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Latest & greatest articles for heart failure
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Hand-held ultrasound devices for cardiac assessment and diagnosis of heartfailure, in the community or primary care setting Hand-held ultrasound devices - Health Technology Wales > Hand-held ultrasound devices Hand-held ultrasound devices Topic Status Complete Hand-held ultrasound devices for cardiac assessment and diagnosis of heartfailure, in the community or primary care setting. Outcome of the appraisal Hand-held ultrasound devices (HUDs) show promise in the diagnosis of heartfailure (...) was this topic appraised? Heartfailure is a common and serious condition that is exerting an increasing burden on cardiology and heart imaging services in Wales. The diagnosis of heartfailure can be suspected from clinical assessment and biochemical testing but the use of cardiac ultrasound (echocardiography) is pivotal to either confirming or excluding the diagnosis. Echocardiography is usually done in a hospital setting, but the use of hand-held ultrasound devices means that it can be offered as a quick
Rivaroxaban With or Without Aspirin in Patients With HeartFailure and Chronic Coronary or Peripheral Artery Disease Patients with chronic coronary artery disease or peripheral artery disease and history of heartfailure (HF) are at high risk for major adverse cardiovascular events. We explored the effects of rivaroxaban with or without aspirin in these patients.The COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) randomized 27 395 participants with chronic (...) coronary artery disease or peripheral artery disease to rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily, rivaroxaban 5 mg twice daily alone, or aspirin 100 mg alone. Patients with New York Heart Association functional class III or IV HF or left ventricular ejection fraction (EF) <30% were excluded. The primary major adverse cardiovascular events outcome comprised cardiovascular death, stroke, or myocardial infarction, and the primary safety outcome was major bleeding using modified
Use of sodium glucose cotransporter 2 inhibitors and risk of major cardiovascular events and heartfailure: Scandinavian register based cohort study. To investigate the cardiovascular effectiveness of sodium glucose cotransporter 2 (SGLT2) inhibitors in routine clinical practice.Cohort study using data from nationwide registers and an active-comparator new-user design.Denmark, Norway, and Sweden, from April 2013 to December 2016.20 983 new users of SGLT2 inhibitors and 20 983 new users (...) of dipeptidyl peptidase 4 (DPP4) inhibitors, aged 35-84, matched by age, sex, history of major cardiovascular disease, and propensity score.Primary outcomes were major cardiovascular events (composite of myocardial infarction, stroke, and cardiovascular death) and heartfailure (hospital admission for heartfailure or death due to heartfailure). Secondary outcomes were the individual components of the cardiovascular composite and any cause death. In the primary analyses, patients were defined as exposed
Effects of Serelaxin in Patients with Acute HeartFailure. Serelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure.In this multicenter, double-blind, placebo-controlled, event-driven trial, we enrolled patients who were hospitalized for acute heart (...) and worsening heartfailure at 5 days.A total of 6545 patients were included in the intention-to-treat analysis. At day 180, death from cardiovascular causes had occurred in 285 of the 3274 patients (8.7%) in the serelaxin group and in 290 of the 3271 patients (8.9%) in the placebo group (hazard ratio, 0.98; 95% confidence interval [CI], 0.83 to 1.15; P = 0.77). At day 5, worsening heartfailure had occurred in 227 patients (6.9%) in the serelaxin group and in 252 (7.7%) in the placebo group (hazard ratio
Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heartfailure: design and rationale for the DEED FRAIL-AHF trial. To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heartfailure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days
Trends in Kidney Function Outcomes Following RAAS Inhibition in Patients With HeartFailure With Reduced Ejection Fraction Angiotensin-converting enzyme (ACE) inhibitors are beneficial in heartfailure with reduced ejection fraction (HFrEF). We sought to describe longitudinal trends in estimated glomerular filtration rate (eGFR) in HFrEF and how ACE-inhibitor therapy influences these changes.Post hoc analysis of trial data.Symptomatic (Treatment Trial, n=2,423) and asymptomatic (Prevention
