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Latest & greatest articles for heart failure
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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
Association of genetically predicted testosterone with thromboembolism, heartfailure, and myocardial infarction: mendelian randomisation study in UK Biobank. To determine whether endogenous testosterone has a causal role in thromboembolism, heartfailure, and myocardial infarction.Two sample mendelian randomisation study using genetic variants as instrumental variables, randomly allocated at conception, to infer causality as additional randomised evidence.Reduction by Dutasteride of Prostate (...) Cancer Events (REDUCE) randomised controlled trial, UK Biobank, and CARDIoGRAMplusC4D 1000 Genomes based genome wide association study.3225 men of European ancestry aged 50-75 in REDUCE; 392 038 white British men and women aged 40-69 from the UK Biobank; and 171 875 participants of about 77% European descent, from CARDIoGRAMplusC4D 1000 Genomes based study for validation.Thromboembolism, heartfailure, and myocardial infarction based on self reports, hospital episodes, and death.Of the UK Biobank
Prospective Validation of the Emergency HeartFailure Mortality Risk Grade for Acute HeartFailure Improved risk stratification of acute heartfailure in the emergency department may inform physicians' decisions regarding patient admission or early discharge disposition. We aimed to validate the previously-derived Emergency Heartfailure Mortality Risk Grade for 7-day (EHMRG7) and 30-day (EHMRG30-ST) mortality.We conducted a multicenter, prospective validation study of patients with acute heart (...) failure at 9 hospitals. We surveyed physicians for their estimates of 7-day mortality risk, obtained for each patient before knowledge of the model predictions, and compared these with EHMRG7 for discrimination and net reclassification improvement. We also prospectively examined discrimination of the EHMRG30-ST model, which incorporates all components of EHMRG7 as well as the presence of ST-depression on the 12-lead ECG.We recruited 1983 patients seeking emergency department care for acute heart
Anti-Inflammatory Therapy with Canakinumab for the Prevention of Hospitalization for HeartFailure Subclinical inflammation is associated with an increased risk of heartfailure and with adverse prognosis in patients with established heartfailure. Yet, treatments specifically directed at reducing inflammation in patients with heartfailure have not yet shown improved clinical outcomes. We tested the hypothesis that the interleukin-1β inhibitor canakinumab would prevent hospitalization (...) for heartfailure (HHF) and the composite of HHF or heartfailure-related mortality.We randomized 10 061 patients with prior myocardial infarction and high-sensitivity C-reactive protein ≥2 mg/L to canakinumab 50, 150, or 300 mg or placebo, given subcutaneously once every 3 months. In total, 2173 (22%) reported a history of heartfailure at baseline. We tested the hypothesis that canakinumab prevents prospectively collected HHF events and the composite of HHF or heartfailure-related mortality.A total
Effect of Barthel Index on the Risk of Thirty-Day Mortality in Patients With Acute HeartFailure Attending the Emergency Department: A Cohort Study of Nine Thousand Ninety-Eight Patients From the Epidemiology of Acute HeartFailure in Emergency Department We assess the value of the Barthel Index (BI) in predicting 30-day mortality risk among patients with acute heartfailure who are attending the emergency department (ED).We selected 9,098 acute heartfailure patients from the Acute Heart (...) . In comparison with baseline BI score, ED BI score consistently provided greater discrimination. Neither baseline BI score nor the change in BI score from baseline to the ED visit added further prognostic value to the ED BI score.Functional status assessed by the BI score at the ED visit is a strong predictor of 30-day mortality in acute heartfailure patients, with higher predictive value than baseline BI score and acute functional decline. Routine recording of BI score at the ED visit may help
the prespecified secondary end
points cardiovascular death and the composite of all-cause death and
hospitalization for heart failure.In this pragmatic, registry-based randomized clinical trial, we
used a nationwide quality registry for coronary care for trial procedures
and evaluated end points through the Swedish population registry
(mortality), the Swedish inpatient registry (heartfailure), and cause of
death registry (cardiovascular death). Patients with suspected acute
myocardial infarction and oxygen (...) saturation of ≥90% were randomly
assigned to receive either supplemental oxygen at 6 L/min for 6 to 12
hours delivered by open face mask or ambient air.A total of 6629 patients were enrolled. Acute heartfailure
treatment, left ventricular systolic function assessed by echocardiography, and
infarct size measured by high-sensitive cardiac troponin T were similar in the
2 groups during the hospitalization period. All-cause death or hospitalization
for heartfailure within 1 year after randomization
Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for HeartFailure: The PACT-HF Randomized Clinical Trial. Health care services that support the hospital-to-home transition can improve outcomes in patients with heartfailure (HF).To test the effectiveness of the Patient-Centered Care Transitions in HF transitional care model in patients hospitalized for HF.Stepped-wedge cluster randomized trial of 2494 adults hospitalized for HF across 10 (...) hospitals in Ontario, Canada, from February 2015 to March 2016, with follow-up until November 2016.Hospitals were randomized to receive the intervention (n = 1104 patients), in which nurse-led self-care education, a structured hospital discharge summary, a family physician follow-up appointment less than 1 week after discharge, and, for high-risk patients, structured nurse homevisits and heart function clinic care were provided to patients, or usual care (n = 1390 patients), in which transitional care
Trends in survival after a diagnosis of heartfailure in the United Kingdom 2000-2017: population based cohort study. To report reliable estimates of short term and long term survival rates for people with a diagnosis of heartfailure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.Population based cohort study.Primary care, United Kingdom.Primary care data for 55 959 patients aged 45 and overwith a new diagnosis of heartfailure and 278 679 age (...) and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data.Survival rates at one, five, and 10 years and cause of death for people with and without heartfailure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.Overall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8