. All patients underwent 16 sessions of therapy for 8 weeks. Results There was a significant difference in the average MAP based on therapy duration in the drugs + EA group, whereas there was no significant difference between drugs + SA and drugs without EA groups. There was a substantial difference between the average MAP in the drugs + EA group at the beginning of therapy compared with that at midtherapy (P < 0.05) and at the beginning of treatment and at the end of therapy (P < 0.05). There was no significant difference in the mean HR between the groups. Clinically, after 16 treatment sessions, patients receiving combined drugs and EA treatment presented with stable MAP and HR. Conclusions Drugs combined with EA maintained the stability of MAP and HR in patients with chronic HFrEF.
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Affiliation(s)
- Dwi Surya Supriyana
- Department of Medical Acupunture, Medical Acupuncture Physician, Faculty of Medicine, Universitas Sebelas Maret, Surakarta/Medical Acupuncture Division, Universitas Sebelas Maret Teaching Hospital, Surakarta, Indonesia
| | - Arsita Eka Prasetyawati
- Master of Public Health, Family Medicine Physician, Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Habibie Arifianto
- Cardiovascular Imaging Consultant, Heart Failure Physician, Sebelas Maret Heart Failure Clinic, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/Universitas Sebelas Maret Teaching Hospital, Surakarta, Indonesia
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Jarjour M, Ducharme A. Optimization of GDMT for patients with heart failure and reduced ejection fraction: can physiological and biological barriers explain the gaps in adherence to heart failure guidelines? Drugs Context 2023; 12:2023-5-6. [PMID: 38021409 PMCID: PMC10664772 DOI: 10.7573/dic.2023-5-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Heart failure is a growing epidemic with high mortality rates and recurrent hospital admissions that creates a burden on affected individuals, their caregivers and the whole healthcare system. Throughout the years, many randomized trials have established the effectiveness of several pharmacological therapies and electrophysiological devices to reduce hospitalizations and improve quality of life and survival, mostly for patients with heart failure with reduced ejection fraction (HFrEF). These studies led to the publication of national societies' recommendations to guide clinicians in the management of HFrEF. Yet, many reports have shown significant care gaps in adherence to these recommendations in clinical practice, highlighting suboptimal use and/or dosing of evidence-based therapies. Adherence to guidelines has been shown to be associated with the best prognosis in HFrEF, with patients presenting with intolerances or contraindications having the highest risk of events; however, it remains unclear whether this association is causal or merely a marker of more advanced disease. Furthermore, individual characteristics may limit the possibility of reaching the targeted dosage of specific agents. Herein, we provide a comprehensive overview of clinicians' adherence to heart failure guidelines in a specialized real-life setting, particularly regarding use and optimization of guideline-derived medical therapies, as well as the implementation of more recent agents such as sacubitril/valsartan and SGLT2 inhibitors. We seek potential explanations for suboptimal treatment and its impact on patient outcomes.
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Affiliation(s)
- Marilyne Jarjour
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Canada
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Pinsino A, Carey MR, Husain S, Mohan S, Radhakrishnan J, Jennings DL, Nguonly AS, Ladanyi A, Braghieri L, Takeda K, Faillace RT, Sayer GT, Uriel N, Colombo PC, Yuzefpolskaya M. The Difference Between Cystatin C- and Creatinine-Based Estimated GFR in Heart Failure With Reduced Ejection Fraction: Insights From PARADIGM-HF. Am J Kidney Dis 2023; 82:521-533. [PMID: 37086965 DOI: 10.1053/j.ajkd.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/02/2023] [Indexed: 04/24/2023]
Abstract
RATIONALE & OBJECTIVE The clinical implications of the discrepancy between cystatin C (cysC)- and serum creatinine (Scr)-estimated glomerular filtration rate (eGFR) in patients with heart failure (HF) and reduced ejection fraction (HFrEF) are unknown. STUDY DESIGN Post-hoc analysis of randomized trial data. SETTING & PARTICIPANTS 1,970 patients with HFrEF enrolled in PARADIGM-HF with available baseline cysC and Scr measurements. EXPOSURE Intraindividual differences between eGFR based on cysC (eGFRcysC) and Scr (eGFRScr; eGFRdiffcysC-Scr). OUTCOMES Clinical outcomes included the PARADIGM-HF primary end point (composite of cardiovascular [CV] mortality or HF hospitalization), CV mortality, all-cause mortality, and worsening kidney function. We also examined poor health-related quality of life (HRQoL), frailty, and worsening HF (WHF), defined as HF hospitalization, emergency department visit, or outpatient intensification of therapy between baseline and 8-month follow-up. ANALYTICAL APPROACH Fine-Gray subdistribution hazard models and Cox proportional hazards models were used to regress clinical outcomes on baseline eGFRdiffcysC-Scr. Logistic regression was used to investigate the association of baseline eGFRdiffcysC-Scr with poor HRQoL and frailty. Linear regression models were used to assess the association of WHF with eGFRcysC, eGFRScr, and eGFRdiffcysC-Scr at 8-month follow-up. RESULTS Baseline eGFRdiffcysC-Scr was higher than +10 and lower than-10mL/min/1.73m2 in 13.0% and 35.7% of patients, respectively. More negative values of eGFRdiffcysC-Scr were associated with worse outcomes ([sub]hazard ratio per standard deviation: PARADIGM-HF primary end point, 1.18; P=0.008; CV mortality, 1.34; P=0.001; all-cause mortality, 1.39; P<0.001; worsening kidney function, 1.31; P=0.05). For a 1-standard-deviation decrease in eGFRdiffcysC-Scr, the prevalences of poor HRQoL and frailty increased by 29% and 17%, respectively (P≤0.008). WHF was associated with a more pronounced decrease in eGFRcysC than in eGFRScr, resulting in a change in 8-month eGFRdiffcysC-Scr of-4.67mL/min/1.73m2 (P<0.001). LIMITATIONS Lack of gold-standard assessment of kidney function. CONCLUSIONS In patients with HFrEF, discrepancies between eGFRcysC and eGFRScr are common and are associated with clinical outcomes, HRQoL, and frailty. The decline in kidney function associated with WHF is more marked when assessed with eGFRcysC than with eGFRScr. PLAIN-LANGUAGE SUMMARY Kidney function assessment traditionally relies on serum creatinine (Scr) to establish an estimated glomerular filtration rate (eGFR). However, this has been challenged with the introduction of an alternative marker, cystatin C (cysC). Muscle mass and nutritional status have differential effects on eGFR based on cysC (eGFRcysC) and Scr (eGFRScr). Among ambulatory patients with heart failure enrolled in PARADIGM-HF, we investigated the clinical significance of the difference between eGFRcysC and eGFRScr. More negative values (ie, eGFRScr>eGFRcysC) were associated with worse clinical outcomes (including mortality), poor quality of life, and frailty. In patients with progressive heart failure, which is characterized by muscle loss and poor nutritional status, the decline in kidney function was more pronounced when eGFR was estimated using cysC rather than Scr.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center; Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Matthew R Carey
- Department of Medicine, Columbia University Irving Medical Center
| | - Syed Husain
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center
| | - Jai Radhakrishnan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center
| | - Douglas L Jennings
- Department of Pharmacy, Columbia University Irving Medical Center; Department of Pharmacy Practice, Long Island University College of Pharmacy, New York
| | - Austin S Nguonly
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Annamaria Ladanyi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center; Department of Medicine, Cleveland Clinic, Cleveland, OH
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center
| | | | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
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Narayan SI, Terre GV, Amin R, Shanghavi KV, Chandrashekar G, Ghouse F, Ahmad BA, S GN, Satram C, Majid HA, Bayoro DK. The Pathophysiology and New Advancements in the Pharmacologic and Exercise-Based Management of Heart Failure With Reduced Ejection Fraction: A Narrative Review. Cureus 2023; 15:e45719. [PMID: 37868488 PMCID: PMC10590213 DOI: 10.7759/cureus.45719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a clinical syndrome whose management has significantly evolved based on the pathophysiology and disease process. It is widely prevalent, has a relatively high mortality rate, and is comparatively more common in men than women. In HFrEF, the series of maladaptive processes that occur lead to an inability of the muscle of the left ventricle to pump blood efficiently and effectively, causing cardiac dysfunction. The neurohormonal and hemodynamic adaptations play a significant role in the advancement of the disease and are critical to guiding the treatment and management of HFrEF. The first-line therapy, which includes loop diuretics, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, hydralazine/isosorbide-dinitrate, and mineralocorticoid receptor antagonists (MRAs), has been proven to provide symptomatic relief and decrease mortality and complications. The newly recommended drugs for guideline-based therapy, angiotensin receptor/neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors, soluble guanylate cyclase, and myosin activators and modulators have also been shown to improve cardiac function, reverse cardiac remodeling, and reduce mortality rates. Recent studies have demonstrated that exercise-based therapy has resulted in an improved quality of life, exercise capacity, cardiac function, and decreased hospital readmission rates, but it has not had a considerable reduction in mortality rates. Combining multiple therapies alongside holistic advances such as exercise therapy may provide synergistic benefits, ultimately leading to improved outcomes for patients with HFrEF. Although first-line treatment, novel pharmacologic management, and exercise-based therapy have been shown to improve prognosis, the existing literature suggests a need for further studies evaluating the long-term effects of MRA and ARNI.