Cardiac contractility modulation device implantation for heartfailureCardiac contr Cardiac contractility modulation de actility modulation device vice implantation for heartfailure implantation for heartfailure Interventional procedures guidance Published: 26 June 2019 www.nice.org.uk/guidance/ipg655 Y Y our responsibility our responsibility This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement (...) tissues. It can lead to oedema in the lungs (causing breathlessness) and swelling of the legs. Other symptoms include reduced ability to exercise, fatigue and malaise. Heartfailure can be caused by structural or functional abnormalities of the heart. Current treatments 2.2 NICE's guideline describes the diagnosis and management of chronic heartfailure in adults. Treatments for heartfailure include drugs to improve heart function, cardiac rehabilitation, cardiac resynchronisation therapy and cardiac
Analysis of How Emergency Physicians' Decisions to Hospitalize or Discharge Patients With Acute HeartFailure Match the Clinical Risk Categories of the MEESSI-AHF Scale The Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute HeartFailure (MEESSI-AHF) is a validated clinical decision tool that characterizes risk of mortality in emergency department (ED) acute heartfailure patients. The objective of this study is to compare the distribution of risk (...) categories between hospitalized and discharged ED patients with acute heart failure.We included consecutive acute heartfailure patients from 34 Spanish EDs. Patients were retrospectively classified according to MEESSI-AHF risk categories. We calculated the odds of hospitalization (versus direct discharge from the ED) across MEESSI-AHF risk categories. Next, we assessed the following 30-day postdischarge outcomes: ED revisit, hospitalization, death, and their combination. We used Cox hazards models
Usefulness of Right Ventricular to Pulmonary Circulation Coupling as an Indicator of Risk for Recurrent Admissions in HeartFailure With Preserved Ejection Fraction In recent years, the study of right ventricular (RV) to pulmonary circulation (PC) coupling in heartfailure with preserved ejection fraction (HFpEF) has been a matter of special interest. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has emerged as a reliable noninvasive index
Hand-held ultrasound devices for cardiac assessment and diagnosis of heartfailure Hand-held ultrasound devices - Health Technology Wales > Hand-held ultrasound devices Hand-held ultrasound devices Topic Status Complete Hand-held ultrasound devices for cardiac assessment and diagnosis of heartfailure, in the community or primary care setting. Outcome of the appraisal Hand-held ultrasound devices (HUDs) show promise in the diagnosis of heartfailure in a primary care or community setting (...) and serious condition that is exerting an increasing burden on cardiology and heart imaging services in Wales. The diagnosis of heartfailure can be suspected from clinical assessment and biochemical testing but the use of cardiac ultrasound (echocardiography) is pivotal to either confirming or excluding the diagnosis. Echocardiography is usually done in a hospital setting, but the use of hand-held ultrasound devices means that it can be offered as a quick and portable test to people in a primary care
Effect of Neladenoson Bialanate on Exercise Capacity Among Patients With HeartFailure With Preserved Ejection Fraction: A Randomized Clinical Trial. Heartfailure with preserved ejection fraction (HFpEF) lacks effective treatments. Based on preclinical studies, neladenoson bialanate, a first-in-class partial adenosine A1 receptor agonist, has the potential to improve several heartfailure-related cardiac and noncardiac abnormalities but has not been evaluated to treat HFpEF.To determine (...) whether neladenoson improves exercise capacity, physical activity, cardiac biomarkers, and quality of life in patients with HFpEF and to find the optimal dose.Phase 2b randomized clinical trial conducted at 76 centers in the United States, Europe, and Japan. Patients (N = 305) with New York Heart Association class II or III HFpEF with elevated natriuretic peptide levels were enrolled between May 10, 2017, and December 7, 2017 (date of final follow-up: June 20, 2018).Participants were randomized (1:2:2
Effect of Dapagliflozin on HeartFailure and Mortality in Type 2 Diabetes Mellitus In DECLARE-TIMI 58 (Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the composite end point of cardiovascular death/hospitalization for heartfailure (HHF) in a broad population of patients with type 2 diabetes mellitus. However, the impact of baseline left ventricular ejection fraction (EF) on the clinical (...) benefit of sodium-glucose cotransporter 2 inhibition is unknown.In the DECLARE-TIMI 58 trial, baseline heartfailure (HF) status was collected from all patients, and EF was collected when available. HF with reduced EF (HFrEF) was defined as EF <45%. Outcomes of interest were the composite of cardiovascular death/HHF, its components, and all-cause mortality.Of 17 160 patients, 671 (3.9%) had HFrEF, 1316 (7.7%) had HF without known reduced EF, and 15 173 (88.4%) had no history of HF at baseline
Association between mortality and implantable cardioverter-defibrillators by aetiology of heartfailure: a propensity-matched analysis of the WARCEF trial. There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced (...) proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heartfailure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641
