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Collins KA, Reeves GR, Miller NH, Whellan DJ, O’Connor CM, Marcus BH, Kitzman DW, Kraus WE. Clinical Predictors of Adherence to Exercise Training Among Individuals With Heart Failure: THE HF-ACTION STUDY. J Cardiopulm Rehabil Prev 2023; 43:205-213. [PMID: 36479935 PMCID: PMC10148892 DOI: 10.1097/hcr.0000000000000757] [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] [Indexed: 12/13/2022]
Abstract
PURPOSE Suboptimal adherence is a major limitation to achieving the benefits of exercise interventions, and our ability to predict and improve adherence is limited. The purpose of this analysis was to identify baseline clinical and demographic characteristics predicting exercise training adherence in the HF-ACTION study cohort. METHODS Adherence to exercise training, defined by the total duration of exercise performed (min/wk), was evaluated in 1159 participants randomized to the HF-ACTION exercise intervention. More than 50 clinical, demographic, and exercise testing variables were considered in developing a model of the min/wk end point for 1-3 mo (supervised training) and 10-12 mo (home-based training). RESULTS In the multivariable model for 1-3 mo, younger age, lower income, more severe mitral regurgitation, shorter 6-min walk test distance, lower exercise capacity, and Black or African American race were associated with poorer exercise intervention adherence. No variable accounted for >2% of the variance and the adjusted R2 for the final model was 0.14. Prediction of adherence was similarly limited for 10-12 mo. CONCLUSIONS Clinical and demographic variables available at the initiation of exercise training provide very limited information for identifying patients with heart failure who are at risk for poor adherence to exercise interventions.
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Affiliation(s)
| | | | - Nancy Houston Miller
- The Lifecare Company, Lost Altos, CA
- Department of Medicine, Stanford University School of Medicine, Los Altos, CA
| | - David J Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | - Bess H. Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, CA
| | - Dalane W. Kitzman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - William E. Kraus
- Department of Medicine, Duke University School of Medicine, Durham, NC
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Felker GM, North R, Mulder H, Jones WS, Anstrom KJ, Patel MJ, Butler J, Ezekowitz JA, Lam C, O’Connor CM, Roessig L, Hernandez AF, Armstrong PW. Clinical Implications of Negatively Adjudicated Heart Failure Events: Data From the VICTORIA Study. Circulation 2023; 147:694-696. [PMID: 36802884 PMCID: PMC9978923 DOI: 10.1161/circulationaha.122.062055] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- G. Michael Felker
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Rebecca North
- Duke Aging Center, Duke University School of Medicine, Durham, NC
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kevin J. Anstrom
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | | | - Carolyn Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | | | | | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Senni M, Alemayehu WG, Sim D, Edelmann F, Butler J, Ezekowitz J, Hernandez AF, Lam CS, O’Connor CM, Pieske B, Ponikowski P, Roessig L, Voors AA, Westerhout CM, McMullan C, Armstrong PW. Efficacy and Safety of Vericiguat in Patients with Heart Failure with Reduced Ejection Fraction Treated with Sacubitril/Valsartan: Insights from the
VICTORIA
Trial. Eur J Heart Fail 2022; 24:1614-1622. [DOI: 10.1002/ejhf.2608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michele Senni
- ASST Papa Giovanni XXIII Hospital, Bergamo University of Milan Bicocca Italy
| | | | | | | | - Javed Butler
- University of Mississippi Medical Center Jackson MS
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DeFilippis EM, Echols M, Adamson PB, Batchelor WB, Cooper LB, Cooper LS, Desvigne-Nickens P, George RT, Ibrahim NE, Jessup M, Kitzman DW, Leifer ES, Mendoza M, Piña IL, Psotka M, Senatore FF, Stein KM, Teerlink JR, Yancy CW, Lindenfeld J, Fiuzat M, O’Connor CM, Vardeny O, Vaduganathan M. Improving Enrollment of Underrepresented Racial and Ethnic Populations in Heart Failure Trials: A Call to Action From the Heart Failure Collaboratory. JAMA Cardiol 2022; 7:540-548. [PMID: 35319725 PMCID: PMC9098689 DOI: 10.1001/jamacardio.2022.0161] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Despite bearing a disproportionate burden of heart failure (HF), Black and Hispanic individuals have been poorly represented in HF clinical trials. Underrepresentation in clinical trials limits the generalizability of the findings to these populations and may even introduce uncertainties and hesitancy when translating trial data to the care of people from underrepresented groups. The Heart Failure Collaboratory, a consortium of stakeholders convened to enhance HF therapeutic development, has been dedicated to improving recruitment strategies for patients from diverse and historically underrepresented groups. Observations Despite federal policies from the US Food and Drug Administration and National Institutes of Health aimed at improving trial representation, gaps in trial enrollment proportionate to the racial and ethnic composition of the HF population have persisted. Increasing trial globalization with limited US enrollment is a major driver of these patterns. Additional barriers to representative enrollment include inequities in care access, logistical issues in participation, restrictive enrollment criteria, and English language requirements. Conclusions and Relevance Strategies for improving diverse trial enrollment include methodical study design and site selection, diversification of research leadership and staff, broadening of eligibility criteria, community and patient engagement, and broad stakeholder commitment. In contemporary HF trials, diverse trial enrollment is not only feasible but can be efficiently achieved to improve the generalizability and translation of trial knowledge to clinical practice.
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Affiliation(s)
- Ersilia M. DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Melvin Echols
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Richard T. George
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Eric S. Leifer
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martin Mendoza
- Office of Minority Health, US Department of Health and Human Services (HHS), Bethesda, Maryland
| | | | | | - Fortunato Fred Senatore
- Center for Drug Evaluation and Research, Food and Drug Administration, Division of Cardiovascular and Renal Products, Silver Spring, Maryland
| | | | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | | | - Mona Fiuzat
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Christopher M. O’Connor
- Inova Heart and Vascular Institute, Falls Church, Virginia
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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5
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Rosner CM, Atkins M, Saeed IM, de Lemos JA, Khera A, Maghsoudi A, Min J, Tehrani BN, O’Connor CM, deFilippi CR. Patients With Myocarditis Associated With COVID-19 Vaccination. J Am Coll Cardiol 2022; 79:1317-1319. [PMID: 35361355 PMCID: PMC8958986 DOI: 10.1016/j.jacc.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 12/25/2022]
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Butler J, Zheng Y, Bonderman D, Lund L, DeFilippi CR, Blaustein R, Ezekowitz JA, Freitas C, Hernandez AF, O’Connor CM, Voors A, Westerhout CM, Lam CS, Armstrong PW. EJECTION FRACTION, BIOMARKERS, AND OUTCOMES IN HEART FAILURE WITH REDUCED EJECTION FRACTION AND THE IMPACT OF VERICIGUAT ON OUTCOMES IN THE VICTORIA TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01363-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Felker GM, North R, Jones WS, Anstrom KJ, Patel MJ, Butler J, Ezekowitz JA, Lam CS, O’Connor CM, Roessig L, Hernandez AF, Armstrong PW. CLASSIFICATION AND IMPLICATIONS OF HEART FAILURE EVENTS FROM THE VICTORIA TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dimond M, Fiuzat M, Psotka MA, O’Connor CM, Consortium HFCAR, Abraham WT, Ahmad T, Anker SD, Felker MG, Filippatos G, Kitzman DW, Leifer E, Lewis EF, Lindenfeld J, Mentz RJ, Nkulikiyinka R, Schaber D, Sharma A, Solomon SD, Stockbridge N, Teerlink JR, Whellan DJ, Wittes JT. FUNCTIONAL AND SYMPTOMATIC CLINICAL ENDPOINTS IN HEART FAILURE RESEARCH: INSIGHTS FROM THE HEART FAILURE COLLABORATORY (HFC) - ACADEMIC RESEARCH CONSORTIUM (ARC) SCIENTIFIC EXPERT PANEL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fiuzat M, Hamo CE, Butler J, Abraham WT, DeFilippis EM, Fonarow GC, Lindenfeld J, Mentz RJ, Psotka MA, Solomon SD, Teerlink JR, Vaduganathan M, Vardeny O, McMurray JJ, O’Connor CM. Optimal Background Pharmacological Therapy for Heart Failure Patients in Clinical Trials: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:504-510. [PMID: 35115106 PMCID: PMC9180686 DOI: 10.1016/j.jacc.2021.11.033] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/28/2021] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
With the current landscape of approved therapies for heart failure (HF), there is a need to determine the role of a standard background therapy against which novel therapies are studied. The Heart Failure Collaboratory convened a multistakeholder group of clinical investigators, clinicians, patients, government representatives including U.S. Food and Drug Administration and National Institutes of Health participants, payers, and industry in March 2021 to discuss whether standardization of background drug therapy is necessary in clinical trials in patients with HF. The current paper summarizes the discussion and provides potential conceptual approaches, with a focus on therapies indicated for HF with reduced ejection fraction.