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Affiliation(s)
| | - Giselle V Terre
- Department of Medicine, Universidad Iberoamericana (UNIBE), Santo Domingo, DOM
| | - Rutvi Amin
- Department of Medicine, Surat Municipal Institute of Medical Education and Research, Surat, IND
| | - Keshvi V Shanghavi
- Department of Medicine, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, IND
| | | | - Farhana Ghouse
- Department of Medicine, Saint James School of Medicine, St. Vincent, VCT
| | - Binish A Ahmad
- Department of Medicine, King Edward Medical University, Lahore, PAK
| | - Gowri N S
- Department of Medicine, Taras Shevchenko National University of Kyiv, Kyiv, UKR
| | - Christena Satram
- Department of Medicine, Lincoln American University, Georgetown, GUY
| | - Hamna A Majid
- Department of Medicine, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Danielle K Bayoro
- Department of Medicine, Medical University of the Americas, Nevis, KNA
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Sundin A, Ionescu SI, Balkan W, Hare JM. Mesenchymal STRO-1/STRO-3 + precursor cells for the treatment of chronic heart failure with reduced ejection fraction. Future Cardiol 2023; 19:567-581. [PMID: 37933628 PMCID: PMC10652293 DOI: 10.2217/fca-2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/30/2023] [Indexed: 11/08/2023] Open
Abstract
The heart is susceptible to proinflammatory and profibrotic responses after myocardial injury, leading to further worsening of cardiac dysfunction. Important developments in the management of heart failure with reduced ejection fraction have reduced morbidity and mortality; however, these therapies focus on optimizing cardiac function through hemodynamic and neurohormonal pathways and not by repairing the underlying cardiac injury. The potential of cell-based therapy to reverse cardiac injury has received substantial attention. Herein are examined the phase II and III studies of bone marrow-derived mesenchymal STRO-1+ or STRO-1/STRO-3+ precursor cells in patients with ischemic and nonischemic heart failure with reduced ejection fraction, addressing the safety and efficacy of cell-based therapy throughout multiple clinical trials, the optimal dose and the steps toward revolutionizing the treatment of heart failure.
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Affiliation(s)
- Andrew Sundin
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Simona I Ionescu
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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14
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Munoz KJ, Feig CL, Frandsen EL. Takotsubo cardiomyopathy in a 4-year-old female with pneumococcal meningitis. Cardiol Young 2023; 33:1722-1725. [PMID: 36918289 DOI: 10.1017/s1047951123000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
A previously healthy 4-year-old female presented in cardiogenic shock with pneumococcal meningitis. Findings on echocardiogram raised suspicion for takotsubo cardiomyopathy. With supportive care, left ventricular systolic function normalised. Findings on cardiac imaging helped determine the aetiology and avoid further invasive studies or unnecessary treatment.
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Affiliation(s)
- Kevin J Munoz
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Cheyenne L Feig
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Erik L Frandsen
- Department of Pediatric Cardiology, Loma Linda Children's Hospital, Loma Linda, CA, USA
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15
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Iacoviello M, Marini M, Gori M, Orso F, Gonzini L, Gorini M, Fenici P, Maggioni AP. DAPA-HF applicability: the point of view of a cardiology setting. Acta Cardiol 2023; 78:840-845. [PMID: 37605991 DOI: 10.1080/00015385.2023.2243130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/18/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023]
Abstract
Randomised clinical trials, observational studies, and meta-analyses have shown that sodium-glucose cotransporter 2 inhibitors (SGLT2-i) reduce the risk of hospitalisation for heart failure (HF), chronic kidney disease (CKD) progression, and mortality in patients with HF, irrespective of the presence of type 2 diabetes mellitus. However, real-world epidemiology may differ from clinical trial populations, thereby limiting generalisability and delaying the introduction of novel treatments in clinical practice.The aim of the present study was to assess the prevalence of DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) inclusion criteria in a population of HF with reduced ejection fraction (HFrEF) patients enrolled in the Italian Network on Heart Failure (IN-HF) registry.Overall, 3415 IN-HF patients matched the 4744 patients in DAPA-HF, overlapping for most baseline characteristics (e.g. similar average ejection fraction), with a slightly lower prevalence of type 2 diabetes and of HF ischaemic aetiology and a higher percentage of NYHA class II patients. The theoretical eligibility to DAPA-HF in a cardiology setting resulted to be 73%.The availability of an easily accessible database from a large nationwide prospective registry allows to provide insights to clinicians and policy makers on the applicability of the DAPA HF findings to a contemporary population of HFrEF patients followed by cardiologists. It is reasonable to assume that the results of this analysis can be applicable to the entire SGLT2-ir class of drugs.
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Affiliation(s)
- Massimo Iacoviello
- Medical and Surgical Sciences Department, University of Foggia, Foggia, Italy
| | - Marco Marini
- Cardiovascular Sciences Cardiology Department, Ospedali Riuniti, Ancona, Italy
| | - Mauro Gori
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Orso
- Department of Experimental and Clinical Medicine, University of Florence and Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lucio Gonzini
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Marco Gorini
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Peter Fenici
- Catholic University of the Sacred Heart, School of Medicine and Surgery, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
- Medical Affairs, AstraZeneca S.p.A, Milan, Italy
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16
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Li Kam Wa ME, Assar SZ, Kirtane AJ, Perera D. Revascularisation for Ischaemic Cardiomyopathy. Interv Cardiol 2023; 18:e24. [PMID: 37655258 PMCID: PMC10466461 DOI: 10.15420/icr.2023.06] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 09/02/2023] Open
Abstract
Coronary artery disease is a leading cause of heart failure with reduced ejection fraction. Coronary artery bypass grafting appears to provide clinical benefits such as improvements in quality of life, reductions in readmissions and MI, and favourable effects on long-term mortality; however, there is a significant short-term procedural risk when left ventricular function is severely impaired, which poses a conundrum for many patients. Could percutaneous coronary intervention provide the same benefits without the hazard of surgery? There have been no randomised studies to support this practice until recently. The REVIVED-BCIS2 trial (NCT01920048) assessed the outcomes of percutaneous coronary intervention in addition to optimal medical therapy in patients with ischaemic left ventricular dysfunction and stable coronary artery disease. This review examines the trial results in detail, suggests a pathway for investigation and revascularisation in ischaemic cardiomyopathy, and explores some of the remaining unanswered questions.
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Affiliation(s)
- Matthew E Li Kam Wa
- Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK
| | - Saba Z Assar
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, US
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, US
- Cardiovascular Research Foundation New York, NY, US
| | - Divaka Perera
- Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK
- Cardiovascular Division, Guy's and St Thomas' NHS Foundation Trust London, UK
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17
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Balun A, Akgümüş A, Çetin ZG, Demirtaş B. The Prognostic Value of Geriatric Nutritional Risk Index in Evaluating Rehospitalization and One-Year Mortality in Patients With Heart Failure. Cureus 2023; 15:e44460. [PMID: 37791200 PMCID: PMC10544181 DOI: 10.7759/cureus.44460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Malnutrition is frequently observed in patients with heart failure, and malnutrition causes poor prognosis in these patients. Various calculation tools are used to assess malnutrition, with the geriatric nutritional risk index (GNRI) being one that is frequently used. In our study, we aimed to investigate the value of GNRI in assessing one-year mortality and rehospitalization in patients with heart failure. METHOD A total of 196 patients aged 60 years and older were included in this retrospective study. A GNRI ≤ 98 was defined as malnutrition. Patients were divided into two groups: GNRI ≤ 98 (malnutrition) and GNRI > 98 (non-malnutrition). Rehospitalization due to heart failure and mortality were compared between both groups in the one-year follow-up. RESULTS The duration of hospitalization was significantly lower in the malnourished group compared to the non-malnutrition group (11.5 ± 7.5 days vs. 20.9 ± 16.3 days). All-cause mortality was significantly higher in the malnutrition group (30.8% vs. 18.1, p = 0.045). Risk factors were evaluated to predict all-cause death by Cox regression analysis, and GNRI (hazard ratio (HR) = 0.968; 95%CI: 0.942-0.995; p = 0.018) was associated with all-cause mortality. CONCLUSIONS GNRI, which is used as an indicator of malnutrition, is associated with all-cause mortality at one-year follow-up. Higher mortality was observed in the group with low GNRI, but it was observed that this group was hospitalized for less time due to heart failure.
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Affiliation(s)
- Ahmet Balun
- Cardiology, Bandırma Onyedi Eylül University, Balıkesir, TUR
| | - Alkame Akgümüş
- Cardiology, Bandırma Onyedi Eylül University, Balıkesir, TUR
| | - Zehra G Çetin
- Cardiology, Ankara Bilkent City Hospital, Ankara, TUR
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18
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Karedath J, Nazly S, Murtaza SF, Bhandari S, Sharma A, Talpur S, Vistro MM, Palleti SK. Comparison of Early and Long-Term Mortality in Patients With Reduced and Preserved Ejection Fraction Undergoing Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43245. [PMID: 37692708 PMCID: PMC10491923 DOI: 10.7759/cureus.43245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
The aim of this study was to compare early and long-term mortality in patients with reduced and preserved ejection fraction (EF) undergoing coronary artery bypass graft (CABG). This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Two investigators independently conducted a systematic and comprehensive search of PubMed, EMBASE, and Scopus from inception to July 15, 2023, using the search terms "reduced ejection fraction," "preserved ejection fraction," "coronary artery bypass surgery," and "mortality." Boolean operators (AND, OR) were used with medical subject heading (MeSH) terms to refine the search. The reference lists of all included articles were manually searched to identify potentially relevant studies. We restricted our search to studies published in the English language. The outcomes assessed in this meta-analysis included short-term mortality (including in-hospital and 30-day mortality) and long-term mortality. A total of five studies were included in this meta-analysis. The pooled sample size is 94,399 participants. Pooled analysis showed that the risk of early mortality was significantly higher in patients with reduced EF compared to patients with preserved EF (risk ratio, RR: 2.14, 95% CI: 1.50 to 3.06). The pooled analysis also reported that late mortality was significantly higher in patients with reduced EF compared to patients with preserved EF (RR: 1.67, 95% CI: 1.35 to 2.08). The pooled analysis of studies demonstrated a significantly higher rate of both early and late mortality in patients with reduced EF, emphasizing the importance of EF assessment in risk stratification for CABG patients.
