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Latest & greatest articles for heart failure
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Withdrawal of pharmacological treatment for heartfailure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial. Patients with dilated cardiomyopathy whose symptoms and cardiac function have recovered often ask whether their medications can be stopped. The safety of withdrawing treatment in this situation is unknown.We did an open-label, pilot, randomised trial to examine the effect of phased withdrawal of heartfailure medications in patients (...) ) to phased withdrawal or continuation of treatment. After 6 months, patients in the continued treatment group had treatment withdrawn by the same method. The primary endpoint was a relapse of dilated cardiomyopathy within 6 months, defined by a reduction in LVEF of more than 10% and to less than 50%, an increase in LVEDV by more than 10% and to higher than the normal range, a two-fold rise in NT-pro-BNP concentration and to more than 400 ng/L, or clinical evidence of heartfailure, at which point
2018LancetControlled trial quality: predicted high
Effect of Inorganic Nitrite vs Placebo on Exercise Capacity Among Patients With HeartFailure With Preserved Ejection Fraction: The INDIE-HFpEF Randomized Clinical Trial. There are few effective treatments for heartfailure with preserved ejection fraction (HFpEF). Short-term administration of inorganic nitrite or nitrate preparations has been shown to enhance nitric oxide signaling, which may improve aerobic capacity in HFpEF.To determine the effect of 4 weeks' administration of inhaled (...) /mL; difference, 11 [95% CI, -53 to 75]; P = .74). Worsening heartfailure occurred in 3 participants (2.9%) during the nitrite phase and 8 (7.6%) during the placebo phase.Among patients with HFpEF, administration of inhaled inorganic nitrite for 4 weeks, compared with placebo, did not result in significant improvement in exercise capacity.ClinicalTrials.gov Identifier: NCT02742129.
% CI 0.55 to 0.80, p 40% (62 [23%] in the experimental group vs. 57 [20%] in the control group) • Proportion of patients with coronary artery disease (182 [67%] in the experimental group vs. 202 [72%] in the control group) 10 ¦ CardioMEMS™ for HeartFailure Monitoring Approved 10/4/2018 • Proportion of patients with atrial flutter or atrial fibrillation (120 [44%] in the experimental group vs. 135 [48%] in the control group) • Proportion of patients on nitrates (64 [24%] in the experimental group (...) controlled trials, or clinical practice guidelines. 25 ¦ CardioMEMS™ for HeartFailure Monitoring Approved 10/4/2018 Appendix D. Applicable Codes Note: Inclusion on this list does not guarantee coverage. CODES DESCRIPTION CPT Codes 93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed 93568 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography (List separately
changes in static images (ie, CTA; or, without the use ACR Appropriateness Criteria ® 6 Suspected New-Onset and Known Nonacute HeartFailure of intravenous contrast for coronary calcification, calcium scoring for risk stratification). Delayed imaging helps further the detection of fibrous or fatty tissue replacement in cardiac structures (eg, LV wall) [26,29,30]. Despite marked improvements, prevailing concerns about potential complications are still limitations to the use of this modality (...) of rest and stress MRI. CTA Coronary Arteries There is limited evidence to support the use of cardiac CTA as initial imaging for the evaluation of patients with newly suspected or potential HF. Arteriography Coronary The invasive nature of coronary angiography limits its use for the assessment of patients with newly suspected or potential HF. Variant 2: Differentiating new-onset heartfailure with reduced ejection fraction (HFrEF) from new-onset heartfailure with preserved ejection fraction (HFpEF
Acute exacerbation of congestive heartfailure Acute exacerbation of congestive heartfailure - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Acute exacerbation of congestive heartfailure Last reviewed: February 2019 Last updated: October 2018 Summary Clinical syndrome of reduced cardiac output, tissue hypoperfusion, increased pulmonary pressure, and tissue congestion. Presents with dyspnoea, decreased exercise (...) tolerance, swelling of the legs, fatigue, and generalised weakness. Clinical diagnosis is supported by ancillary tests such as ECG, chest x-ray, B-type natriuretic peptide, and echocardiogram. In cases where echocardiographic images are suboptimal or when an unusual cause of heartfailure is suspected, and for diagnosis of specific cardiomyopathies, other tests (e.g., cardiac catheterisation with haemodynamic measurements, computed tomography, and cardiac magnetic resonance imaging) are used. Diuretics