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Affiliation(s)
- Mona Fiuzat
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
| | - Carine E. Hamo
- Division of Cardiology, Mount Sinai University Hospital, New York, New York, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ersilia M. DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Gregg C. Fonarow
- Division of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Joann Lindenfeld
- Cardiology Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J. Mentz
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Scott D. Solomon
- Cardiology Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Scotland, United Kingdom
| | - Christopher M. O’Connor
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA;,Inova Heart and Vascular Institute, Falls Church, Virginia, USA
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Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB, Chen H, Upadhya B, Reed SD, Espeland MA, Hewston L, O’Connor CM. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med 2021; 385:203-216. [PMID: 33999544 PMCID: PMC8353658 DOI: 10.1056/nejmoa2026141] [Citation(s) in RCA: 236] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Older patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Interventions to address physical frailty in this population are not well established. METHODS We conducted a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (total scores range from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the 6-month rate of rehospitalization for any cause. RESULTS A total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67%. After adjustment for baseline Short Physical Performance Battery score and other baseline characteristics, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). At 6 months, the rates of rehospitalization for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio, 0.93; 95% CI, 0.66 to 1.19). There were 21 deaths (15 from cardiovascular causes) in the intervention group and 16 deaths (8 from cardiovascular causes) in the control group. The rates of death from any cause were 0.13 and 0.10, respectively (rate ratio, 1.17; 95% CI, 0.61 to 2.27). CONCLUSIONS In a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care. (Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.).
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Affiliation(s)
- Dalane W. Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - David J. Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amy M. Pastva
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Robert J. Mentz
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC
| | | | - M. Benjamin Nelson
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Bharathi Upadhya
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shelby D. Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Mark A. Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Internal Medicine, Section on Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - LeighAnn Hewston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Philadelphia, PA
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Chouairi F, Pacor J, Miller PE, Fuery MA, Caraballo C, Sen S, Leifer ES, Felker GM, Fiuzat M, O’Connor CM, Januzzi JL, Friedman DJ, Desai NR, Ahmad T, Freeman JV. Effects of Atrial Fibrillation on Heart Failure Outcomes and NT-proBNP Levels in the GUIDE-IT Trial. Mayo Clin Proc Innov Qual Outcomes 2021; 5:447-455. [PMID: 33997640 PMCID: PMC8105522 DOI: 10.1016/j.mayocpiqo.2021.02.005] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate effects of atrial fibrillation (AF) on cardiac biomarkers and outcomes in a trial population of patients with heart failure (HF) with reduced ejection fraction treated with optimal guideline-directed medical therapy. Methods We performed a secondary analysis of 894 patients in the Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure (GUIDE-IT) trial (January 2013–July 2016). Patients were stratified by AF status and compared with regard to guideline-directed medical therapy use, longitudinal levels of N-terminal pro–B type natriuretic peptide (NT-proBNP), and outcomes including HF hospitalization and mortality. Results After adjustment, AF was associated with a significant increase in the risk of HF hospitalization or cardiovascular death (hazard ratio, 1.28; 95% CI, 1.02 to 1.61; P=0.04) and HF hospitalization (hazard ratio, 1.31; 95% CI, 1.02 to 1.68; P=.03) but with no difference in mortality during a median 15 months of follow-up. There were no significant differences in medication treatment between those with and those without AF. At 90 days, a higher proportion of patients with AF (89.4% vs 81.5%; P=.002) had an NT-proBNP level above 1000 pg/mL (to convert NT-proBNP values to pmol/L, multiply by 0.1182), and AF patients had higher NT-proBNP levels at all time points through 2 years of follow-up. Conclusion Among patients with HF with reduced ejection fraction, prevalent AF was associated with higher NT-proBNP concentrations through 2 years of follow-up and higher risk for HF hospitalization despite no substantial differences in medical therapy.
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Affiliation(s)
- Fouad Chouairi
- Section of Cardiovascular Medicine, Yale University, New Haven, CT
- Yale School of Medicine, Yale University, New Haven, CT
| | - Justin Pacor
- Department of Internal Medicine, Yale University, New Haven, CT
- Yale School of Medicine, Yale University, New Haven, CT
| | | | - Michael A. Fuery
- Department of Internal Medicine, Yale University, New Haven, CT
- Yale School of Medicine, Yale University, New Haven, CT
| | - Cesar Caraballo
- Section of Cardiovascular Medicine, Yale University, New Haven, CT
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University, New Haven, CT
| | - Eric S. Leifer
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | | | - Mona Fiuzat
- Duke Clinical Research Institute, Durham, NC
| | | | | | - Daniel J. Friedman
- Section of Cardiovascular Medicine, Yale University, New Haven, CT
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Yale University, New Haven, CT
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University, New Haven, CT
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT
| | - James V. Freeman
- Section of Cardiovascular Medicine, Yale University, New Haven, CT
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT
- Correspondence: Address to James V. Freeman, MD, MPH, MS, Section of Cardiovascular Medicine, Yale School of Medicine, PO Box 208017, New Haven, CT 06520.
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Abraham WT, Psotka MA, Fiuzat M, Filippatos G, Lindenfeld J, Mehran R, Ambardekar AV, Carson PE, Jacob R, Januzzi JL, Konstam MA, Krucoff MW, Lewis EF, Piccini JP, Solomon SD, Stockbridge N, Teerlink JR, Unger EF, Zeitler EP, Anker SD, O’Connor CM. Standardized Definitions for Evaluation of Heart Failure Therapies: Scientific Expert Panel From the Heart Failure Collaboratory and Academic Research Consortium. JACC: Heart Failure 2020; 8:961-972. [DOI: 10.1016/j.jchf.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/28/2022]
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13
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Armstrong PW, Lam CSP, Anstrom KJ, Ezekowitz J, Hernandez AF, O’Connor CM, Pieske B, Ponikowski P, Shah SJ, Solomon SD, Voors AA, She L, Vlajnic V, Carvalho F, Bamber L, Blaustein RO, Roessig L, Butler J. Effect of Vericiguat vs Placebo on Quality of Life in Patients With Heart Failure and Preserved Ejection Fraction: The VITALITY-HFpEF Randomized Clinical Trial. JAMA 2020; 324:1512-1521. [PMID: 33079152 PMCID: PMC7576403 DOI: 10.1001/jama.2020.15922] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Patients with heart failure and preserved ejection fraction (HFpEF) are at high risk of mortality, hospitalizations, and reduced functional capacity and quality of life. OBJECTIVE To assess the efficacy of the oral soluble guanylate cyclase stimulator vericiguat on the physical limitation score (PLS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ). DESIGN, SETTING, AND PARTICIPANTS Phase 2b randomized, double-blind, placebo-controlled, multicenter trial of 789 patients with chronic HFpEF and left ventricular ejection fraction 45% or higher with New York Heart Association class II-III symptoms, within 6 months of a recent decompensation (HF hospitalization or intravenous diuretics for HF without hospitalization), and with elevated natriuretic peptides, enrolled at 167 sites in 21 countries from June 15, 2018, through March 27, 2019; follow-up was completed on November 4, 2019. INTERVENTIONS Patients were randomized to receive vericiguat, up-titrated to 15-mg (n = 264) or 10-mg (n = 263) daily oral dosages, compared with placebo (n = 262) and randomized 1:1:1. MAIN OUTCOMES AND MEASURES The primary outcome was change in the KCCQ PLS (range, 0-100; higher values indicate better functioning) after 24 weeks of treatment. The secondary outcome was 6-minute walking distance from baseline to 24 weeks. RESULTS Among 789 randomized patients, the mean age was 72.7 (SD, 9.4) years; 385 (49%) were female; mean EF was 56%; and median N-terminal pro-brain natriuretic peptide level was 1403 pg/mL; 761 (96.5%) completed the trial. The baseline and 24-week KCCQ PLS means for the 15-mg/d vericiguat, 10-mg/d vericiguat, and placebo groups were 60.0 and 68.3, 57.3 and 69.0, and 59.0 and 67.1, respectively, and the least-squares mean changes were 5.5, 6.4, and 6.9, respectively. The least-squares mean difference in scores between the 15-mg/d vericiguat and placebo groups was -1.5 (95% CI, -5.5 to 2.5; P = .47) and between the 10-mg/d vericiguat and placebo groups was -0.5 (95% CI, -4.6 to 3.5; P = .80). The baseline and 24-week 6-minute walking distance mean scores in the 15-mg/d vericiguat, 10-mg/d vericiguat, and placebo groups were 295.0 m and 311.8m , 292.1 m and 318.3 m, and 295.8 m and 311.4 m, and the least-squares mean changes were 5.0 m, 8.7 m, and 10.5 m, respectively. The least-squares mean difference between the 15-mg/d vericiguat and placebo groups was -5.5 m (95% CI, -19.7 m to 8.8 m; P = .45) and between the 10-mg/d vericiguat and placebo groups was -1.8 m (95% CI, -16.2 m to 12.6 m; P = .81), respectively. The proportions of patients who experienced symptomatic hypotension were 6.4% in the 15-mg/d vericiguat group, 4.2% in the 10-mg/d vericiguat group, and 3.4% in the placebo group; those with syncope were 1.5%, 0.8%, and 0.4%, respectively. CONCLUSIONS AND RELEVANCE Among patients with HFpEF and recent decompensation, 24-week treatment with vericiguat at either 15-mg/d or 10-mg/d dosages compared with placebo did not improve the physical limitation score of the KCCQ. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03547583.