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Affiliation(s)
- Jithin Karedath
- Internal Medicine, King's College Hospital NHS Foundation Trust, London, GBR
| | - Sumreen Nazly
- Internal Medicine, University Medical and Dental College Faisalabad, Faisalabad, PAK
| | - Syeda Fatima Murtaza
- Internal Medicine, Mayo Clinic, Jacksonville, USA
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Anmol Sharma
- Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, NPL
| | - Saifullah Talpur
- Psychiatry, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Muhammad Moiz Vistro
- Internal Medicine, United Medical and Dental College, Creek General Hospital, Karachi, PAK
| | - Sujith K Palleti
- Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, USA
- Nephrology, Loyola University Medical Center, Maywood, USA
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19
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Rikabi S, Kumar S, Shah G. Takotsubo Cardiomyopathy Triggered by Emotional Stress From the Russia-Ukraine War. JACC Case Rep 2023; 16:101895. [PMID: 37396314 PMCID: PMC10313489 DOI: 10.1016/j.jaccas.2023.101895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023]
Abstract
Stress-induced cardiomyopathy presents like acute coronary syndrome and is triggered by emotional stress or critical illness. Increased incidence has been reported during the COVID-19 pandemic and natural disasters. We describe a case of stress-induced cardiomyopathy as an indirect consequence of the Russia-Ukraine war. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Sarah Rikabi
- Internal Medicine Residency Program, Fairview Hospital, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sachin Kumar
- Internal Medicine Residency Program, Fairview Hospital, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gautam Shah
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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20
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Kondo T, Adachi T, Kobayashi K, Okumura T, Izawa H, Murohara T, McMurray JJV, Yamada S. Physical Frailty and Use of Guideline-Recommended Drugs in Patients With Heart Failure and Reduced Ejection Fraction. J Am Heart Assoc 2023; 12:e026844. [PMID: 37301739 PMCID: PMC10356033 DOI: 10.1161/jaha.122.026844] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/19/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Guideline-recommended therapies that improve prognosis remain underused in clinical practice. Physical frailty may lead to underprescription of life-saving therapy. We aimed to investigate the association between physical frailty and the use of evidence-based pharmacological therapy for heart failure with reduced ejection fraction and the impact of this on prognosis. METHODS AND RESULTS The FLAGSHIP (Multicentre Prospective Cohort Study to Develop Frailty-Based Prognostic Criteria for Heart Failure Patients) included patients hospitalized for acute heart failure, and data on physical frailty were collected prospectively. We analyzed 1041 patients with heart failure with reduced ejection fraction (aged 70 years; 73% male) and divided them by physical frailty categories using grip strength, walking speed, Self-Efficacy for Walking-7 score, and Performance Measures for Activities of Daily Living-8 score: categories I (n=371; least frail), II (n=275), III (n=224), and IV (n=171). Overall prescription rates of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists were 69.7%, 87.8%, and 51.9%, respectively. The proportion of patients receiving all 3 drugs decreased as physical frailty increased (in category I patients, 40.2%; IV patients, 23.4%; P for trend<0.001). In adjusted analyses, the severity of physical frailty was an independent predictor for nonuse of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (odds ratio [OR], 1.23 [95% CI, 1.05-1.43] per 1 category increase) and β-blockers (OR, 1.32 [95% CI, 1.06-1.64]), but not mineralocorticoid receptor antagonists (OR, 0.97 [95% CI, 0.84-1.12]). Patients receiving 0 to 1 drug had a higher risk of the composite outcome of all-cause death or heart failure rehospitalization than those treated with 3 drugs in physical frailty categories I and II (hazard ratio [HR], 1.80 [95% CI, 1.08-2.98]) and III and IV (HR, 1.53 [95% CI, 1.01-2.32]) in the multivariate Cox proportional hazard model. CONCLUSIONS Prescription of guideline-recommended therapy decreased as severity of physical frailty increased in heart failure with reduced ejection fraction. Underprescription of guideline-recommended therapy may contribute to the poor prognosis associated with physical frailty.
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Affiliation(s)
- Toru Kondo
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
- British Heart Foundation Cardiovascular Research CentreUniversity of GlasgowUK
| | - Takuji Adachi
- Department of Integrated Health SciencesNagoya University Graduate School of MedicineNagoyaJapan
| | | | - Takahiro Okumura
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Hideo Izawa
- Department of CardiologyFujita Health UniversityToyoakeJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - John J. V. McMurray
- British Heart Foundation Cardiovascular Research CentreUniversity of GlasgowUK
| | - Sumio Yamada
- Department of Integrated Health SciencesNagoya University Graduate School of MedicineNagoyaJapan
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21
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De Keyzer E, Hossein A, Rabineau J, Morissens M, Almorad A, van de Borne P. Non-invasive cardiac kinetic energy distribution: a new marker of heart failure with impaired ejection fraction (KINO-HF). Front Cardiovasc Med 2023; 10:1096859. [PMID: 37200972 PMCID: PMC10185762 DOI: 10.3389/fcvm.2023.1096859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 05/20/2023] Open
Abstract
Background Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. 44% of HF patients present impaired left ventricular ejection fraction (LVEF). Kinocardiography (KCG) technology combines ballistocardiography (BCG) and seismocardiography (SCG). It estimates myocardial contraction and blood flow through the cardiac chambers and major vessels through a wearable device. Kino-HF sought to evaluate the potential of KCG to distinguish HF patients with impaired LVEF from a control group. Methods Successive patients with HF and impaired LVEF (iLVEF group) were matched and compared to patients with normal LVEF ≥ 50% (control). A 60 s KCG acquisition followed cardiac ultrasound. The kinetic energy from KCG signals was computed in different phases of the cardiac cycle (i K s y s t o l i c ; Δ i K d i a s t o l i c ) as markers of cardiac mechanical function. Results Thirty HF patients (67 [59; 71] years, 87% male) were matched with 30 controls (64.5 [49; 73] years, 87% male). SCG Δ i K d i a s t o l i c , BCG i K s y s t o l i c , BCG Δ i K d i a s t o l i c were lower in HF than controls (p < 0.05), while SCG i K s y s t o l i c was similar. Furthermore, a lower SCG i K s y s t o l i c was associated with an increased mortality risk during follow-up. Conclusions KINO-HF demonstrates that KCG can distinguish HF patients with impaired systolic function from a control group. These favorable results warrant further research on the diagnostic and prognostic capabilities of KCG in HF with impaired LVEF.Clinical Trial Registration: NCT03157115.
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Affiliation(s)
- Eva De Keyzer
- Department of Cardiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Amin Hossein
- Laboratoray of Physics and Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jeremy Rabineau
- Laboratoray of Physics and Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Marielle Morissens
- Department of Cardiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Almorad
- Department of Cardiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Heart Rhythm Management Centre, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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22
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Steinberg RS, Udeshi E, Dickert N, Quyyumi A, Chirinos JA, Morris AA. Novel Measures of Arterial Hemodynamics and Wave Reflections Associated With Clinical Outcomes in Patients With Heart Failure. J Am Heart Assoc 2023; 12:e027666. [PMID: 36927108 PMCID: PMC10111560 DOI: 10.1161/jaha.122.027666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background Arterial stiffness and earlier wave reflections can increase afterload and impair cardiovascular function. Most prior studies have been performed in patients with preserved left ventricular function. We describe novel measures of pulsatile arterial hemodynamics and their association with clinical outcomes in patients with heart failure with reduced ejection fraction. Methods and Results Participants with heart failure with reduced ejection fraction (n=137, median age 56 years, 49% women, 58% Black) and age-matched healthy controls (n=124) underwent measurements of large artery stiffness and pulsatile arterial hemodynamics. Carotid-femoral pulse wave velocity and augmentation index were assessed using radial applanation tonometry. Pressure-flow analyses derived reflected wave transit time, the systolic pressure-time integral imposed by proximal aortic characteristic impedance, and the pressure-time integral from wave reflection (wasted pressure effort). Cox proportional hazards models defined associations between hemodynamic measures and (1) all-cause death and (2) a combined end point of left ventricular assist device implant, heart transplant, and death, at 2 years adjusted for race, BNP (B-type natriuretic peptide), and the Meta-Analysis Global Group in Chronic Heart Failure Risk Score. Compared with controls, participants with heart failure with reduced ejection fraction exhibited similar carotid-femoral pulse wave velocity (6.8±1.6 versus 7.0±1.6 m/s, P=0.40) but higher augmentation index normalized to a heart rate of 75 bpm (13±2% versus 22±2%, P<0.001). Shorter reflected wave transit time (ie, earlier wave reflection arrival to the proximal aorta) was associated with an increased risk of death (adjusted hazard ratio [aHR] 1.67 [95% CI 1.03-1.63]) and the combined end point of death/left ventricular assist device/heart transplant (aHR, 1.61 [95% CI, 1.06-2.44]) at 2 years. Wasted pressure effort/proximal aortic characteristic impedance, representing the proportion of systolic load from wave reflection versus aortic root characteristic impedance, was univariately associated with death (hazard ratio (HR), 1.44 [95% CI, 1.05-1.97]) and with death/left ventricular assist device/heart transplant on univariate (HR, 1.42 [95% CI, 1.07-1.88]) and multivariable (aHR, 1.40 [95% CI, 1.02-1.93]) analysis. Conclusions Increased left ventricular systolic load from premature wave reflections is associated with adverse clinical outcomes in patients with heart failure with reduced ejection fraction.
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Affiliation(s)
| | - Eisha Udeshi
- Division of Cardiology Emory University Atlanta GA
| | - Neal Dickert
- Division of Cardiology Emory University Atlanta GA
| | | | - Julio A Chirinos
- Division of Cardiology University of Pennsylvania Philadelphia PA
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23
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Varghese L, Lin W, Linden S, Lum AL, Sim D. Cost-Effectiveness of Empagliflozin on Top of Standard of Care for Heart Failure With Reduced Ejection Fraction in Singapore. Value Health Reg Issues 2023; 34:108-117. [PMID: 36669346 DOI: 10.1016/j.vhri.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/06/2022] [Accepted: 12/13/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The prevalence of heart failure (HF) and its risk factors are high in Singapore. The EMPEROR-Reduced trial demonstrated that add-on empagliflozin resulted in a reduction in the risk of cardiovascular death or hospitalization for HF compared with standard of care (SoC). This study aimed to estimate the cost-effectiveness of empagliflozin+SoC versus SoC in patients with HF with reduced ejection fraction from a Singaporean healthcare perspective. METHODS A Markov cohort model simulated progression through health states based on New York Heart Association classes over a lifetime horizon using a cycle length of 1 month. Transition probabilities, and the risk of transient events (hospitalization for HF and cardiovascular/all-cause death) were modeled based on the EMPEROR-Reduced trial. Costs for HF-related events, adverse events, and for monitoring were estimated from a combination of published literature and publicly available fees for public hospitals/polyclinics. RESULTS Empagliflozin+SoC was estimated to be very cost-effective versus SoC alone with an incremental cost-effectiveness ratio of<8000 Singapore Dollars/quality-adjusted life-year gained. The base-case results were robust as evidenced from the consistency of various scenario and sensitivity analyses performed. When using Kansas City Cardiomyopathy Questionnaire - Clinical Summary Score quartiles as the health states, the incremental cost-effectiveness ratio reduced significantly to 4625 Singapore Dollars/quality-adjusted life-year. CONCLUSION The use of empagliflozin on top of SoC represents a highly cost-effective solution for the treatment of patients with HF with reduced ejection fraction in Singapore when considering its efficacy, relative affordability, and the growing economic burden of HF in Singapore.