HeartFailure After Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone The IRIS trial (Insulin Resistance Intervention After Stroke) demonstrated that pioglitazone reduced the risk for both cardiovascular events and diabetes mellitus in insulin-resistant patients. However, concern remains that pioglitazone may increase the risk for heartfailure (HF) in susceptible individuals.In IRIS, patients with insulin resistance but without diabetes mellitus
The Metabolic Syndrome, Cardiovascular Fitness and Survival in Patients With Advanced Systolic HeartFailure The metabolic syndrome (MetS), which incorporates insulin resistance, visceral adiposity, and dyslipidemia, is an independent risk factor for incident heartfailure (HF), but the impact on survival is uncertain. We sought to determine the relation between the metabolic syndrome and survival in ambulatory systolic HF patients and the impact of MetS on cardiopulmonary exercise test (CPET
. Hjalmarson A, Goldstein S, Fagerberg B, et al., for the MERIT-HF Study Group. Effects of controlled-release metoprolol on coral mortality, hospitalizations, and well-being in patients with heartfailure. JAMA 2000;283:1295-302. CIBIS-II lnvestigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS- II): a randomised trial. Lancet 1999;353:9-13. Heidenreich PA, Lee TT, Massie BM. Effect of beta-blockade on mortality in patients with heartfailure: a meta-analysis of randomized (...) Treatment of Hypertension in Association With HeartFailure VII. Treatment of Hypertension in Association With HeartFailure | Hypertension Canada Guidelines Subgroup Members: Simon W. Rabkin, MD; Gordon W. Moe, MD, MSc; Jonathan G. Howlett, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH; Sonia Butalia, BSc MD MSc
Transcatheter Mitral-Valve Repair in Patients with HeartFailure. Among patients with heartfailure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes.At 78 sites in the United States and Canada, we enrolled patients with heartfailure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical (...) therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heartfailure within 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%.Of the 614 patients who were enrolled in the trial
Genetic and Tissue Engineering Approaches to Modeling the Mechanics of Human HeartFailure for Drug Discovery Heartfailure is the leading cause of death in the western world and as such, there is a great need for new therapies. Heartfailure has a variable presentation in patients and a complex etiology; however, it is fundamentally a condition that affects the mechanics of cardiac contraction, preventing the heart from generating sufficient cardiac output under normal operating pressures. One (...) of the major issues hindering the development of new therapies has been difficulties in developing appropriate in vitro model systems of human heartfailure that recapitulate the essential changes in cardiac mechanics seen in the disease. Recent advances in stem cell technologies, genetic engineering, and tissue engineering have the potential to revolutionize our ability to model and study heartfailure in vitro. Here, we review how these technologies are being applied to develop personalized models
not routinely offer coronary revascularisation to people who have heartfailure with reduced ejection fraction and coronary artery disease.   Cardiac tr Cardiac transplantation ansplantation 1.8.2 Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock.   Implantable cardio Implantable cardiov verter defibrillators and cardiac resynchronisation ther erter defibrillators and cardiac resynchronisation (...) Cardiac rehabilitation 21 1.10 Palliative care 21 T erms used in this guideline 22 Putting this guideline into practice 23 Context 25 Key facts and figures 25 Current practice 25 More information 25 Recommendations for research 26 1 Diuretic therapy for managing fluid overload in people with advanced heartfailure in the community . 26 2 Cardiac MRI versus other imaging techniques for diagnosing heartfailure 26 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing
of right-sided heartfailure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality (...) , is associated with poor clinical outcomes independently of the underlying mechanism of disease: across the spectrum of left ventricular (LV) ejection fraction (EF) in patients with acute and chronic heartfailure (HF), after cardiac surgery, acute myocardial infarction (MI), congenital heart disease (CHD), and PH. To distinguish right-sided HF (RHF) from structural RVD, we define RHF as a clinical syndrome with signs and symptoms of HF resulting from RVD. RHF is caused by the inability of the RV to support