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Affiliation(s)
- Paul W. Armstrong
- Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Carolyn S. P. Lam
- National Heart Centre of Singapore, Duke-National University of Singapore, Singapore
| | - Kevin J. Anstrom
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Justin Ezekowitz
- Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Christopher M. O’Connor
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Burkert Pieske
- Charité University Medicine and German Heart Center, Berlin, Germany
| | | | - Sanjiv J. Shah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Lilin She
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | | | | | - Javed Butler
- University of Mississippi Medical Center, Jackson
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Abraham WT, Fiuzat M, Psotka MA, O’Connor CM. Heart Failure Collaboratory Statement on Remote Monitoring and Social Distancing in the Landscape of COVID-19. JACC Heart Fail 2020; 8:692-694. [PMID: 32731947 PMCID: PMC7324341 DOI: 10.1016/j.jchf.2020.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Christopher M. O’Connor
- Address for correspondence: Dr. Christopher M. O’Connor, Editor-in-Chief, JACC: Heart Failure, American College of Cardiology, Heart House, 2400 N Street NW, Washington, DC 20037.
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15
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Affiliation(s)
- Christopher M. O’Connor
- Address for correspondence: Dr. Christopher M. O’Connor, Editor-in-Chief, JACC: Heart Failure, American College of Cardiology, Heart House, 2400 N Street NW, Washington, DC 20037.
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Bhatt AS, Ambrosy AP, Dunning A, DeVore AD, Butler J, Reed S, Voors A, Starling R, Armstrong PW, Ezekowitz JA, Metra M, Hernandez AF, O’Connor CM, Mentz RJ. The burden of non-cardiac comorbidities and association with clinical outcomes in an acute heart failure trial - insights from ASCEND-HF. Eur J Heart Fail 2020; 22:1022-1031. [PMID: 32212297 PMCID: PMC7394726 DOI: 10.1002/ejhf.1795] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/03/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Non-cardiac comorbidities are highly prevalent in patients with heart failure (HF). Our objective was to define the association between non-cardiac comorbidity burden and clinical outcomes, costs of care, and length of stay within a large randomized trial of acute HF patients. METHODS AND RESULTS Patients with complete medical history for the following comorbidities were included: diabetes mellitus, chronic obstructive pulmonary disease, chronic liver disease, history of cancer within the last 5 years, chronic renal disease (baseline serum creatinine >3.0 mg/mL), current smoking, alcohol abuse, depression, anaemia, peripheral arterial disease, and cerebrovascular disease. Patients were classified by overall burden of non-cardiac comorbidities (0, 1, 2, 3, and 4+). Hierarchical generalized linear models were used to assess associations between comorbidity burden and 30-day all-cause death or HF hospitalization and 180-day all-cause death in addition to costs of care and length of stay. A total of 6945 patients were included in the final analysis. Mean comorbidity number was 2.2 (± 1.34). Patients with 4+ comorbidities had higher rates of 30-day all-cause death/HF hospitalization as compared with patients with no comorbidities [odds ratio (OR) 3.32, 95% confidence interval (CI) 1.61-6.84; P < 0.01]. Similar results were seen with respect to 180-day death (OR 2.13, 95% CI 1.33-3.43; P < 0.01). Higher comorbidity burden was associated with higher 180-day costs of care and length of stay. CONCLUSIONS Higher comorbidity burden is associated with poor clinical outcomes, higher costs of care, and extended length of stay. Further studies are needed to define the impact of comorbidity management programmes on outcomes for HF patients.
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Affiliation(s)
- Ankeet S. Bhatt
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew P. Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Allison Dunning
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Adam D. DeVore
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Shelby Reed
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | - Randall Starling
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | - Marco Metra
- Division of Cardiology, University of Brescia, Brescia, Italy
| | - Adrian F. Hernandez
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | - Robert J. Mentz
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
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17
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18
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Beusekamp JC, Tromp J, Cleland JG, Givertz MM, Metra M, O’Connor CM, Teerlink JR, Ponikowski P, Ouwerkerk W, van Veldhuisen DJ, Voors AA, van der Meer P. Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality. JACC: Heart Failure 2019; 7:970-979. [DOI: 10.1016/j.jchf.2019.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
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19
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20
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Reddy YNV, Borlaug BA, O’Connor CM, Gersh BJ. Novel approaches to the management of chronic systolic heart failure: future directions and unanswered questions. Eur Heart J 2019; 41:1764-1774. [DOI: 10.1093/eurheartj/ehz364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/25/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Despite improvements in outcomes in the last few decades for heart failure (HF) with reduced ejection fraction (HFrEF), there still remains a need for novel therapies as many patients incompletely recover with existing therapies and progress to advanced HF. In this review, we will discuss recent advances in the management of HFrEF with a focus on upcoming therapies that hold the greatest promise for clinical use. We will discuss novel pharmacological therapies and areas of uncertainty with existing therapies. We will also discuss the potential utility and controversy surrounding novel interventions for HF such as percutaneous mitral valve repair, atrial fibrillation ablation, and other emerging interventions with positive signals for benefit in HFrEF. Finally, we will summarize the current state of stem cell and gene therapy for HFrEF and future directions.
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Affiliation(s)
- Yogesh N V Reddy
- The Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, MN 55906, USA
| | - Barry A Borlaug
- The Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, MN 55906, USA
| | | | - Bernard J Gersh
- The Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, MN 55906, USA
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21
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Butler J, Lam CS, Anstrom KJ, Ezekowitz J, Hernandez AF, O’Connor CM, Pieske B, Ponikowski P, Shah SJ, Solomon SD, Voors AA, Wu Y, Carvalho F, Bamber L, Blaustein RO, Roessig L, Armstrong PW. Rationale and Design of the VITALITY-HFpEF Trial. Circ Heart Fail 2019; 12:e005998. [DOI: 10.1161/circheartfailure.119.005998] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B.)
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Duke-National University of Singapore (C.S.P.L.)
- The George Institute for Global Health (C.S.P.L.)
- University Medical Center Groningen, (C.S.P.L.), the Netherlands
| | | | - Justin Ezekowitz
- Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (J.E., P.W.A.)
| | | | - Christopher M. O’Connor
- Duke University Medical Center, Durham, NC (C.M.O.)
- Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.)
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Germany (B.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, and German Centre for Cardiovascular Research (DZHK), Partner site Berlin, and Berlin Institute of Health (BIH), Germany (B.P.)
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Poland (P.P.)
