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(95% CI, 1.51–2.28) Similar in men and women … Retrospective cohort of Kaiser Permanente Northwest Database 8231 +DM, 8845 no DM Up to 6 rates (person-years): DM: 30.9/1000 No DM: 12.4/1000 Rate ratio, 2.5 (95% CI, 2.3–2.7) … … CAD indicates coronary artery disease; DM, diabetes mellitus; ellipses (…), not reported; HF, heartfailure; HR, hazard ratio; MESA, Multi-Ethnic Study of Atherosclerosis; NHANES, National Health and Nutrition Examination Survey; and RR, relative risk. The risk of HF (...) via vascular smooth muscle cell proliferation and inflammation ( ). DM is also associated with more atherogenic dyslipidemia, in which low-density lipoprotein cholesterol particles are more atherogenic, and with endothelial dysfunction, which promotes leukocyte and platelet adhesion, thrombosis, inflammation, and coronary plaque ulceration. Figure 1. Pathophysiology of heartfailure in diabetes mellitus. The hyperglycemia, insulin resistance, and hyperinsulinemia that often accompany diabetes
, Beanlands RSB, Mielniczuk LM . N-terminal pro B-type natriuretic peptide and high-sensitivity cardiac troponin T levels are related to the extent of hibernating myocardium in patients with ischemic heartfailure. Can J Cardiol . 2017 ; 33:1478–1488. doi: 10.1016/j.cjca.2017.06.012 AlBadri A, Lai K, Wei J, Landes S, Mehta PK, Li Q, Johnson D, Reis SE, Kelsey SF, Bittner V, et al. . Inflammatory biomarkers as predictors of heartfailure in women without obstructive coronary artery disease: a report from (...) , Wagoner LE, et al. . A polymorphism within a conserved beta(1)-adrenergic receptor motif alters cardiac function and beta-blocker response in human heartfailure. Proc Natl Acad Sci U S A . 2006 ; 103:11288–11293. doi: 10.1073/pnas.0509937103 Cresci S, Kelly RJ, Cappola TP, Diwan A, Dries D, Kardia SL, Dorn GW Clinical and genetic modifiers of long-term survival in heartfailure. J Am Coll Cardiol . 2009 ; 54:432–444. doi: 10.1016/j.jacc.2009.05.009 Liggett SB, Cresci S, Kelly RJ, Syed FM, Matkovich
Effect of Once-Weekly Exenatide in Patients With Type 2 Diabetes Mellitus With and Without HeartFailure and HeartFailure-Related Outcomes: Insights From the EXSCEL Trial Once-weekly exenatide (EQW) had a neutral effect on hospitalization for heartfailure (HHF) in the EXSCEL study (Exenatide Study of Cardiovascular Event Lowering), with no differential treatment effect on major adverse cardiac events by baseline heartfailure (HF) status. EQW's effects on secondary end points based on HHF (...) status have not been reported. The objective was to explore the effects of EQW on secondary end points in patients with and without baseline HF and test the effects of EQW on recurrent HHF events.The prespecified analysis of the randomized controlled EXSCEL trial, which enrolled patients with type 2 diabetes mellitus with and without additional cardiovascular disease, analyzed EQW effects on all-cause death, each major adverse cardiac event component, first HHF, and repeat HHF, by baseline HF status
Optimizer Smart Implantable Pulse Generator (IPG) – Cardiac Contractility Modulation (CCM) therapy for patients with Chronic HeartFailure 1 Public Summary Document Application No. 1387.2 – Optimizer® Smart Implantable Pulse Generator (IPG) – Cardiac Contractility Modulation (CCM) therapy for patients with Chronic HeartFailure Applicant: Impulse Dynamics and Life Systems Date of MSAC consideration: MSAC 75 th Meeting, 28-29 March 2019 Context for decision: MSAC makes its advice in accordance (...) with its Terms of Reference, visit the MSAC website 1. Purpose of application An application for the resubmission of an implantable pulse generator (IPG) delivering Cardiac Contractility Modulation (CCM) therapy for patients with chronic heartfailure was received from Impulse Dynamics Australia Pty Ltd by the Department of Health. 2. MSAC’s advice to the Minister After considering the strength of the available evidence in relation to comparative safety, clinical effectiveness and cost-effectiveness
Improving Communication in HeartFailure Patient Care Although implantable cardioverter-defibrillators (ICDs) reduce sudden death, these patients die of heartfailure (HF) or other diseases. To prevent shocks at the end of life, clinicians should discuss deactivating the defibrillation function.The purpose of this study was to determine if a clinician-centered teaching intervention and automatic reminders increased ICD deactivation discussions and increased device deactivation.In this 6-center (...) , single-blinded, cluster-randomized, controlled trial, primary outcomes were proportion of patients: 1) having ICD deactivation discussions; and 2) having the shocking function deactivated. Secondary outcomes included goals of care conversations and advance directive completion.A total of 525 subjects were included with advanced HF who had an ICD: 301 intervention and 224 control. At baseline, 52% (n = 272) were not candidates for advanced therapies (i.e., cardiac transplant or mechanical circulatory