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Affiliation(s)
| | - Weiqin Lin
- Department of Cardiology, National University Heart Centre Singapore Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stephan Linden
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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24
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Zippel-Schultz B, Silber S, Helms TM. [Do telemonitoring centers improve the prognosis of patients with congestive heart failure?]. MMW Fortschr Med 2023; 165:50-53. [PMID: 36894857 DOI: 10.1007/s15006-023-2368-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Bettina Zippel-Schultz
- Deutsche Stiftung für chronisch Kranke, Schwabacher Straße 32, 90762, Fürth, Deutschland
| | - Sigmund Silber
- Kardiologiezentrum undTelemonitoring-Zentrum, Tal 21, 80331, München, Deutschland.
| | - Thomas M Helms
- Deutsche Stiftung für chronisch Kranke, Büro Berlin, Schwabacher Straße 32, 90762, Fürth, Deutschland
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25
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Choday S, Ravi N, Parisapogu A, Ojinna BT, Sherpa ML. Effects of Sodium-Glucose Cotransporter Inhibitor Use in Type 2 Diabetes Mellitus Patients With Heart Failure. Cureus 2023; 15:e34687. [PMID: 36909046 PMCID: PMC9994637 DOI: 10.7759/cureus.34687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/04/2023] [Indexed: 02/08/2023] Open
Abstract
The advances in the development of sodium-glucose cotransporter 2 inhibitors (SGLT2i) have expanded the variety of favorable approaches to treating diabetes mellitus. It is possible to have an improvement in insulin resistance and natriuresis by inhibiting the reabsorption of sodium and glucose at the proximal tubules in the kidney, and a decrease in cardiovascular mortality in patients with diabetes mellitus (DM). In addition, SGLT2i provides renoprotection by reducing intraglomerular higher blood pressure. The usage of SGLT2i also provides hemodynamic and metabolic benefits. SGLT2i demonstrates large cardiovascular benefits in patients both with and without diabetes, as well as in existing heart failure patients. These SGLT2i have direct and indirect effects on the kidney, likely contributing to stated cardiovascular benefits. Here we review the literature on the direct effects of SGLT2 inhibitors in diabetic patients with heart failure (HF). We assume that the benefit in cardiac cells modulated by SGLT2i is due to the inhibition of sodium transporters affecting intracellular sodium homeostasis. In conclusion, the sodium transporters in cardiac cells provide, at least partly, an example of the clinical benefits of SGLT2i observed in HF patients.
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Affiliation(s)
- Silpa Choday
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Niriksha Ravi
- Internal Medicine and Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Blessing T Ojinna
- Internal Medicine and Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Medicine, University of Nigeria Nsukka, College of Medicine, Enugu, NGA
| | - Mingma L Sherpa
- Internal Medicine and Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Tran SK, Ngo TH, Lai TT, Truong GK, Tran KDD, Vo PM, Nguyen PT, Nguyen PH, Nguyen TT, Nguyen OTK, Nguyen T, Nguyen KT, Tran HD. Effectiveness of Spironolactone in Terms of Galectin-3 Levels in Patients with Heart Failure with a Reduced Ejection Fraction in the Vietnamese Population. Healthcare (Basel) 2023; 11:253. [PMID: 36673621 PMCID: PMC9858831 DOI: 10.3390/healthcare11020253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background: Galectin-3 is a biomarker that has been demonstrated to play a significant role in myocardial fibrosis and remodeling in the pathogenesis of heart failure. Furthermore, spironolactone has the ability to control galectin-3 levels in heart failure patients. Objectives: The aim of our study was to determine the factors associated with the increase in galectin-3 and the alteration of galectin-3 concentration in patients with heart failure with a reduced ejection fraction after 12 weeks of treatment with spironolactone. Materials and methods: A cross-sectional descriptive study was conducted on 122 patients with heart failure with a reduced ejection fraction. Those patients were nonusers of spironolactone and presented for examination or had been hospitalized at the Can Tho Cardiovascular Hospital in Vietnam. The demographic and cardiovascular risk factor details were obtained at baseline, and galectin-3 levels were measured at baseline and also 12 weeks after taking spironolactone 25 mg once daily vs. 50 mg once daily. Results: The median baseline galectin-3 was 54.82 ± 26.06. Galectin-3 levels were positively correlated with age, NT-proBNP, and negatively correlated between EF and galectin-3 levels (p < 0.05). After 12 weeks of treatment with spironolactone, the galectin-3 concentration decreased from 54.82 ± 26.06 to 44.20 ± 24.36 (p < 0.05). According to the subgroup analysis, the average concentration of galectin-3 decreased the most in the group of patients with grade 3 hypertension and NYHA class III heart failure. The 50 mg once-daily dose of spironolactone significantly improved galectin-3 concentrations compared with the 25 mg once-daily group, at 17.11 ± 20.81 (p < 0.05) (reduced 29.05%) and 3.46 ± 6.81 ng/mL (p < 0.05) (reduced 6.87%), respectively. Conclusion: Treatment with spironolactone played an essential role in reducing galectin-3 concentrations, especially spironolactone 50 mg once daily, which showed a significant effect on reducing galectin-3 compared with a 25 mg once-daily dose.
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Affiliation(s)
- Son Kim Tran
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Toan Hoang Ngo
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Tin Trung Lai
- Department of Cardiology, Can Tho Cardiovascular Hospital, Can Tho City 900000, Vietnam
| | - Giang Khanh Truong
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Khoa Dang Dang Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 90000, Vietnam
| | - Phuong Minh Vo
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Phi The Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Phi Hoang Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Thuan Tuan Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Oanh Thi Kim Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
| | - Kien Trung Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 90000, Vietnam
| | - Hung Do Tran
- Faculty of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho City 90000, Vietnam
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27
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Khan MS, Butler J, Anker SD, Filippatos G, Ferreira JP, Pocock SJ, Januzzi JL, Piña IL, Böhm M, Ponikowski P, Verma S, Brueckmann M, Vedin O, Zeller C, Zannad F, Packer M. Impact of Empagliflozin in Heart Failure With Reduced Ejection Fraction in Patients With Ischemic Versus Nonischemic Cause. J Am Heart Assoc 2023; 12:e027652. [PMID: 36565199 PMCID: PMC9973606 DOI: 10.1161/jaha.122.027652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/14/2022] [Indexed: 12/25/2022]
Abstract
Background Outcomes and treatment effects of therapy may vary according to the cause of heart failure (HF). Methods and Results In this post hoc analysis of the EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction) trial, the effect of empagliflozin on cardiovascular and renal outcomes was assessed according to the cause of HF. The cause of HF was investigator reported and stratified as ischemic or nonischemic. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs. Of the 3730 patients enrolled, 1929 (51.7%) had ischemic cause. In the placebo arm, patients with ischemic cause of HF did not have a significantly higher risk of cardiovascular mortality (HR, 1.21 [95% CI, 0.90-1.63]) and hospitalization for HF (HR, 0.90 [95% CI, 0.72-1.12]) compared with nonischemic cause. Empagliflozin compared with placebo significantly reduced the risk of cardiovascular death or hospitalization for HF in patients with ischemic and nonischemic cause (HR, 0.82 [95% CI, 0.68-0.99] for ischemic and HR, 0.67 [95% CI, 0.55-0.82] for nonischemic cause; P interaction=0.15). The benefit of empagliflozin on HF hospitalization, the renal composite end point, estimated glomerular filtration slope changes, and health status scores were also consistent in both groups without treatment by cause modification. Conclusions Empagliflozin offers cardiovascular and renal benefits in patients with heart failure with reduced ejection fraction regardless of the cause of HF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03057977.
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Affiliation(s)
| | - Javed Butler
- Baylor Scott and White Research InstituteDallasTX
- Department of MedicineUniversity of Mississippi School of MedicineJacksonMS
| | - Stefan D. Anker
- Department of Cardiology (CVK)Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Charité Universitätsmedizin BerlinBerlinGermany
- Institute of Heart DiseasesWrocław Medical UniversityWrocławPoland
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital AttikonAthensGreece
| | | | - Stuart J. Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | | | - Ileana L. Piña
- Department of MedicineWayne State and Central Michigan UniversitiesDetroitMI
| | - Michael Böhm
- Department of Internal Medicine IIIUniversity Hospital Saarland, Saarland UniversityHomburgSaarGermany
| | - Piotr Ponikowski
- Centre for Heart DiseasesWrocław Medical UniversityWrocławPoland
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael’s HospitalUniversity of TorontoTorontoCanada
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbHIngelheimGermany
- Faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
- First Department of MedicineFaculty of Medicine Mannheim of the University of HeidelbergMannheimGermany
| | - Ola Vedin
- Boehringer Ingelheim ABStockholmSweden
| | - Cordula Zeller
- Université de Lorraine, CIC Inserm, CHRU NancyNancyFrance
| | - Faiez Zannad
- Boehringer Ingelheim Pharma GmbH & Co. KGBiberachGermany
| | - Milton Packer
- Baylor University Medical CenterDallasTX
- Imperial CollegeLondonUnited Kingdom
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Ryan M, De Silva K, Morgan H, O’Gallagher K, Demir OM, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah AM, Chiribiri A, Perera D. Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability. Circ Cardiovasc Interv 2022; 15:e012394. [PMID: 36538582 PMCID: PMC9760472 DOI: 10.1161/circinterventions.122.012394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. METHODS Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. RESULTS Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2 s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2 s-1 had 86% sensitivity and 76% specificity. CONCLUSIONS Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
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Affiliation(s)
- Matthew Ryan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kalpa De Silva
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Holly Morgan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kevin O’Gallagher
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ozan M. Demir
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Haseeb Rahman
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Howard Ellis
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Luke Dancy
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | - Daniel Sado
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | | | | | - Michael Marber
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ajay M. Shah
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Amedeo Chiribiri
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
- Imaging Sciences Division, King’s College London, UK (A.C.)