- Cardiology Department, Military Hospital, Wrocław, Poland (P.P.)
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Scott D. Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Adriaan A. Voors
- Department of Cardiology, University of Groningen (A.A.V.), the Netherlands
| | - Yi Wu
- Bayer AG, Wuppertal, Germany (Y.W., F.C., L.B., L.R.)
| | | | - Luke Bamber
- Bayer AG, Wuppertal, Germany (Y.W., F.C., L.B., L.R.)
| | | | | | - Paul W. Armstrong
- Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (J.E., P.W.A.)
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22
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Tahhan AS, Vaduganathan M, Greene SJ, Fonarow GC, Fiuzat M, Jessup M, Lindenfeld J, O’Connor CM, Butler J. Enrollment of Older Patients, Women, and Racial and Ethnic Minorities in Contemporary Heart Failure Clinical Trials. JAMA Cardiol 2018; 3:1011-1019. [DOI: 10.1001/jamacardio.2018.2559] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Ayman Samman Tahhan
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen J. Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Gregg C. Fonarow
- Ahmanson-University of California, Los Angeles Cardiomyopathy Center, University of California, Los Angeles
- Section Editor, JAMA Cardiology
| | - Mona Fiuzat
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | | | | | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson
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23
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Jiang W, Whellan DJ, Adams KF, Babyak MA, Boyle SH, Wilson JL, Patel CB, Rogers JG, Harris WS, O’Connor CM. Long-Chain Omega-3 Fatty Acid Supplements in Depressed Heart Failure Patients. JACC: Heart Failure 2018; 6:833-843. [DOI: 10.1016/j.jchf.2018.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/21/2022]
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24
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Parikh KS, Sharma K, Fiuzat M, Surks HK, George JT, Honarpour N, Depre C, Desvigne-Nickens P, Nkulikiyinka R, Lewis GD, Gomberg-Maitland M, O’Connor CM, Stockbridge N, Califf RM, Konstam MA, Januzzi JL, Solomon SD, Borlaug BA, Shah SJ, Redfield MM, Felker GM. Heart Failure With Preserved Ejection Fraction Expert Panel Report. JACC: Heart Failure 2018; 6:619-632. [DOI: 10.1016/j.jchf.2018.06.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 01/08/2023]
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25
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Ortel TL, Gockerman JP, Califf RM, McCann RL, O’Connor CM, Metzler DM, Greenberg CS. Parenteral Anticoagulation with the Heparinoid Lomoparan (Org 10172) in Patients with Heparin Induced Thrombocytopenia and Thrombosis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648434] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryProgressive thrombocytopenia may develop in as many as 5% of patients receiving heparin anticoagulation. In these patients, the risk of thromboembolic complications as well as continued thrombocytopenia necessitates discontinuation of heparin and initiation of an alternative anticoagulant when indicated. The heparinoid Lomoparan (Org 10172) is a mixture of several nonheparin low molecular weight glycosaminoglycans with proven anticoagulant efficacy that is generally non-reactive with platelets in the presence of plasma from patients with heparin induced thrombocytopenia, whereas standard heparin will induce platelet aggregation. We evaluated the role of heparinoid as a potential alternative anticoagulant in patients with heparin induced thrombocytopenia. During a 6 month period, we identified six patients with heparin induced thrombocytopenia who required an alternative parenteral anticoagulant, four as primary treatment for specific medical problem, and two as anticoagulation during a necessary surgical procedure. Heparinoid was used successfully in both medical and surgical patients requiring parenteral anticoagulation. In no case was there an exacerbation of the thrombocytopenia nor thromboembolic complications while on heparinoid therapy. Three of our patients sustained hemorrhagic complications, predominantly in the post-surgical setting in association with elevated anti-factor Xa levels and additional anticoagulant agents. We feel that these results confirm the utility of heparinoid anticoagulation in a select subset of patients with heparin induced thrombocytopenia who require continued parenteral anticoagulation.
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Affiliation(s)
- Thomas L Ortel
- The Divisions of Hematology/Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jon P Gockerman
- The Divisions of Hematology/Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert M Califf
- The Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard L McCann
- The Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher M O’Connor
- The Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Diane M Metzler
- The Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
| | - Charles S Greenberg
- The Divisions of Hematology/Oncology, Duke University Medical Center, Durham, North Carolina, USA
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26
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Hicks KA, Mahaffey KW, Mehran R, Nissen SE, Wiviott SD, Dunn B, Solomon SD, Marler JR, Teerlink JR, Farb A, Morrow DA, Targum SL, Sila CA, Thanh Hai MT, Jaff MR, Joffe HV, Cutlip DE, Desai AS, Lewis EF, Gibson CM, Landray MJ, Lincoff AM, White CJ, Brooks SS, Rosenfield K, Domanski MJ, Lansky AJ, McMurray JJ, Tcheng JE, Steinhubl SR, Burton P, Mauri L, O’Connor CM, Pfeffer MA, Hung HJ, Stockbridge NL, Chaitman BR, Temple RJ, Fitter HD, Illoh K, Cavanaugh KJ, Scirica BM, Irony I, Brown Kichline RE, Levine JG, Park A, Sacks L, Szarfman A, Unger EF, Wachter LA, Zuckerman B, Mitchel Y, Peddicord D, Shook T, Kisler B, Jaffe C, Bartley R, DeMets DL, Mencini M, Janning C, Bai S, Lawrence J, D’Agostino RB, Pocock SJ. 2017 Cardiovascular and Stroke Endpoint Definitions for Clinical Trials. J Am Coll Cardiol 2018; 71:1021-1034. [DOI: 10.1016/j.jacc.2017.12.048] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
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27
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Hicks KA, Mahaffey KW, Mehran R, Nissen SE, Wiviott SD, Dunn B, Solomon SD, Marler JR, Teerlink JR, Farb A, Morrow DA, Targum SL, Sila CA, Hai MTT, Jaff MR, Joffe HV, Cutlip DE, Desai AS, Lewis EF, Gibson CM, Landray MJ, Lincoff AM, White CJ, Brooks SS, Rosenfield K, Domanski MJ, Lansky AJ, McMurray JJ, Tcheng JE, Steinhubl SR, Burton P, Mauri L, O’Connor CM, Pfeffer MA, Hung HJ, Stockbridge NL, Chaitman BR, Temple RJ. 2017 Cardiovascular and Stroke Endpoint Definitions for Clinical Trials. Circulation 2018; 137:961-972. [DOI: 10.1161/circulationaha.117.033502] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/22/2017] [Indexed: 11/16/2022]
Abstract
This publication describes uniform definitions for cardiovascular and stroke outcomes developed by the Standardized Data Collection for Cardiovascular Trials Initiative and the US Food and Drug Administration (FDA). The FDA established the Standardized Data Collection for Cardiovascular Trials Initiative in 2009 to simplify the design and conduct of clinical trials intended to support marketing applications. The writing committee recognizes that these definitions may be used in other types of clinical trials and clinical care processes where appropriate. Use of these definitions at the FDA has enhanced the ability to aggregate data within and across medical product development programs, conduct meta-analyses to evaluate cardiovascular safety, integrate data from multiple trials, and compare effectiveness of drugs and devices. Further study is needed to determine whether prospective data collection using these common definitions improves the design, conduct, and interpretability of the results of clinical trials.
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Affiliation(s)
- Karen A. Hicks
- Division of Cardiovascular and Renal Products, Office of Drug Evaluation I, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (K.A.H., S.L.T., N.L.S.)
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California (K.W.M.)
| | - Roxana Mehran
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York (R.M.)
| | - Steven E. Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio (S.E.N., A.M.L.)
| | - Stephen D. Wiviott
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts (S.D.W., D.A.M.)
| | - Billy Dunn
- Division of Neurology Products, Office of Drug Evaluation I, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (B.D., J.R.M.)
| | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts (S.D.S., A.S.D., E.F.L., M.A.P.)
| | - John R. Marler
- Division of Neurology Products, Office of Drug Evaluation I, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (B.D., J.R.M.)