Rivaroxaban in Patients with HeartFailure, Sinus Rhythm, and Coronary Disease. Heartfailure is associated with activation of thrombin-related pathways, which predicts a poor prognosis. We hypothesized that treatment with rivaroxaban, a factor Xa inhibitor, could reduce thrombin generation and improve outcomes for patients with worsening chronic heartfailure and underlying coronary artery disease.In this double-blind, randomized trial, 5022 patients who had chronic heartfailure, a left (...) ventricular ejection fraction of 40% or less, coronary artery disease, and elevated plasma concentrations of natriuretic peptides and who did not have atrial fibrillation were randomly assigned to receive rivaroxaban at a dose of 2.5 mg twice daily or placebo in addition to standard care after treatment for an episode of worsening heartfailure. The primary efficacy outcome was the composite of death from any cause, myocardial infarction, or stroke. The principal safety outcome was fatal bleeding
Efficacy of telemedical interventional management in patients with heartfailure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Remote patient management in patients with heartfailure might help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a full manifestation of a heartfailure decompensation. We aimed to investigate the efficacy of our remote patient management intervention (...) on mortality and morbidity in a well defined heartfailure population.The Telemedical Interventional Management in HeartFailure II (TIM-HF2) trial was a prospective, randomised, controlled, parallel-group, unmasked (with randomisation concealment), multicentre trial with pragmatic elements introduced for data collection. The trial was done in Germany, and patients were recruited from hospitals and cardiology practices. Eligible patients had heartfailure, were in New York Heart Association class II or III
2018LancetControlled trial quality: predicted high
Iron deficiency in chronic heartfailure: caseâ€based practical guidance In patients with chronic heartfailure, iron deficiency, even in the absence of anaemia, can aggravate the underlying disease and have a negative impact on clinical outcomes and quality of life. The 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heartfailure recognize iron deficiency as a co-morbidity in chronic heartfailure and recommend iron status screening in all (...) newly diagnosed patients with chronic heartfailure. Furthermore, the guidelines specifically recommend considerations of intravenous iron therapy, ferric carboxymaltose, for the treatment of iron deficiency. However, in spite of these recommendations, iron deficiency remains often overlooked and undertreated. This may be due, in part, to the lack of clinical context and practical guidance accompanying the guidelines for the treating physician. Here, we provide practical guidance complemented
, fluid retention, and fatigue; and signs including basal crepitations, and peripheral oedema. Heartfailure is (...) classified into two main categories with either a reduced or preserved ejection fraction. Symptoms are classified according to severity using the New York Heart Association (NYHA) functional classification. The most common underlying cause is coronary artery disease. Complications include arrhythmias, depression, cachexia, chronic kidney disease, sexual dysfunction, and sudden cardiac (...) Factors for HF ( Hypertension , Diabetes Mellitus, Metabolic Syndrome, and Atherosclerotic Disease) e249 5. Cardiac Structural Abnormalities 2013 8. Evaluation and Management of Right-Sided HeartFailure : A Scientific Statement From the American Heart Association Evaluation and Management of Right-Sided HeartFailure : A Scientific Statement From the American Heart Association | Circulation Search for this keyword Search Search for this keyword Search Header Publisher Menu AHA Scientific Statement
Sex differences in outcomes of heartfailure in an ambulatory, population-based cohort from 2009 to 2013 Heartfailure remains a substantial cause of morbidity and mortality in women. We examined the sex differences in heartfailure incidence, mortality and hospital admission in a population-based cohort.All Ontario residents who were diagnosed with heartfailure in an ambulatory setting between Apr. 1, 2009, and Mar. 31, 2014, were included in this study. Incident cases of heartfailure were (...) captured through physician billing using a validated algorithm. Outcomes were mortality and hospital admission for heartfailure within 1 year of the diagnosis. Probability of death and hospital admission were calculated using the Kaplan-Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model.A total of 90 707 diagnoses of heartfailure were made in an ambulatory setting during the study period (47% women). Women were more likely to be older and more frail