| | - Divaka Perera
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
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López-Vilella R, Donoso Trenado V, Jover Pastor P, Sánchez-Lázaro I, Martínez Dolz L, Almenar Bonet L. Why Iron Deficiency in Acute Heart Failure Should Be Treated: A Real-World Clinical Practice Study. Life (Basel) 2022; 12:life12111828. [PMID: 36362983 PMCID: PMC9699465 DOI: 10.3390/life12111828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background. This study aims to determine whether the administration of ferric carboxymaltose (FCM) in patients with acute heart failure (AHF) and iron deficiency (ID) improves morbidity and mortality. Methods. We studied 890 consecutive patients admitted for AHF. Patients were divided into six groups according to reduced left ventricular ejection fraction (HFrEF) or preserved (HFpEF), presence of ID, and administration of FCM. Emergency visits, re-admissions, and all-cause mortality were assessed at 6 months. Results. The overall prevalence of ID was 91.2%. In the HFrEF group, no differences were found in isolated events when patients with untreated vs. treated ID were compared, while differences were found in the combined event rate (p = 0.049). The risk calculation showed an absolute risk reduction (ARR) of 10% and relative risk reduction (RRR) of 18%. In HFpEF there was a positive trend with regard to the combined event (p = 0.107), with an ARR of 9% and an RRR of 15%. The number of patients we needed to treat to prevent a combined event was 10.5 in HFrEF and 10.8 in HFpEF. Conclusions. FCM in AHF reduced the combined event rate of emergency visits, re-admission, and all-cause death at 6 months in HF with left ventricular ejection fraction <50%, and showed a positive trend in HFpEF.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-961245851
| | - Víctor Donoso Trenado
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Pablo Jover Pastor
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Siao WZ, Chen YH, Tsai CF, Lee CM, Jong GP. Diabetes Mellitus and Heart Failure. J Pers Med 2022; 12:1698. [PMID: 36294837 DOI: 10.3390/jpm12101698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
The coexistence of diabetes mellitus (DM) and heart failure (HF) is frequent and is associated with a higher risk of hospitalization for HF and all-cause and cardiovascular mortality. It has been estimated that millions of people are affected by HF and DM, and the prevalence of both conditions has increased over time. Concomitant HF and diabetes confer a worse prognosis than each alone; therefore, managing DM care is critical for preventing HF. This article reviews the prevalence of HF and diabetes and the correlated prognosis as well as provides a basic understanding of diabetic cardiomyopathy, including its pathophysiology, focusing on the relationship between DM and HF with a preserved ejection fraction and summarizes the potential aldosterone and the mineralocorticoid receptor antagonists approaches for managing heart failure and DM. Sodium–glucose cotransporter 2 inhibitors (SGLT2Is) are an emerging class of glucose-lowering drugs, and the role of SGLT2Is in DM patients with HF was reviewed to establish updated and comprehensive concepts for improving optimal medical care in clinical practice.
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Alexandre A, Schmidt C, Campinas A, Gomes C, Magalhães S, Preza-Fernandes J, Torres S, Santos M. Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal. J Cardiovasc Dev Dis 2022; 9. [PMID: 36286296 DOI: 10.3390/jcdd9100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p < 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p < 0.01). Patients enrolled in CR were more likely to be treated with sacubitril/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p < 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1.04; 95% CI 1.01−1.07), higher education level (adjusted OR 3.31; 95% CI 1.63−6.70), stroke (adjusted OR 3.29; 95% CI 1.06−10.27), COPD (adjusted OR 4.82; 95% CI 1.53−15.16), and no ICD status (adjusted OR 2.68; 95% CI 1.36−5.26) were independently associated with CR non-enrollment. The main reasons for not being enrolled in CR were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Despite the relatively high proportion (35%) of HFrEF patients who underwent CR, the enrollment rate can be further improved. Innovative multi-level strategies addressing physicians’ awareness, patients’ comorbidities, and geographical issues should be pursued.
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Chen YW, Lee WC, Fang HY, Sun CK, Sheu JJ. Coronary Artery Bypass Graft Surgery Brings Better Benefits to Heart Failure Hospitalization for Patients with Severe Coronary Artery Disease and Reduced Ejection Fraction. Diagnostics (Basel) 2022; 12. [PMID: 36140634 DOI: 10.3390/diagnostics12092233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: We compared the outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) for revascularization in patients with reduced ejection fraction (EF) and severe coronary artery disease (CAD). Methods: Between February 2006 and February 2020, a total of 797 patients received coronary angiograms due to left ventricular EF ≤ 40% at our hospital. After excluding diagnoses of dilated cardiomyopathy, valvular heart disease, prior CABG, acute ST-segment myocardial infarction, and CAD with low Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score (≤22), 181 patients with severe coronary artery disease (CAD) with SYNTAX score >22 underwent CABG or PCI for revascularization. Vascular characteristics as well as echocardiographic data were compared between CABG (n = 58) and PCI (n = 123) groups. Results: A younger age (62 ± 9.0 vs. 66 ± 12.1; p = 0.016), higher new EuroSCORE II (8.6 ± 7.3 vs. 3.2 ± 2.0; p < 0.001), and higher SYNTAX score (40.5 ± 9.8 vs. 35.4 ± 8.3; p < 0.001) were noted in the CABG group compared to those in the PCI group. The CABG group had a significantly higher cardiovascular mortality rate at 1-year (19.6% vs. 5.0%, p = 0.005) and 3-year (25.0% vs. 11.4%, p = 0.027) follow-ups but a lower incidence of heart failure (HF) hospitalization at 1-year (11.1% vs. 28.2%, p = 0.023) and 3-year (3.6% vs. 42.5%, p = 0.001) follow-ups compared to those of the PCI group. Conclusions: Compared with PCI, revascularization with CABG was related to a lower incidence of HF hospitalization but a worse survival outcome in patients with severe CAD and reduced EF. CABG-associated reduction in HF hospitalization was more notable when SYNTAX score ≥33.
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Butler J, Shahzeb Khan M, Lindenfeld J, Abraham WT, Savarese G, Salsali A, Zeller C, Peil B, Filippatos G, Ponikowski P, Anker SD. Minimally Clinically Important Difference in Health Status Scores in Patients With HFrEF vs HFpEF. JACC Heart Fail 2022; 10:651-661. [PMID: 35780032 DOI: 10.1016/j.jchf.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Differences in clinically important thresholds in patient-reported outcomes measures such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) remain less well-established in patients with heart failure with preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF). OBJECTIVES The purpose of this study was to estimate meaningful thresholds for improvement or deterioration in the KCCQ-Total Symptom Score (TSS) in patients with HFrEF versus HFpEF. METHODS This secondary analysis of EMPERIAL program used anchor- and distribution-based approaches to estimate thresholds for improvement or deterioration in the KCCQ-TSS using Patient Global Impression of Severity (PGIS) as the primary anchor. Mean change in KCCQ-TSS from baseline to week 12 was calculated for each PGIS. RESULTS A total of 312 HFrEF and 315 HFpEF patients were enrolled. At week 12, mean changes in KCCQ-TSS corresponding to PGIS changes of "any improvement," "1-category improvement," and "1-category deterioration" were 13 ± 17, 12 ± 17, -3 ± 16 points in HFrEF, and 15 ± 18, 13 ± 17, -7 ± 18 points in HFpEF. Threshold for meaningful within-patient change in KCCQ-TSS was ≥9 points in HFrEF and ≥7 points in HFpEF patients. Sensitivity and specificity of ≥9 points/≥7 points change was 0.65 and 0.70 for HFrEF and 0.64 and 0.66 for HFpEF. Cumulative distribution function curves of KCCQ-TSS change from baseline to week 12 showed a shift to higher scores in both HFrEF and HFpEF patients. CONCLUSIONS In the EMPERIAL program, a change in KCCQ-TSS of ≥9 points in HFrEF and ≥7 points in HFpEF represents the minimal clinically important difference for improvement, confirming the broad range of 5-10 points as meaningful thresholds.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA.
| | | | - JoAnn Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet; and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Afshin Salsali
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, USA; Faculty of Medicine, Rutgers University, New Brunswick, New Jersey
| | - Cordula Zeller
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach an der Riß, Germany
| | - Barbara Peil
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim AM Rhein, Germany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
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Jan RK, Alsheikh-Ali A, Mulla AA, Sulaiman K, Panduranga P, Al-Mahmeed W, Bazargani N, Al-Suwaidi J, Al-Jarallah M, Al-Motarreb A, Salam A, Al-Zakwani I. Outcomes of guideline-based medical therapy in patients with acute heart failure and reduced left ventricular ejection fraction: Observations from the Gulf acute heart failure registry (Gulf CARE). Medicine (Baltimore) 2022; 101:e29452. [PMID: 35687781 PMCID: PMC9276384 DOI: 10.1097/md.0000000000029452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/22/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to report on the use, predictors and outcomes of guideline-based medical therapy (GBMT) in patients with acute heart failure (HF) with reduced ejection fraction of <40% (HFrEF), from seven countries in the Arabian Gulf.Patients with acute HFrEF (N = 2680), aged 18 years or older, and hospitalized February-November 2012 were recruited and data were collected post discharge at 3 months (n = 2477) and 1 year (n = 2418). The use and doses of GBMT were evaluated as per European, American and Canadian HF guidelines. Analyses were performed using multivariate logistic regression. This study was registered at clinicaltrials.gov (NCT01467973).The majority of patients were on dual (39%) and triple (39%) GBMT modalities, 14% received one GBMT medication, while 7.2% were not on any GBMT medications. On admission, 80% of patients were on renin-angiotensin system (RAS) blockers, 75% on b-blockers and 56% on mineralocorticoid receptor antagonists (MRAs), with a small proportion of these patients were taking target doses (RAS blockers 13%, b-blockers 7.3%, MRAs 14%). Patients taking triple GBMT were younger (P < .001), less likely to have comorbidities such as diabetes mellitus (P < .001) and CKD/dialysis (P < .001), less likely to receive in-hospital invasive treatments (P < .001), and more likely to be treated by a cardiologist (P < .001), than patients on a single medication. Patients taking triple GBMT showed significantly reduced all-cause mortality both at 3-months (P = .048), and at 12-months (P = .003), compared to patients taking no GBMT.Triple GBMT prescribing and dosing in patients with HFrEF were suboptimal in the Arabian Gulf. Further studies are required to investigate GBMT utilization and dosing in the outpatient setting.