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California (J.R.T.)
| | - Andrew Farb
- Division of Cardiovascular Devices, Center for Devices and Radiological Health (CDRH), United States Food and Drug Administration (FDA), Silver Spring, Maryland (A.F.)
| | - David A. Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts (S.D.W., D.A.M.)
| | - Shari L. Targum
- Division of Cardiovascular and Renal Products, Office of Drug Evaluation I, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (K.A.H., S.L.T., N.L.S.)
| | - Cathy A. Sila
- Neurological Institute, University Hospitals-Cleveland Medical Center, Cleveland, Ohio (C.A.S.)
| | - Mary T. Thanh Hai
- Office of Drug Evaluation II, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (M.T.T.)
| | - Michael R. Jaff
- Department of Medicine, Harvard Medical School, Boston, Massachusetts (M.R.J.)
| | - Hylton V. Joffe
- Division of Bone, Reproductive and Urologic Products, Office of Drug Evaluation III, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (H.V.J.)
| | - Donald E. Cutlip
- Cardiology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (D.E.C.)
| | - Akshay S. Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts (S.D.S., A.S.D., E.F.L., M.A.P.)
| | - Eldrin F. Lewis
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts (S.D.S., A.S.D., E.F.L., M.A.P.)
| | - C. Michael Gibson
- Cardiovascular Division, Department of Medicine, Harvard Medical School, Boston, Massachusetts (C.M.G.)
| | - Martin J. Landray
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, United Kingdom (M.J.L.)
| | - A. Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio (S.E.N., A.M.L.)
| | - Christopher J. White
- Department of Cardiology, Ochsner Clinical School, New Orleans, Louisiana (C.J.W.)
| | | | - Kenneth Rosenfield
- Vascular Medicine and Intervention, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts (K.R.)
| | - Michael J. Domanski
- Peter Munk Cardiac Centre, University Health Network/Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada (M.J.D.)
| | - Alexandra J. Lansky
- Department of Internal Medicine, Section of Cardiology, Yale School of Medicine, New Haven, Connecticut (A.J.L.)
| | - John J.V. McMurray
- Institute of Cardiovascular & Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (J.J.V.M.)
| | - James E. Tcheng
- Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina (J.E.T.)
| | - Steven R. Steinhubl
- Division of Digital Medicine, Scripps Translational Science Institute, La Jolla, California (S.R.S.)
| | - Paul Burton
- Cardiovascular and Metabolism Medical Affairs, Janssen Pharmaceuticals Inc., Titusville, New Jersey (P.B.)
| | - Laura Mauri
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts (L.M.)
| | | | - Marc A. Pfeffer
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts (S.D.S., A.S.D., E.F.L., M.A.P.)
| | - H.M. James Hung
- Division of Biometrics I, Office of Biostatistics, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (H.M.J.H.)
| | - Norman L. Stockbridge
- Division of Cardiovascular and Renal Products, Office of Drug Evaluation I, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (K.A.H., S.L.T., N.L.S.)
| | - Bernard R. Chaitman
- Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis, Missouri (B.R.C.)
| | - Robert J. Temple
- Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration (FDA), Silver Spring, Maryland (R.J.T.)
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Fudim M, O’Connor CM, Dunning A, Ambrosy AP, Armstrong PW, Coles A, Ezekowitz JA, Greene SJ, Metra M, Starling RC, Voors AA, Hernandez AF, Felker GM, Mentz RJ. Aetiology, timing and clinical predictors of early vs. late readmission following index hospitalization for acute heart failure: insights from ASCEND-HF. Eur J Heart Fail 2018; 20:304-314. [PMID: 29082629 PMCID: PMC5826892 DOI: 10.1002/ejhf.1020] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/27/2017] [Accepted: 08/28/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS Patients hospitalized for heart failure (HF) are at high risk for 30-day readmission. This study sought to examine the timings and causes of readmission within 30 days of an HF hospitalization. METHODS AND RESULTS Timing and cause of readmission in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure) trial were assessed. Early and late readmissions were defined as admissions occurring within 0-7 days and 8-30 days post-discharge, respectively. Patients who died in hospital or remained hospitalized at day 30 post-randomization were excluded. Patients were compared by timing and cause of readmission. Logistic and Cox proportional hazards regression analyses were used to identify independent risk factors for early vs. late readmission and associations with 180-day outcomes. Of the 6584 patients (92%) in the ASCEND-HF population included in this analysis, 751 patients (11%) were readmitted within 30 days for any cause. Overall, 54% of readmissions were for non-HF causes. The median time to rehospitalization was 11 days (interquartile range: 6-18 days) and 33% of rehospitalizations occurred by day 7. Rehospitalization within 30 days was independently associated with increased risk for 180-day all-cause death [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.93-2.94; P < 0.001]. Risk for 180-day all-cause death did not differ according to early vs. late readmission (HR 0.99, 95% CI 0.67-1.45; P = 0.94). CONCLUSIONS In this hospitalized HF trial population, a significant majority of 30-day readmissions were for non-HF causes and one-third of readmissions occurred in the first 7 days. Early and late readmissions within the 30-day timeframe were associated with similarly increased risk for death. Continued efforts to optimize multidisciplinary transitional care are warranted to improve rates of early readmission.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
| | | | - Allison Dunning
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
| | - Andrew P. Ambrosy
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
| | | | - Adrian Coles
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
| | | | - Stephen J. Greene
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Metra
- Division of Cardiology, Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy
| | | | - Adriaan A. Voors
- Division of Cardiology, University of Groningen, Groningen, the Netherlands
| | | | - G. Michael Felker
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
| | - Robert J. Mentz
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
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O’Connor CM, Psotka MA, Fiuzat M, Lindenfeld J, Abraham WT, Bristow MR, Canos D, Harrington RA, Hillebrenner M, Jessup M, Malik FI, Solomon SD, Stockbridge N, Tcheng JE, Unger EF, Whellan DJ, Zuckerman B, Califf RM. Improving Heart Failure Therapeutics Development in the United States. J Am Coll Cardiol 2018; 71:443-453. [DOI: 10.1016/j.jacc.2017.11.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/30/2017] [Accepted: 11/27/2017] [Indexed: 01/24/2023]
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30
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Felker GM, Anstrom KJ, Adams KF, Ezekowitz JA, Fiuzat M, Houston-Miller N, Januzzi JL, Mark DB, Piña IL, Passmore G, Whellan DJ, Yang H, Cooper LS, Leifer ES, Desvigne-Nickens P, O’Connor CM. Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial. JAMA 2017; 318:713-720. [PMID: 28829876 PMCID: PMC5605776 DOI: 10.1001/jama.2017.10565] [Citation(s) in RCA: 346] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE The natriuretic peptides are biochemical markers of heart failure (HF) severity and predictors of adverse outcomes. Smaller studies have evaluated adjusting HF therapy based on natriuretic peptide levels ("guided therapy") with inconsistent results. OBJECTIVE To determine whether an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy improves clinical outcomes vs usual care in high-risk patients with HF and reduced ejection fraction (HFrEF). DESIGN, SETTINGS, AND PARTICIPANTS The Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) study was a randomized multicenter clinical trial conducted between January 16, 2013, and September 20, 2016, at 45 clinical sites in the United States and Canada. This study planned to randomize 1100 patients with HFrEF (ejection fraction ≤40%), elevated natriuretic peptide levels within the prior 30 days, and a history of a prior HF event (HF hospitalization or equivalent) to either an NT-proBNP-guided strategy or usual care. INTERVENTIONS Patients were randomized to either an NT-proBNP-guided strategy or usual care. Patients randomized to the guided strategy (n = 446) had HF therapy titrated with the goal of achieving a target NT-proBNP of less than 1000 pg/mL. Patients randomized to usual care (n = 448) had HF care in accordance with published guidelines, with emphasis on titration of proven neurohormonal therapies for HF. Serial measurement of NT-proBNP testing was discouraged in the usual care group. MAIN OUTCOMES AND MEASURES The primary end point was the composite of time-to-first HF hospitalization or cardiovascular mortality. Prespecified secondary end points included all-cause mortality, total hospitalizations for HF, days alive and not hospitalized for cardiovascular reasons, the individual components on the primary end point, and adverse events. RESULTS The data and safety monitoring board recommended stopping the study for futility when 894 (median age, 63 years; 286 [32%] women) of the planned 1100 patients had been enrolled with follow-up for a median of 15 months. The primary end point occurred in 164 patients (37%) in the biomarker-guided group and 164 patients (37%) in the usual care group (adjusted hazard ratio [HR], 0.98; 95% CI, 0.79-1.22; P = .88). Cardiovascular mortality was 12% (n = 53) in the biomarker-guided group and 13% (n = 57) in the usual care group (HR, 0.94; 95% CI; 0.65-1.37; P = .75). None of the secondary end points nor the decreases in the NT-proBNP levels achieved differed significantly between groups. CONCLUSIONS AND RELEVANCE In high-risk patients with HFrEF, a strategy of NT-proBNP-guided therapy was not more effective than a usual care strategy in improving outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01685840.