Incidence of heartfailure after pacemaker implantation: a nationwide Danish Registry-based follow-up study The objective of the current study is to investigate the risk of heartfailure (HF) after implantation of a pacemaker (PM) with a right ventricular pacing (RVP) lead in comparison to a matched cohort without a PM and factors associated with this risk.All patients without a known history of HF who had a PM implanted with an RVP lead between 2000 and 2014 (n = 27 704) were identified using
Identifying optimal doses of heartfailure medications in men compared with women: a prospective, observational, cohort study. Guideline-recommended doses of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and β blockers are similar for men and women with heartfailure with reduced ejection fraction (HFrEF), even though there are known sex differences in pharmacokinetics of these drugs. We hypothesised that there might be sex differences in the optimal (...) dose of ACE inhibitors or ARBs and β blockers in patients with HFrEF.We did a post-hoc analysis of BIOSTAT-CHF, a prospective study in 11 European countries of patients with heartfailure in whom initiation and up-titration of ACE inhibitors or ARBs and β blockers was encouraged by protocol. We included only patients with left ventricular ejection fraction less than 40%, and excluded those who died within the first 3 months. Primary outcome was a composite of time to all-cause mortality
Ivabradine for Adults with Stable Chronic HeartFailure: A Review of Clinical Effectiveness Ivabradine for Adults with Stable Chronic HeartFailure: A Review of Clinical Effectiveness | CADTH.ca Find the information you need Ivabradine for Adults with Stable Chronic HeartFailure: A Review of Clinical Effectiveness Ivabradine for Adults with Stable Chronic HeartFailure: A Review of Clinical Effectiveness Last updated: May 15, 2019 Project Number: RC1119-000 Product Line: Research Type: Drug (...) Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical effectiveness of ivabradine for patients with stable chronic heartfailure and with left ventricular ejection fraction > 35% and 40%? Key Message There were no studies identified with inclusion criteria of patients with stable chronic heartfailure and left ventricular ejection fraction greater than 35% and less than or equal to 40% Two studies, however, included patients with LVEF less than 40% and were
Natriuretic Peptide Testing for Monitoring of HeartFailure Therapy: A Review of Clinical Effectiveness, Clinical Utility, Cost-Effectiveness, and Guidelines Natriuretic Peptide Testing for Monitoring of HeartFailure Therapy: A Review of Clinical Effectiveness, Clinical Utility, Cost-Effectiveness, and Guidelines | CADTH.ca Find the information you need Natriuretic Peptide Testing for Monitoring of HeartFailure Therapy: A Review of Clinical Effectiveness, Clinical Utility, Cost-Effectiveness (...) , and Guidelines Natriuretic Peptide Testing for Monitoring of HeartFailure Therapy: A Review of Clinical Effectiveness, Clinical Utility, Cost-Effectiveness, and Guidelines Last updated: August 19, 2019 Project Number: RC1163-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical effectiveness and clinical utility of natriuretic peptide testing for the monitoring of heartfailure therapy? What is the cost
Point of Care Ultrasound for Assessment of Patients with Suspected or Known Chronic HeartFailure in Emergency Departments: Clinical Utility and Cost-Effectiveness Point of Care Ultrasound for Assessment of Patients with Suspected or Known Chronic HeartFailure in Emergency Departments: Clinical Utility and Cost-Effectiveness | CADTH.ca Find the information you need Point of Care Ultrasound for Assessment of Patients with Suspected or Known Chronic HeartFailure in Emergency Departments (...) : Clinical Utility and Cost-Effectiveness Point of Care Ultrasound for Assessment of Patients with Suspected or Known Chronic HeartFailure in Emergency Departments: Clinical Utility and Cost-Effectiveness Last updated: August 27, 2019 Project Number: RB1380-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What is the clinical utility of point of care ultrasound for the assessment of patients with suspected or known chronic heartfailure
. -,NO. -,2019 Hollenberg et al. -,2019:-–- HeartFailure Hospitalization Pathway 9TABLE 4 Key Comorbid Conditions to Consider Comorbidity Management Relevant Guidelines/Pathways Cardiovascular Coronary artery disease/acute coronary syndrome Assess and treat ischemia, and consider revascularization. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction Atrial ?brillation/ ?utter (...) Patients Hospitalized with HeartFailure: Risk Assessment, Management, and Clinical Trajectory EXPERT CONSENSUS DECISION PATHWAY 2019 ACC Expert Consensus Decision PathwayonRiskAssessment, Management, and Clinical Trajectory of Patients Hospitalized With HeartFailure A Report of the American College of Cardiology Solution Set Oversight Committee Writing Committee Steven M. Hollenberg, MD, FACC, Chair Lynne Warner Stevenson, MD, FACC, Vice Chair Tariq Ahmad, MD, MPH, FACC Vaibhav J. Amin, MD