Health Status After Transcatheter Mitral-Valve Repair in HeartFailure and Secondary Mitral Regurgitation: COAPT Trial In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for HeartFailure Patients with Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) led to reduced heartfailure (HF) hospitalizations and improved survival in patients with symptomatic HF and 3+ to 4+ secondary mitral regurgitation (MR) on maximally-tolerated (...) timepoint (24-month mean difference in SF-36 summary scores: physical 3.6 points; 95% CI: 1.4 to 5.8 points; mental 3.6 points; 95% CI: 0.8 to 6.4 points).Among patients with symptomatic HF and 3+ to 4+ secondary MR receiving maximally-tolerated medical therapy, edge-to-edge TMVr resulted in substantial early and sustained health status improvement compared with medical therapy alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for HeartFailure Patients With Functional
Intramyocardial Injection of Mesenchymal Precursor Cells and Successful Temporary Weaning From Left Ventricular Assist Device Support in Patients With Advanced HeartFailure: A Randomized Clinical Trial. Left ventricular assist device (LVAD) therapy improves myocardial function, but few patients recover sufficiently for explant, which has focused attention on stem cells to augment cardiac recovery.To assess efficacy and adverse effects of intramyocardial injections of mesenchymal precursor (...) cells (MPCs) during LVAD implant.A randomized phase 2 clinical trial involving patients with advanced heartfailure, undergoing LVAD implant, at 19 North American centers (July 2015-August 2017). The 1-year follow-up ended August 2018.Intramyocardial injections of 150 million allogeneic MPCs or cryoprotective medium as a sham treatment in a 2:1 ratio (n = 106 vs n = 53).The primary efficacy end point was the proportion of successful temporary weans (of 3 planned assessments) from LVAD support within
Heartfailure drug treatment. Heartfailure is the most common cardiovascular reason for hospital admission for people older than 60 years of age. Few areas in medicine have progressed as remarkably as heartfailure treatment over the past three decades. However, progress has been consistent only for chronic heartfailure with reduced ejection fraction. In acutely decompensated heartfailure and heartfailure with preserved ejection fraction, none of the treatments tested to date have been (...) definitively proven to improve survival. Delaying or preventing heartfailure has become increasingly important in patients who are prone to heartfailure. The prevention of worsening chronic heartfailure and hospitalisations for acute decompensation is also of great importance. The objective of this Series paper is to provide a concise and practical summary of the available drug treatments for heartfailure. We support the implementation of the international guidelines. We offer views on the basis of our
in heartfailure management, in which the treatment specifically targets the underlying pathophysiological mechanisms responsible for the symptoms. These treatments include treatment of electromechanical dyssynchrony and dysrhythmia by cardiac resynchronisation and implantable cardioverter-defibrillators; neurohumoral modification by baroreflex and vagal stimulation; prevention of adverse cardiac remodelling by interatrial shunts; and finally targeting the myocardium directly by cell therapy (...) Beyond pharmacological treatment: an insight into therapies that target specific aspects of heartfailure pathophysiology. Heartfailure is a common syndrome associated with substantial morbidity and mortality. The management of symptoms and the strategies for improving prognosis have largely been based on pharmacological treatments. The pathophysiology of heartfailure is complex because of the multiple causes responsible for this syndrome. This Series paper presents some examples of advances
Multimodality imaging in ischaemic heartfailure. In heartfailure, extensive evaluation with modern non-invasive imaging modalities is needed to assess causes, pathophysiology, and haemodynamics, to determine prognosis and consider therapeutic options. This systematic evaluation includes a stepwise assessment of left ventricular size and function, the presence and severity of coronary artery disease, mitral regurgitation, pulmonary hypertension, right ventricular dilation and dysfunction (...) , and tricuspid regurgitation. Based on this imaging-derived information, the need for specific therapies besides optimised medical therapy can be determined. The need for revascularisation, implantation of an implantable cardiac defibrillator, and mitral or tricuspid valve repair or replacement, can be (partially) guided by non-invasive imaging. Importantly, randomised controlled trials on the use of non-inasive imaging to guide therapy are scarce in this field and most non-pharmacological therapies