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Affiliation(s)
| | | | | | | | - Mona Fiuzat
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - James L. Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | - Hongqiu Yang
- Duke Clinical Research Institute, Durham, NC, USA
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Eric S. Leifer
- Division of Cardiovascular Sciences, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | | | - Christopher M. O’Connor
- Duke Clinical Research Institute, Durham, NC, USA
- Inova Heart and Vascular Center, Fairfax, VA, USA
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31
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Greene SJ, Hernandez AF, Dunning A, Ambrosy AP, Armstrong PW, Butler J, Cerbin LP, Coles A, Ezekowitz JA, Metra M, Starling RC, Teerlink JR, Voors AA, O’Connor CM, Mentz RJ. Hospitalization for Recently Diagnosed Versus Worsening Chronic Heart Failure. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.04.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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32
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Sun JL, Boyle SH, Samad Z, Babyak MA, Wilson JL, Kuhn C, Becker RC, Ortel TL, Williams RB, Rogers JG, O’Connor CM, Velazquez EJ, Jiang W. Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients. Eur J Prev Cardiol 2017; 24:591-599. [PMID: 28067532 PMCID: PMC6093615 DOI: 10.1177/2047487316686435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims Mental stress-induced myocardial ischemia (MSIMI) occurs in up to 70% of patients with clinically stable ischemic heart disease and is associated with increased risk of adverse prognosis. We aimed to examine the prognostic value of indices of MSIMI and exercise stress-induced myocardial ischemia (ESIMI) in a population of ischemic heart disease patients that was not confined by having a recent positive physical stress test. Methods and results The Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study enrolled 310 subjects who underwent mental and exercise stress testing and were followed annually for a median of four years. Study endpoints included time to first and total rate of major adverse cardiovascular events, defined as all-cause mortality and hospitalizations for cardiovascular causes. Cox and negative binomial regression adjusting for age, sex, resting left ventricular ejection fraction, and heart failure status were used to examine associations of indices of MSIMI and ESIMI with study endpoints. The continuous variable of mental stress-induced left ventricular ejection fraction change was significantly associated with both endpoints (all p values < 0.05). For every reduction of 5% in left ventricular ejection fraction induced by mental stress, patients had a 5% increase in the probability of a major adverse cardiovascular event at the median follow-up time and a 20% increase in the number of major adverse cardiovascular events endured over the follow-up period of six years. Indices of ESIMI did not predict endpoints ( ps > 0.05). Conclusion In patients with stable ischemic heart disease, mental, but not exercise, stress-induced left ventricular ejection fraction change significantly predicts risk of future adverse cardiovascular events.
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Affiliation(s)
- Julia L Sun
- Department of Medicine, University of Chicago Medical Center, USA
| | - Stephen H Boyle
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Zainab Samad
- Departments of Medicine, Duke University Medical Center, USA
| | - Michael A Babyak
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Jennifer L Wilson
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Cynthia Kuhn
- Pharmacology and Cancer Biology, Duke University Medical Center, USA
| | - Richard C Becker
- Department of Medicine, University of Cincinnati Medical Center, USA
| | - Thomas L Ortel
- Departments of Medicine, Duke University Medical Center, USA
| | | | - Joseph G Rogers
- Departments of Medicine, Duke University Medical Center, USA
- Duke Clinical Research Institute, USA
| | - Christopher M O’Connor
- Departments of Medicine, Duke University Medical Center, USA
- Duke Clinical Research Institute, USA
| | - Eric J Velazquez
- Departments of Medicine, Duke University Medical Center, USA
- Duke Clinical Research Institute, USA
| | - Wei Jiang
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
- Departments of Medicine, Duke University Medical Center, USA
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33
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Felker GM, Mentz RJ, Cole RT, Adams KF, Egnaczyk GF, Fiuzat M, Patel CB, Echols M, Khouri MG, Tauras JM, Gupta D, Monds P, Roberts R, O’Connor CM. Efficacy and Safety of Tolvaptan in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol 2017; 69:1399-1406. [DOI: 10.1016/j.jacc.2016.09.004] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 01/11/2023]
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34
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Greene SJ, Hernandez AF, Sun JL, Metra M, Butler J, Ambrosy AP, Ezekowitz JA, Starling RC, Teerlink JR, Schulte PJ, Voors AA, Armstrong PW, O’Connor CM, Mentz RJ. Influence of Clinical Trial Site Enrollment on Patient Characteristics, Protocol Completion, and End Points. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.116.002986. [DOI: 10.1161/circheartfailure.116.002986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 08/08/2016] [Indexed: 12/12/2022]
Abstract
Background—
Most international acute heart failure trials have failed to show benefit with respect to key end points. The impact of site enrollment and protocol execution on trial performance is unclear.
Methods and Results—
We assessed the impact of varying site enrollment volume among all 7141 acute heart failure patients from the ASCEND-HF trial (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure). Overall, 398 sites enrolled ≥1 patient, and median enrollment was 12 patients (interquartile range, 5–23). Patients from high enrolling sites (>60 patients/site) tended to have lower ejection fraction, worse New York Heart Association functional class, and lower utilization of guideline-directed medical therapy but fewer comorbidities and lower B-type natriuretic peptide level. Every 10 patient increase (up to 100 patients) in site enrollment correlated with lower likelihood of protocol noncompletion (odds ratio, 0.93; 95% confidence interval [CI], 0.89–0.98). After adjustment, increasing site enrollment predicted higher risk of persistent dyspnea at 6 hours (per 10 patient increase: odds ratio 1.02; 95% CI, 1.01–1.03) but not at 24 hours (odds ratio, 0.99; 95% CI, 0.98–1.00). Higher site enrollment was independently associated with lower risk of 30-day death or rehospitalization (per 10 patient increase: odds ratio, 0.98, 95% CI, 0.96–0.99) but not 180-day mortality (hazard ratio, 0.99; 95% CI, 0.98–1.01). The influence of increasing site enrollment on clinical end points varied across geographic regions with strongest associations in Latin America and Asia-Pacific (all interaction
P
<0.01).
Conclusions—
In this large, acute heart failure trial, site enrollment correlated with protocol completion and was independently associated with trial end points. Individual and regional site performance present challenges to be considered in design of future acute heart failure trials.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00475852.
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Affiliation(s)
- Stephen J. Greene
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Adrian F. Hernandez
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Jie-Lena Sun
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Marco Metra
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Javed Butler
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Andrew P. Ambrosy
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Justin A. Ezekowitz
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Randall C. Starling
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - John R. Teerlink
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Phillip J. Schulte
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Adriaan A. Voors
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Paul W. Armstrong
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Christopher M. O’Connor
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
| | - Robert J. Mentz
- From the Division of Cardiology, Duke University Medical Center, Durham, NC (S.J.G., A.F.H., A.P.A., C.M.O., R.J.M.); Duke Clinical Research Institute, Durham, NC (A.F.H., J.-L.S., A.P.A., P.J.S., C.M.O., R.J.M.); Cardiology, University of Brescia, Italy (M.M.); Division of Cardiology, Stony Brook University, NY (J.B.); Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E., P.W.A.); Cleveland Clinic, OH (R.C.S.); Section of Cardiology, San Francisco Veterans Affairs Medical Center,
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ter Maaten JM, Damman K, Hanberg JS, Givertz MM, Metra M, O’Connor CM, Teerlink JR, Ponikowski P, Cotter G, Davison B, Cleland JG, Bloomfield DM, Hillege HL, van Veldhuisen DJ, Voors AA, Testani JM. Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.116.003109. [DOI: 10.1161/circheartfailure.116.003109] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 07/14/2016] [Indexed: 11/16/2022]
Abstract
Background—
Chloride plays a role in renal salt sensing, neurohormonal activation, and regulation of diuretic targets, and hypochloremia predicts mortality in acute heart failure (AHF). AHF therapies, such as diuretics, alter chloride homeostasis. We studied the association between (changes in) chloride levels and diuretic responsiveness, decongestion, and mortality in patients with AHF.