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Affiliation(s)
- Reem K. Jan
- College of Medicine, Mohammed Bin Rashid University of Medicine & Health Sciences, Dubai, UAE
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine & Health Sciences, Dubai, UAE
| | - Arif Al Mulla
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Kadhim Sulaiman
- Department of Cardiology, Royal Hospital, Muscat, Oman
- Director General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | | | - Wael Al-Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | | | - Jassim Al-Suwaidi
- Department of Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
- Qatar Cardiovascular Research Centre, Doha, Qatar
| | - Mohammed Al-Jarallah
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Ahmed Al-Motarreb
- Department of Internal Medicine, Faculty of Medicine, Sana’a University, Sana’a, Yemen
| | - Amar Salam
- Department of Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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35
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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: 543] [Impact Index Per Article: 271.5] [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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36
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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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37
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Greene SJ, Ezekowitz JA, Anstrom KJ, Demyanenko V, Givertz MM, Piña IL, O'Connor CM, Koglin J, Roessig L, Hernandez AF, Armstrong PW, Mentz RJ. Medical Therapy During Hospitalization for Heart Failure with Reduced Ejection Fraction: The VICTORIA Registry: Medical Therapy During Hospitalization for HFrEF. J Card Fail 2022; 28:1063-1077. [PMID: 35301107 DOI: 10.1016/j.cardfail.2022.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 10/13/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND For patients hospitalized for heart failure with reduced ejection fraction (HFrEF), guidelines recommend optimization of medical therapy prior to discharge. The degree to which changes in medical therapy occur during hospitalizations for HFrEF in North American clinical practice is unclear. METHODS The VICTORIA registry enrolled patients hospitalized for worsening chronic HFrEF across 51 sites in the US and Canada from February 2018-January 2019. Among patients with complete medication data and not receiving dialysis, use and dose of angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA), and sodium glucose cotransporter-2 inhibitors (SGLT2i) were assessed at admission and discharge. RESULTS Among 1,695 patients, median (IQR) age was 69 (59-79) years and 33% were women. Among eligible patients, 33%, 25%, and 55% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA at discharge, respectively; 99% were not prescribed SGLT2i. For each medication, >50% of patients remained on stable sub-target doses or no medication during hospitalization. In-hospital rates of initiation/dose increase were 20% for ACEI/ARB, 4% for ARNI, 20% for beta-blocker, 22% for MRA, and <1% for SGLT2i; corresponding rates of dose decrease/discontinuation were 11%, 2%, 9%, 5%, and <1%, respectively. Overall, 17% and 28% of eligible patients were prescribed triple therapy prior to admission and at discharge, respectively. At both admission and discharge, 1% of patients were prescribed triple therapy at target doses. Across classes of medication, multiple factors were independently associated with higher likelihood of in-hospital initiation/dosing increase (e.g., Canadian enrollment, White race, intensive care admission) and discontinuation/dosing decrease (e.g., worse renal function, intensive care admission). CONCLUSIONS In this contemporary North American registry of patients hospitalized for worsening chronic HFrEF, for each recommended medical therapy, the large majority of eligible patients remained on stable sub-target doses or without medication at admission and discharge. Although most patients had no alterations in medical therapy, hospitalization in Canada and multiple patient characteristics were associated with higher likelihood of favorable in-hospital medication changes.
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Affiliation(s)
- Stephen J Greene
- From the Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin J Anstrom
- From the Duke Clinical Research Institute, Durham, North Carolina
| | | | - Michael M Givertz
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Ileana L Piña
- Department of Medicine, Jefferson University, Philadelphia, Pennsylvania
| | | | | | | | - Adrian F Hernandez
- From the Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Robert J Mentz
- From the Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Abdelhamid M, Elsisi GH, Seyam A, Shafie A, Kirollos M, Emad S, Mansy S, Sobhy M. Dapagliflozin cost-effectiveness analysis in heart failure patients in Egypt. J Med Econ 2022; 25:450-456. [PMID: 35291896 DOI: 10.1080/13696998.2022.2054226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS In Egypt, cardiovascular (CV) diseases are not only the cause of 33% of disability-adjusted life years but are also a leading cause of death. This study aimed to evaluate dapagliflozin's cost-effectiveness as an add-on to the standard of care (SOC) for the treatment of heart failure with reduced ejection fraction (HF-rEF) from the Egyptian healthcare system perspective. MATERIALS AND METHODS A state transition model was utilized to assess the cost-effectiveness of dapagliflozin as an add-on to the SOC and a cost-minimization analysis was performed to compare dapagliflozin to sacubitril/valsartan, as they have had similar efficacy. Patients were stratified into four health states using the KCCQ-TSS, in addition to a CV and non-CV mortality health states. Urgent heart failure (HF) visits and hospitalizations were captured as transient states. Clinical parameters and baseline characteristics were based on the DAPA-HF trial, utility scores were extracted from published articles, and costs were derived from the Universal Health Insurance Authority national database. Deterministic and probabilistic sensitivity analyses were performed. RESULTS The treatment costs of HF-rEF patients receiving dapagliflozin compared to SOC are 47,901EGP ($10,550) and 34,377EGP ($7,572), respectively. The quality-adjusted life-years (QALYs) of dapagliflozin compared to SOC are 4.57 and 4.20, respectively. This resulted in an incremental cost per effectiveness ratio (ICER) of 36,449EGP ($8,028) per QALY gained over the lifetime horizon, suggesting this is cost-effective. Results of the cost-minimization analysis showed cost savings where the annual costs of dapagliflozin vs. sacubitril/valsartan are 10,914EGP ($2,404) and 32,242EGP ($7,101), respectively. CONCLUSION Dapagliflozin was found to be a highly cost-effective and cost-saving medication when compared to SOC and sacubitril/valsartan, respectively, in the treatment of HF-rEF from Egyptian healthcare system perspective. The ICER was below the willingness-to-pay threshold because dapagliflozin improved outcomes (less frequent hospitalization and mortality).
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Affiliation(s)
- Magdy Abdelhamid
- Cardiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Gihan Hamdy Elsisi
- HTA Office, LLC, Cairo, Egypt
- Faculty of Economics and Political Sciences, American University in Cairo, Cairo, Egypt
| | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | - Ahmed Shafie
- Cardiology Department, Faculty of Medicine, Zagazig University, Giza, Egypt
| | - Mary Kirollos
- Health Technology Assessment Department, Egyptian Authority for Unified Procurement, Medical Supply and Management of Medical Technology (UPA), Cairo, Egypt
| | - Sandy Emad
- Pharmacoeconomic Unit, Egyptian Drug Authority, Giza, Egypt
| | | | - Mohamed Sobhy
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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39
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Sant'Anna LB, Couceiro SLM, Ferreira EA, Sant'Anna MB, Cardoso PR, Mesquita ET, Sant'Anna GM, Sant'Anna FM. Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:766676. [PMID: 34901227 PMCID: PMC8652049 DOI: 10.3389/fcvm.2021.766676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the effects of invasive vagal nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF). Background: Heart failure is characterized by autonomic nervous system imbalance and electrical events that can lead to sudden death. The effects of parasympathetic (vagal) stimulation in patients with HF are not well-established. Methods: From May 1994 to July 2020, a systematic review was performed using PubMed, Embase, and Cochrane Library for clinical trials, comparing VNS with medical therapy for the management of chronic HFrEF (EF ≤ 40%). A meta-analysis of several outcomes and adverse effects was completed, and GRADE was used to assess the level of evidence. Results: Four randomized controlled trials (RCT) and three prospective studies, totalizing 1,263 patients were identified; 756 treated with VNS and 507 with medical therapy. RCT data were included in the meta-analysis (fixed-effect distribution). Adverse effects related to VNS were observed in only 11% of patients. VNS was associated with significant improvement (GRADE = High) in the New York Heart Association (NYHA) functional class (OR, 2.72, 95% CI: 2.07–3.57, p < 0.0001), quality of life (MD −14.18, 95% CI: −18.09 to −10.28, p < 0.0001), a 6-min walk test (MD, 55.46, 95% CI: 39.11–71.81, p < 0.0001) and NT-proBNP levels (MD −144.25, 95% CI: −238.31 to −50.18, p = 0.003). There was no difference in mortality (OR, 1.24; 95% CI: 0.82–1.89, p = 0.43). Conclusions: A high grade of evidence demonstrated that vagal nerve stimulation improves NYHA functional class, a 6-min walk test, quality of life, and NT-proBNP levels in patients with chronic HFrEF, with no differences in mortality.