Cardiac rehabilitation for heartfailure can improve quality of life and fitness. The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heartfailure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000803/cardiac (...) -rehabilitation-for-heart-failure-can-improve-quality-of-life-and-fitness.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Telemonitoring using active cardiac implantable devices in ventricular tachyarrhythmia and heartfailure 1 Translation of the key statement of the final report N16-02 Telemonitoring mithilfe von aktiven kardialen implantierbaren Aggregaten bei ventrikulärer Tachyarrhythmie sowie Herzinsuffizienz (Version 1.2; Status: 4 July 2018). Please note: This document was translated by an external translator and is provided as a service by IQWiG to English-language readers. However, solely the German (...) original text is absolutely authoritative and legally binding. Extract IQWiG Reports – Commission No. N16-02 Telemonitoring using active cardiac implantable devices in ventricular tachyarrhythmia and heartfailure 1 Extract of final report N16-02 Version 1.2 Telemonitoring using active cardiac implantable devices 4 July 2018 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details Publisher: Institute for Quality and Efficiency in Health Care Topic: Telemonitoring using
Ivabradine (Lancora) for HeartFailure Ivabradine (Lancora) for HeartFailure | CADTH.ca Find the information you need Ivabradine (Lancora) for HeartFailure Ivabradine (Lancora) for HeartFailure Last updated: August 8, 2019 Project Number: HO0006-000 Product Line: Technology Review Result type: Report Heartfailure is a condition characterized by reduced cardiac output occurring due to complications of cardiovascular disease. It is a leading cause of hospital admissions and has a poor
Dapagliflozin in Patients with HeartFailure and Reduced Ejection Fraction. In patients with type 2 diabetes, inhibitors of sodium-glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heartfailure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heartfailure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes.In this phase 3, placebo (...) -controlled trial, we randomly assigned 4744 patients with New York Heart Association class II, III, or IV heartfailure and an ejection fraction of 40% or less to receive either dapagliflozin (at a dose of 10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of worsening heartfailure (hospitalization or an urgent visit resulting in intravenous therapy for heartfailure) or cardiovascular death.Over a median of 18.2 months, the primary outcome occurred
Association of Change in N-Terminal Pro-B-Type Natriuretic Peptide Following Initiation of Sacubitril-Valsartan Treatment With Cardiac Structure and Function in Patients With HeartFailure With Reduced Ejection Fraction. In patients with heartfailure and reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan reduces N-terminal pro-b-type natriuretic peptide (NT-proBNP) concentrations. The effect of sacubitril-valsartan on cardiac remodeling is uncertain.To determine whether NT (...) -proBNP changes in patients with HFrEF treated with sacubitril-valsartan correlate with changes in measures of cardiac volume and function.Prospective, 12-month, single-group, open-label study of patients with HFrEF enrolled in 78 outpatient sites in the United States. Sacubitril-valsartan was initiated and the dose adjusted. Enrollment commenced on October 25, 2016, and follow-up was completed on October 22, 2018.NT-proBNP concentrations among patients treated with sacubitril-valsartan.The primary
Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With HeartFailure and Reduced Ejection Fraction: A Randomized Clinical Trial. Compared with enalapril, sacubitril-valsartan reduces cardiovascular mortality and heartfailure hospitalization in patients with heartfailure and reduced ejection fraction (HFrEF). These benefits may be related to effects on hemodynamics and cardiac remodeling.To determine whether treatment of HFrEF with sacubitril-valsartan improves (...) central aortic stiffness and cardiac remodeling compared with enalapril.Randomized, double-blind clinical trial of 464 participants with heartfailure and ejection fraction of 40% or less enrolled across 85 US sites between August 17, 2016, and June 28, 2018. Follow-up was completed on January 26, 2019.Randomization (1:1) to sacubitril-valsartan (n = 231; target dosage, 97/103 mg twice daily) vs enalapril (n = 233; target dosage, 10 mg twice daily) for 12 weeks.The primary outcome was change from
Angiotensin-Neprilysin Inhibition in HeartFailure with Preserved Ejection Fraction. The angiotensin receptor-neprilysin inhibitor sacubitril-valsartan led to a reduced risk of hospitalization for heartfailure or death from cardiovascular causes among patients with heartfailure and reduced ejection fraction. The effect of angiotensin receptor-neprilysin inhibition in patients with heartfailure with preserved ejection fraction is unclear.We randomly assigned 4822 patients with New York Heart (...) Association (NYHA) class II to IV heartfailure, ejection fraction of 45% or higher, elevated level of natriuretic peptides, and structural heart disease to receive sacubitril-valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily) or valsartan (target dose, 160 mg twice daily). The primary outcome was a composite of total hospitalizations for heartfailure and death from cardiovascular causes. Primary outcome components, secondary outcomes (including NYHA class change, worsening