Methods and Results—
Patients hospitalized for AHF in the PROTECT trial (n=2033) with serum chloride levels within 24 hours of admission and 14 days later were studied (n=1960). Hypochloremia was defined as serum chloride <96 mEq/L. Mean baseline chloride was 100.8±5.0 mEq/L. Low baseline chloride was associated with high bicarbonate, poor diuretic response, less hemoconcentration, and worsening heart failure (all
P
<0.01). Newly developed hypochloremia at day 14 was common and associated with a decline in renal function and an increase in blood urea nitrogen (
P
<0.01). In multivariable analyses, chloride measured at day 14, but not baseline chloride, was strongly and independently associated with mortality through 180 days (hazard ratio per unit decrease: 1.07 [1.03–1.10];
P
<0.001). In comparison, sodium was not significantly associated with mortality after multivariable adjustment at any time point. Hypochloremia at baseline that resolved was not associated with mortality (
P
=0.55), but new or persistent hypochloremia at day 14 was associated with increased mortality (hazard ratio: 3.11 [2.17–4.46];
P
<0.001).
Conclusions—
Low serum chloride at AHF hospital admission was strongly associated with impaired decongestion. New or persistent hypochloremia 14 days later was independently associated with reduced survival, whereas hypochloremia that resolved by day 14 was not.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00354458.
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Affiliation(s)
- Jozine M. ter Maaten
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Kevin Damman
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Jennifer S. Hanberg
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Michael M. Givertz
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Marco Metra
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Christopher M. O’Connor
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - John R. Teerlink
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Piotr Ponikowski
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Gad Cotter
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Beth Davison
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - John G. Cleland
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Daniel M. Bloomfield
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Hans L. Hillege
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Dirk J. van Veldhuisen
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Adriaan A. Voors
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
| | - Jeffrey M. Testani
- From the University Medical Center, University of Groningen, The Netherlands (J.M.t.M., K.D., H.L.H., D.J.v.V., A.A.V.); Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.t.M., J.S.H., J.M.T.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical
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Paine NJ, Hinderliter AL, Blumenthal JA, Adams KF, Sueta CA, Chang PP, O’Connor CM, Sherwood A. Reactive hyperemia is associated with adverse clinical outcomes in heart failure. Am Heart J 2016; 178:108-14. [PMID: 27502858 DOI: 10.1016/j.ahj.2016.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/16/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Impaired endothelial function, as assessed by brachial artery flow-mediated dilation (FMD), is an established risk factor for cardiovascular events. FMD is impaired in heart failure (HF) patients, but less is known about hyperemic brachial artery flow. We investigated the relationship between FMD and hyperemic flow with adverse clinical outcomes in HF patients. METHODS Brachial artery FMD and hyperemic flow were assessed in 156 patients (70.5 % Male; 45.5% Caucasian; mean age (± SD) = 56.2 (±12.4) years) with HF and reduced left ventricular ejection fraction (LVEF). Cox proportional hazard models were used to assess the potential explanatory association of FMD and hyperemic flow with the composite outcome of death or cardiovascular hospitalization over a median 5-year follow-up period. RESULTS Both FMD and hyperemic flow were negatively correlated with age, but unrelated to sex, race, body mass index, LVEF or N-terminal pro-B-Type natriuretic peptide (NT-ProBNP). Reduced hyperemic flow, but not FMD, was associated with an increased risk of death or cardiac hospitalization after controlling for traditional risk factors. CONCLUSION The association of reduced hyperemic flow with increased risk of adverse clinical outcomes suggests that micro-vascular function may be an important prognostic marker in patients with HF.
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ter Maaten JM, Valente MA, Damman K, Cleland JG, Givertz MM, Metra M, O’Connor CM, Teerlink JR, Ponikowski P, Bloomfield DM, Cotter G, Davison B, Subacius H, van Veldhuisen DJ, van der Meer P, Hillege HL, Gheorghiade M, Voors AA. Combining Diuretic Response and Hemoconcentration to Predict Rehospitalization After Admission for Acute Heart Failure. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.115.002845. [DOI: 10.1161/circheartfailure.115.002845] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/02/2016] [Indexed: 11/16/2022]
Abstract
Background—
Both diuretic response and hemoconcentration are indicators of decongestion and have individually been found to predict rehospitalization after admission for acute heart failure (HF). This study examines the value of combining diuretic response and hemoconcentration to better predict patients at low risk for rehospitalization after admission for acute HF.
Methods and Results—
Diuretic response (defined as weight change per 40 mg of furosemide on day 4 after admission) and hemoconcentration (change in hemoglobin at discharge or day 7) were tested both individually and combined to predict the risk of HF and cardiovascular rehospitalization 60 days after hospitalization for acute HF. Analyses were performed in 1180 patients enrolled in the Placebo-Controlled Randomized Study of the Selective Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) trial and validated in 1776 patients enrolled in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial. Poor diuretic response was associated with low systolic blood pressure, high blood urea nitrogen, and history of coronary revascularization in both data sets (all
P
<0.05). Hemoconcentration was mainly associated with better renal function (
P
<0.05). Patients who displayed both favorable diuretic response and hemoconcentration had a markedly lower risk of rehospitalization for HF in PROTECT (multivariable HR, 0.41; 95% CI, 0.24 to 0.70;
P
<0.001) compared with all other patients. This finding was confirmed in EVEREST (multivariable HR, 0.52; 95% CI, 0.33 to 0.82;
P
=0.004) for patients with favorable diuretic response and hemoconcentration compared with all other patients.
Conclusions—
Combining 2 indicators of decongestion, hemoconcentration and diuretic response improves risk prediction for early rehospitalization after an admission for acute HF and may provide clinicians with an easily accessible tool to identify low-risk patients.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT00354458 and NCT00071331.
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Affiliation(s)
- Jozine M. ter Maaten
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Mattia A.E. Valente
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Kevin Damman
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - John G. Cleland
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Michael M. Givertz
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Marco Metra
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Christopher M. O’Connor
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - John R. Teerlink
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Piotr Ponikowski
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Daniel M. Bloomfield
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Gadi Cotter
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Beth Davison
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Haris Subacius
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Dirk J. van Veldhuisen
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Peter van der Meer
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Hans L. Hillege
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Mihai Gheorghiade
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
| | - Adriaan A. Voors
- From the Departments of Cardiology (J.M.t.M., M.A.E.V., K.D., D.J.v.V., P.v.d.M., H.L.H., A.A.V.) and Epidemiology (H.L.H.), University of Groningen, University Medical Center Groningen, The Netherlands; University of Hull, Kingston Upon Hull, United Kingdom (J.G.C.); Brigham and Women’s Hospital, Boston, MA (M.M.G.); University of Brescia, Italy (M.M.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.C.); University of California at San Francisco, San Francisco Veterans Affairs Medical
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Demissei B, Postmus D, Liu L, Cleland J, O’Connor CM, Metra M, Ponikowski P, Teerlink J, Cotter G, Davison B, Givertz M, Bloomfield D, Dittrich H, Voors A, Hillege H. HETEROGENEITY IN EFFICACY OF ROLOFYLLINE USING A RISK-BASED EVALUATION IN PATIENTS HOSPITALIZED WITH ACUTE HEART FAILURE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Felker GM, Mentz RJ, Adams KF, Cole RT, Egnaczyk GF, Patel CB, Fiuzat M, Gregory D, Wedge P, O’Connor CM, Udelson JE, Konstam MA. Tolvaptan in Patients Hospitalized With Acute Heart Failure. Circ Heart Fail 2015; 8:997-1005. [DOI: 10.1161/circheartfailure.115.002259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- G. Michael Felker
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Robert J. Mentz
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Kirkwood F. Adams
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Robert T. Cole
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Gregory F. Egnaczyk
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Chetan B. Patel
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Mona Fiuzat
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Douglas Gregory
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Patricia Wedge
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Christopher M. O’Connor
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - James E. Udelson
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Marvin A. Konstam
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe G, Oparil S, White WB. Treatment of Hypertension in Patients With Coronary Artery Disease. Hypertension 2015; 65:1372-407. [PMID: 25828847 DOI: 10.1161/hyp.0000000000000018] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe O, Oparil S, White WB. Treatment of Hypertension in Patients With Coronary Artery Disease. J Am Coll Cardiol 2015; 65:1998-2038. [PMID: 25840655 DOI: 10.1016/j.jacc.2015.02.038] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Jiang W, Boyle SH, Ortel TL, Samad Z, Velazquez EJ, Harrison RW, Wilson J, Kuhn C, Williams RB, O’Connor CM, Becker RC. Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J 2015; 169:496-507.e1. [PMID: 25819856 PMCID: PMC4382806 DOI: 10.1016/j.ahj.2014.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/15/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. METHODS Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. RESULTS Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n=117) met criteria for MSIMI and 18.15% (n=49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10μM (6.95[5.54] vs. -14.23[8.75].; P=0.045), epinephrine 10μM (12.84[4.84] vs. -6.40[7.61].; P=0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P<.001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. CONCLUSIONS These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.