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Affiliation(s)
- Lucas Bonacossa Sant'Anna
- Medical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil
| | | | - Eduardo Amar Ferreira
- Medical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil
| | - Mariana Bonacossa Sant'Anna
- Medical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil
| | - Pedro Rey Cardoso
- Medical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil
| | | | | | - Fernando Mendes Sant'Anna
- Hospital Santa Izabel, Rio de Janeiro, Brazil.,Department of Education and Graduation, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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40
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Mohanty AF, Levitan EB, King JB, Dodson JA, Vardeny O, Cook J, Herrick JS, He T, Patterson OV, Alba PR, Russo PA, Obi EN, Choi ME, Fang JC, Bress AP. Sacubitril/Valsartan Initiation Among Veterans Who Are Renin-Angiotensin-Aldosterone System Inhibitor Naïve With Heart Failure and Reduced Ejection Fraction. J Am Heart Assoc 2021; 10:e020474. [PMID: 34612065 PMCID: PMC8751890 DOI: 10.1161/jaha.120.020474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
Background Sacubitril/valsartan, a first‐in‐class angiotensin receptor neprilysin inhibitor, received US Food and Drug Administration approval in 2015 for heart failure with reduced ejection fraction (HFrEF). Our objective was to describe the sacubitril/valsartan initiation rate, associated characteristics, and 6‐month follow‐up dosing among veterans with HFrEF who are renin‐angiotensin‐aldosterone system inhibitor (RAASi) naïve. Methods and Results Retrospective cohort study of veterans with HFrEF who are RAASi naïve defined as left ventricular ejection fraction (LVEF) ≤40%; ≥1 in/outpatient heart failure visit, first RAASi (sacubitril/valsartan, angiotensin‐converting enzyme inhibitor [ACEI]), or angiotensin‐II receptor blocker [ARB]) fill from July 2015 to June 2019. Characteristics associated with sacubitril/valsartan initiation were identified using Poisson regression models. From July 2015 to June 2019, we identified 3458 sacubitril/valsartan and 29 367 ACEI or ARB initiators among veterans with HFrEF who are RAASi naïve. Sacubitril/valsartan initiation increased from 0% to 26.5%. Sacubitril/valsartan (versus ACEI or ARB) initiators were less likely to have histories of stroke, myocardial infarction, or hypertension and more likely to be older and have diabetes mellitus and lower LVEF. At 6‐month follow‐up, the prevalence of ≥50% target daily dose for sacubitril/valsartan, ACEI, and ARB initiators was 23.5%, 43.2%, and 47.1%, respectively. Conclusions Sacubitril/valsartan initiation for HFrEF in the Veterans Administration increased in the 4 years immediately following Food and Drug Administration approval. Sacubitril/valsartan (versus ACEI or ARB) initiators had fewer baseline cardiovascular comorbidities and the lowest proportion on ≥50% target daily dose at 6‐month follow‐up. Identifying the reasons for lower follow‐up dosing of sacubitril/valsartan could support guideline recommendations and quality improvement strategies for patients with HFrEF.
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Affiliation(s)
- April F Mohanty
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Emily B Levitan
- Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL
| | - Jordan B King
- Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT.,Institute for Health Research Kaiser Permanente Colorado Aurora CO
| | - John A Dodson
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY
| | - Orly Vardeny
- University of Minnesota Medical School Minneapolis MN
| | - James Cook
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Jennifer S Herrick
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Tao He
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Olga V Patterson
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Patrick R Alba
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Patricia A Russo
- US Health Economics & Outcomes Research Novartis Pharmaceuticals CorporationEast Hanover NJ
| | - Engels N Obi
- US Health Economics & Outcomes Research Novartis Pharmaceuticals CorporationEast Hanover NJ
| | | | - James C Fang
- Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Adam P Bress
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT.,Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT
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41
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Hosseini Farahabadi M, Milani-Nejad S, Liu S, Yu W, Shafie M. Left Atrial Dilatation and Reduced Left Ventricular Ejection Fraction Are Associated With Cardioembolic Stroke. Front Neurol 2021; 12:680651. [PMID: 34589043 PMCID: PMC8475948 DOI: 10.3389/fneur.2021.680651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Left atrial (LA) dilatation and heart failure are independent risk factors for ischemic stroke. The goal of this study is to evaluate the association between LA dilatation and reduced left ventricular ejection fraction (EF) with cardioembolic stroke. Methods: Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016 and 2017 were included based on the following criteria: age >18 and availability of echocardiogram. Stroke was categorized into cardioembolic and non-cardioembolic. EF was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51% (male), 41-53% (female), moderately abnormal: 30-40%, and severely abnormal: <30%. LA volume was categorized into normal (≤34 ml/m2) vs. enlarged (≥35 ml/m2). Other variables included gender, hypertension [systolic blood pressure (SBP) ≥ 140 or diastolic blood pressure (DBP) ≥ 90], and known history of atrial fibrillation (Afib). Results: Two hundred eighteen patients had cardioembolic, and 235 had non-cardioembolic stroke. Among patients with cardioembolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and enlarged LA, respectively, as compared with 19 (8.1%) and 65 (27.7%) patients with non-cardioembolic stroke (p < 0.0001). The odds of cardioembolic stroke were 2.0 (95% CI: 0.1-6.0) and 8.8 times (95% CI: 1.9-42.3) higher in patients with moderately and severely reduced EF, respectively, than in patients with normal EF. The odds of cardioembolic stroke was 2.4 times (95% CI: 1.5-3.9) higher in patients with enlarged LA than in patients with normal LA size. Compared with patients with normal LA and EF, patients with combined enlarged LA and reduced EF had significantly higher rates of Afib (43.4 vs. 9.0%, p < 0.0001) and cardioembolic stroke (78.3 vs. 43.4%, p < 0.0001). Conclusions: LA dilatation along with reduced EF is a reliable predictor of Afib and cardioembolic stroke. Further studies are warranted to determine the benefit of anticoagulation for secondary stroke prevention in such patient population.
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Affiliation(s)
| | - Shadi Milani-Nejad
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Shimeng Liu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,Department of Neurology, Beijing Tiatan Hospital, Capital Medical University, Beijing, China
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Mohammad Shafie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
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42
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Jones E, Randall EB, Hummel SL, Cameron DM, Beard DA, Carlson BE. Phenotyping heart failure using model-based analysis and physiology-informed machine learning. J Physiol 2021; 599:4991-5013. [PMID: 34510457 DOI: 10.1113/jp281845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023] Open
Abstract
To phenotype mechanistic differences between heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction, a closed-loop model of the cardiovascular system coupled with patient-specific transthoracic echocardiography (TTE) and right heart catheterization (RHC) data was used to identify key parameters representing haemodynamics. Thirty-one patient records (10 HFrEF, 21 HFpEF) were obtained from the Cardiovascular Health Improvement Project database at the University of Michigan. Model simulations were tuned to match RHC and TTE pressure, volume, and cardiac output measurements in each patient. The underlying physiological model parameters were plotted against model-based norms and compared between HFrEF and HFpEF. Our results confirm the main mechanistic parameter driving HFrEF is reduced left ventricular (LV) contractility, whereas HFpEF exhibits a heterogeneous phenotype. Conducting principal component analysis, k -means clustering, and hierarchical clustering on the optimized parameters reveal (i) a group of HFrEF-like HFpEF patients (HFpEF1), (ii) a classic HFpEF group (HFpEF2), and (iii) a group of HFpEF patients that do not consistently cluster (NCC). These subgroups cannot be distinguished from the clinical data alone. Increased LV active contractility ( p < 0.001 ) and LV passive stiffness ( p < 0.001 ) at rest are observed when comparing HFpEF2 to HFpEF1. Analysing the clinical data of each subgroup reveals that elevated systolic and diastolic LV volumes seen in both HFrEF and HFpEF1 may be used as a biomarker to identify HFrEF-like HFpEF patients. These results suggest that modelling of the cardiovascular system and optimizing to standard clinical data can designate subgroups of HFpEF as separate phenotypes, possibly elucidating patient-specific treatment strategies. KEY POINTS: Analysis of data from right heart catheterization (RHC) and transthoracic echocardiography (TTE) of heart failure (HF) patients using a closed-loop model of the cardiovascular system identifies key parameters representing haemodynamic cardiovascular function in patients with heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF). Analysing optimized parameters representing cardiovascular function using machine learning shows mechanistic differences between HFpEF groups that are not seen analysing clinical data alone. HFpEF groups presented here can be subdivided into three subgroups: HFpEF1 described as 'HFrEF-like HFpEF', HFpEF2 as 'classic HFpEF', and a third group of HFpEF patients that do not consistently cluster. Focusing purely on cardiac function consistently captures the underlying dysfunction in HFrEF, whereas HFpEF is better characterized by dysfunction in the entire cardiovascular system. Our methodology reveals that elevated left ventricular systolic and diastolic volumes are potential biomarkers for identifying HFrEF-like HFpEF patients.