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Tang WW, Dupont M, Hernandez AF, Voors AA, Hsu AP, Felker GM, Butler J, Metra M, Anker SD, Troughton RW, Gottlieb SS, McMurray JJ, Armstrong PW, Massie BM, Califf RM, O’Connor CM, Starling RC. Comparative Assessment of Short-Term Adverse Events in Acute Heart Failure With Cystatin C and Other Estimates of Renal Function. JACC: Heart Failure 2015; 3:40-49. [DOI: 10.1016/j.jchf.2014.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/23/2014] [Accepted: 06/30/2014] [Indexed: 01/10/2023]
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Mentz RJ, Tulsky JA, Granger BB, Anstrom KJ, Adams PA, Dodson GC, Fiuzat M, Johnson KS, Patel CB, Steinhauser KE, Taylor DH, O’Connor CM, Rogers JG. The palliative care in heart failure trial: rationale and design. Am Heart J 2014; 168:645-651.e1. [PMID: 25440791 DOI: 10.1016/j.ahj.2014.07.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. METHODS PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life. CONCLUSIONS PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points.
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48
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Kalogeropoulos AP, Tang WHW, Hsu A, Felker GM, Hernandez AF, Troughton RW, Voors AA, Anker SD, Metra M, McMurray JJ, Massie BM, Ezekowitz JA, Califf RM, O’Connor CM, Starling RC, Butler J. High-Sensitivity C-Reactive Protein in Acute Heart Failure: Insights From the ASCEND-HF Trial. J Card Fail 2014; 20:319-26. [DOI: 10.1016/j.cardfail.2014.02.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/30/2014] [Accepted: 02/06/2014] [Indexed: 11/16/2022]
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Wilcox JE, Fonarow GC, Zhang Y, Albert NM, Curtis AB, Gheorghiade M, Heywood JT, Mehra MR, O’Connor CM, Reynolds D, Walsh MN, Yancy CW. Clinical Effectiveness of Cardiac Resynchronization and Implantable Cardioverter-Defibrillator Therapy in Men and Women With Heart Failure. Circ Heart Fail 2014; 7:146-53. [DOI: 10.1161/circheartfailure.113.000789] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Many clinical trials have demonstrated a benefit for cardiac resynchronization (CRT) and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure and reduced ejection fraction, yet questions have been raised with regard to the benefit of ICDs for women. The purpose of this study was to determine the clinical effectiveness of CRT and ICD therapy as a function of sex in outpatients with heart failure and reduced ejection fraction (≤35%).
Methods and Results—
Data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) were analyzed by device status and sex among guideline-eligible patients for vital status (alive/dead) at 24 months. Multivariate generalized estimating equation analyses were conducted adjusting for baseline patient and practice characteristics. In the ICD/CRT-defibrillator (CRT-D) eligible cohort (n=7748), there were 5485 (71%) men and 2261 (29%) women. In the CRT-pacemaker (CRT-P)/CRT-D eligible cohort (n=1188), there were 824 (69%) men and 364 (31%) women. The clinical benefit associated with ICD/CRT-D therapy was similar in both men and women (men adjusted odds ratio, 0.71; 95% confidence interval, 0.57–0.87;
P
=0.0012; and women adjusted odds ratio, 0.65; 95% confidence interval, 0.49–0.85;
P
=0.0019). For CRT-P/CRT-D, the associated benefits showed no significant heterogeneity (men adjusted odds ratio, 0.59; 95% confidence interval, 0.33–1.06;
P
=0.0793; and women adjusted odds ratio, 0.44; 95% confidence interval, 0.22–0.90;
P
=0.0243). The device-by-sex interactions were not significant (
P
=0.4441 for CRT-P/CRT-D and
P
=0.5966 for ICD/CRT-D).
Conclusions—
The use of guideline-directed CRT and ICD therapy was associated with substantially reduced 24-month mortality in eligible men and women with heart failure and reduced ejection fraction. Device therapies should be offered to all eligible patients with heart failure, without modification based on sex.
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Affiliation(s)
- Jane E. Wilcox
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Gregg C. Fonarow
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Yan Zhang
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Nancy M. Albert
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Anne B. Curtis
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Mihai Gheorghiade
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - J. Thomas Heywood
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Mandeep R. Mehra
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Christopher M. O’Connor
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Dwight Reynolds
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Mary Norine Walsh
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
| | - Clyde W. Yancy
- From the Division of Cardiology (J.E.W., C.W.Y.) and Center for Cardiovascular Innovation (M.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.); Medtronic, Inc, Mounds View, MN (Y.Z.); Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, OH (N.M.A.); Department of Medicine, University at Buffalo, NY (A.B.C.); Division of Cardiology, Scripps
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Givertz MM, Postmus D, Hillege HL, Mansoor GA, Massie BM, Davison BA, Ponikowski P, Metra M, Teerlink JR, Cleland JG, Dittrich HC, O’Connor CM, Cotter G, Voors AA. Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure. Circ Heart Fail 2014; 7:59-67. [DOI: 10.1161/circheartfailure.113.000556] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background—
Prior studies have demonstrated adverse risk associated with baseline and worsening renal function in acute heart failure, but none has modeled the trajectories of change in renal function and their impact on outcomes.
Methods and Results—
We used linear mixed models of serial measurements of blood urea nitrogen and creatinine to describe trajectories of renal function in 1962 patients with acute heart failure and renal dysfunction enrolled in the Placebo-Controlled Randomized Study of the Selective A
1
Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function study. We assessed risk of 180-day mortality and 60-day cardiovascular or renal readmission and used Cox regression to determine association between renal trajectories and outcomes. Compared with patients alive at 180 days, patients who died were older, had lower blood pressure and ejection fraction, and higher creatinine levels at baseline. On average for the entire cohort, creatinine rose from days 1 to 3 and increased further after discharge, with the trajectory dependent on the day of discharge. Blood urea nitrogen, creatinine, and the rate of change in creatinine from baseline were the strongest independent predictors of 180-day mortality and 60-day readmission, whereas the rate of change of blood urea nitrogen from baseline was not predictive of outcomes. Baseline blood urea nitrogen >35 mg/dL and increase in creatinine >0.1 mg/dL per day increased the risk of mortality, whereas stable or decreasing creatinine was associated with reduced risk.
Conclusions—
Patients with acute heart failure and renal dysfunction demonstrate variable rise and fall in renal indices during and immediately after hospitalization. Risk of morbidity and mortality can be predicted based on baseline renal function and creatinine trajectory during the first 7 days.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT00328692 and NCT00354458.
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Affiliation(s)
- Michael M. Givertz
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Douwe Postmus
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Hans L. Hillege
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - George A. Mansoor
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Barry M. Massie
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Beth A. Davison
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Piotr Ponikowski
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Marco Metra
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - John R. Teerlink
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - John G.F. Cleland
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Howard C. Dittrich
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Christopher M. O’Connor
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Gad Cotter
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
| | - Adriaan A. Voors
- From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.M.G.); University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (D.P., H.L.H., A.A.V.); Merck Research Laboratories, Rahway, NJ (G.A.M.); San Francisco VAMC, University of California, San Francisco (B.M.M., J.R.T.); Momentum Research, Inc, Durham, NC (B.A.D., G.C.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.)
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