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Affiliation(s)
- Edith Jones
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - E Benjamin Randall
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Scott L Hummel
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA
| | - David M Cameron
- Fredrick Meijer Heart and Vascular Institute, Grand Rapids, MI, USA
| | - Daniel A Beard
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Brian E Carlson
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
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43
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Greene SJ, Choi S, Lippmann SJ, Mentz RJ, Greiner MA, Hardy NC, Hammill BG, Luo N, Samsky MD, Heidenreich PA, Laskey WK, Yancy CW, Peterson PN, Curtis LH, Hernandez AF, Fonarow GC, O'Brien EC. Clinical Effectiveness of Sacubitril/Valsartan Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc 2021; 10:e021459. [PMID: 34350772 PMCID: PMC8475054 DOI: 10.1161/jaha.121.021459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/24/2022]
Abstract
Background Sacubitril/Valsartan has been highly efficacious in randomized trials of heart failure with reduced ejection fraction (HFrEF). However, the effectiveness of sacubitril/valsartan in older patients hospitalized for HFrEF in real‐world US practice is unclear. Methods and Results This study included Medicare beneficiaries age ≥65 years who were hospitalized for HFrEF ≤40% in the Get With The Guidelines–Heart Failure registry between October 2015 and December 2018, and eligible for sacubitril/valsartan. Associations between discharge prescription of sacubitril/valsartan and clinical outcomes were assessed after inverse probability of treatment weighting and adjustment for other HFrEF medications. Overall, 1551 (10.9%) patients were discharged on sacubitril/valsartan. Of those not prescribed sacubitril/valsartan, 7857 (62.0%) were prescribed an angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker. Over 12‐month follow‐up, compared with a discharge prescription of angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker, sacubitril/valsartan was independently associated with lower all‐cause mortality (adjusted hazard ratio [HR], 0.82; 95% CI, 0.72–0.94; P=0.004) but not all‐cause hospitalization (adjusted HR, 0.97; 95% CI, 0.89–1.07; P=0.55) or heart failure hospitalization (adjusted HR, 1.04; 95% CI, 0.91–1.18; P=0.59). Patients prescribed sacubitril/valsartan versus those without a prescription had lower risk of all‐cause mortality (adjusted HR, 0.69; 95% CI, 0.60–0.79; P<0.001), all‐cause hospitalization (adjusted HR, 0.90; 95% CI, 0.82–0.98; P=0.02), but not heart failure hospitalization (adjusted HR, 0.94; 95% CI, 0.82–1.08; P=0.40). Conclusions Among patients hospitalized for HFrEF, prescription of sacubitril/valsartan at discharge was independently associated with reduced postdischarge mortality compared with angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker, and reduced mortality and all‐cause hospitalization compared with no sacubitril/valsartan. These findings support the use of sacubitril/valsartan to improve postdischarge outcomes among older patients hospitalized for HFrEF in routine US clinical practice.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC
| | - Sujung Choi
- Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Steven J Lippmann
- Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Robert J Mentz
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC
| | - Melissa A Greiner
- Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - N Chantelle Hardy
- Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Bradley G Hammill
- Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Nancy Luo
- Dignity Health Heart and Vascular Institute Sacramento CA
| | - Marc D Samsky
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC
| | - Paul A Heidenreich
- Department of Medicine Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Warren K Laskey
- Division of Cardiology University of New Mexico School of Medicine Albuquerque NM
| | - Clyde W Yancy
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Pamela N Peterson
- Division of Cardiology University of Colorado, Anschutz Medical Campus Aurora CO.,Division of Cardiology Denver Health Medical Center Denver CO
| | - Lesley H Curtis
- Duke Clinical Research Institute Durham NC.,Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Adrian F Hernandez
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center University of California Los Angeles Los Angeles CA
| | - Emily C O'Brien
- Duke Clinical Research Institute Durham NC.,Department of Population Health Sciences Duke University School of Medicine Durham NC
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44
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Butler J, Djatche LM, Lautsch D, Yang L, Patel MJ, Mentz RJ. Representativeness of the VICTORIA Trial Population in Clinical Practice: Analysis of the PINNACLE Registry. J Card Fail 2021; 27:1374-1381. [PMID: 34271161 DOI: 10.1016/j.cardfail.2021.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial, vericiguat reduced the risk of mortality due to cardiovascular problems and of hospitalization due to heart failure (HF) among patients with HF with reduced ejection fraction (HFrEF) and recent worsening HF events (WHFEs). The representativeness of the VICTORIA population of patients with WHFE in clinical practice is unknown. METHODS AND RESULTS Patients with HF and ejection fraction <45% were identified in the Practice Innovation And Clinical Excellence (PINNACLE) registry and were stratified by the occurrence of WHFEs. Characteristics and outcomes of patients in the PINNACLE registry with and without WHFEs were compared to the VICTORIA population. Of the 14,180 PINNACLE patients identified with HFrEF, 26.5% had had a WHFE. The VICTORIA population was similar to PINNACLE patients with WHFEs in mean age (67.3 vs 66.7), ejection fraction (28.9% vs 28.3%), body mass index (26.8 vs 27.6), and comorbidity burden. The rate of hospitalization because of HF at 1 year was 29.6% in the placebo group of VICTORIA, compared to 35.8% in PINNACLE patients with WHFEs and 13.3% in patients without WHFEs. CONCLUSIONS The PINNACLE patients with WHFEs meeting the VICTORIA definition resembled the VICTORIA population in characteristics and outcomes, suggesting that VICTORIA's population may be generalizable to patients with WHFEs in clinical practice.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | | | | | | | | | - Robert J Mentz
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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45
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McCullough PA, Mehta HS, Barker CM, Houten JV, Mollenkopf S, Gunnarsson C, Ryan M, Cork DP. Healthcare utilization and guideline-directed medical therapy in heart failure patients with reduced ejection fraction. J Comp Eff Res 2021; 10:1055-1063. [PMID: 34225473 DOI: 10.2217/cer-2021-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study examines the effect of guideline-directed medical therapy (GDMT) on healthcare utilization in patients with heart failure with reduced ejection fraction from Optum® Integrated File from 1 January 2007 to 30 June 2020. Materials & methods: Patients with both a beta blocker and either an ACE inhibitor (ACE-I), angiotensin receptor blocker (ARB) or angiotensin receptor neprilysin inhibitor were assigned to the GDMT cohort. All others were not on GDMT. Results: Estimated annual all cause hospitalizations and emergency department visits per 100 patients was 29% (80 vs 62 patients) and 26% higher (54 vs 43 patients; p < 0.0001) and annualized hospital days were longer (1.88 vs 1.64; p = 0.0020) for patients not on GDMT. Conclusion: In a real-world population, heart failure with reduced ejection fraction, patients not optimally managed on GDMT had higher annualized healthcare utilization when compared with patients on GDMT.
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Affiliation(s)
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Healthcare, San Diego, CA, USA
| | - Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
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46
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Singh AK, Singh R, Misra A. Do SGLT-2 inhibitors exhibit similar cardiovascular benefit in patients with heart failure with reduced or preserved ejection fraction? J Diabetes 2021; 13:596-600. [PMID: 33792199 DOI: 10.1111/1753-0407.13182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 12/22/2020] [Revised: 02/14/2021] [Accepted: 03/27/2021] [Indexed: 02/05/2023] Open
Abstract
Highlights The beneficial cardiovascular (CV) effects of SGLT-2 inhibitors (SGLT-2i) in patients with heart failure are already known. Whether SGLT-2i exert similar CV effects in heart failure with reduced or preserved ejection fraction is not known. This meta-analysis showed SGLT-2i exert similar CV benefits irrespective of the types of heart failure. Future trials will confirm or refute the CV effects of SGLT-2i in patients with heart failure with preserved ejection fraction.
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Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Anoop Misra
- Department of Diabetes, Fortis-CDOC hospital for Diabetes & Allied Science, New Delhi, India
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47
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Tsai FC, Chen YL, Yen KC, Chiu CH, Chen JH, Yeh YH, Tsai PC. Gene Expression Changes of Humans with Primary Mitral Regurgitation and Reduced Left Ventricular Ejection Fraction. Int J Mol Sci 2021; 22:3454. [PMID: 33810615 DOI: 10.3390/ijms22073454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/18/2022] Open
Abstract
Patients with primary mitral regurgitation (MR) may remain asymptomatic for many years. For unknown reasons, some shift from a compensated to a decompensated state and progress to fatal heart failure. To elucidate the genetic determinants of this process, we recruited 28 patients who underwent mitral valve surgery and stratified them into control, compensated MR, and decompensated MR groups. Tissue biopsies were obtained from the patients’ left ventricular (LV) lateral wall for a transcriptome-wide profiling of 64,769 probes to identify differentially expressed genes (DEGs). Using cutoff values at the 1% FDR significance level and sex- and age-adjusted regression models, we identified 12 significant DEGs (CTGF, MAP1B, SERPINE1, MYH9, MICAL2, MYO1D, CRY1, AQP7P3, HTRA1, PRSS23, IGFBP2, and FN1). The most significant gene was CTGF (adjusted R2 = 0.74, p = 1.80 × 10−8). We found that the majority of genes expressed in the more advanced decompensated MR group were pro-fibrotic genes associated with cardiac fibrosis. In particular, six pro-fibrotic genes (CTGF, SERPINE1, MYH9, HTRA1, PRSS23, and FN1) were overexpressed and enriched in pathways involved in ECM (extracellular matrix) protein remodeling. Therapeutic interventions that antagonize these six genes may slow the progression toward decompensated MR.
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48
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Abstract
The European Society of Cardiology recently addressed the use of SGLT2 inhibitor use in the treatment of heart failure (HF). Dapagliflozin is a SGLT2 inhibitor recently approved by the US FDA for treatment of patients with HF with a reduced ejection fraction with a New York Heart Association classification of II-IV. Dapagliflozin significantly decreases the risk of worsening HF or death from cardiovascular cause compared with placebo and this risk does not differ based on the presence or absence of Type 2 diabetes. This paper aims to summarize the chemistry, pharmacodynamics and pharmacokinetics of dapagliflozin; and evaluates the clinical efficacy of dapagliflozin in the treatment of HF.
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Affiliation(s)
- Sara Sotirakos
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
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49
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El Hadidi S, Rosano G, Tamargo J, Agewall S, Drexel H, Kaski JC, Niessner A, Lewis BS, Coats AJS. Potentially Inappropriate Prescriptions in Heart Failure with Reduced Ejection Fraction (PIP-HFrEF). Eur Heart J Cardiovasc Pharmacother 2020; 8:187-210. [PMID: 32941594 DOI: 10.1093/ehjcvp/pvaa108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a chronic debilitating and potentially life-threatening condition. Heart Failure patients are usually at high risk of polypharmacy and consequently, potentially inappropriate prescribing leading to poor clinical outcomes. Based on the published literature, a comprehensive HF-specific prescribing review tool is compiled to avoid medications that may cause HF or harm HF patients and to optimize the prescribing practice of HF guideline-directed medical therapies. Recommendations are made in line with the last versions of ESC guidelines, ESC position papers, scientific evidence, and experts' opinions.
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Affiliation(s)
- Seif El Hadidi
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, New Cairo, Egypt
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.,Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Heinz Drexel
- VIVIT Institute, Landeskrankenhaus Feldkirch, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Andrew J S Coats
- Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy
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50
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Kałużna-Oleksy M, Krysztofiak H, Migaj J, Wleklik M, Dudek M, Uchmanowicz I, Lesiak M, Straburzyńska-Migaj E. Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up. Nutrients 2020; 12:nu12082330. [PMID: 32759722 PMCID: PMC7468814 DOI: 10.3390/nu12082330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Heart Failure (HF) is a cardiovascular disease with continually increasing morbidity and high mortality. The purpose of this study was to analyze nutritional status in patients diagnosed with HF with reduced ejection fraction (HFrEF) and evaluate the impact of malnutrition on their prognosis. The Polish version of MNA form (Mini Nutritional Assessment) was used to assess the patients’ nutritional status. The New York Heart Association (NYHA) class, exacerbation of HF, chosen echocardiographic and biochemical parameters, e.g., natriuretic peptides or serum albumin, were also analyzed. Among the 120 consecutive patients, 47 (39%) had a normal nutritional status, 62 (52%) were at risk of malnutrition and 11 (9%) were malnourished. The patients with malnutrition more frequently presented with HF exacerbation in comparison to those with normal nutritional status (82% vs. 30% respectively, p = 0.004). There were no significant differences between the investigated groups as to natriuretic peptides; however, both the malnourished patients and those at risk of malnutrition tend to show higher B-type natriuretic peptide (BNP) and NT-proBNP concentrations. During the average 344 days of follow-up 19 patients died and 25 were hospitalized due to decompensated HF. Malnutrition or being at risk of malnutrition seems to be associated with both worse outcomes and clinical status in HFrEF patients.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Correspondence: ; Tel.: +48-535-600-625
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Marta Wleklik
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
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