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Dixon DD, Xu M, Akwo EA, Nair D, Schlundt D, Wang TJ, Blot WJ, Lipworth L, Gupta DK. Depressive Symptoms and Incident Heart Failure Risk in the Southern Community Cohort Study. JACC. HEART FAILURE 2022; 10:254-262. [PMID: 35361444 PMCID: PMC8976159 DOI: 10.1016/j.jchf.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aims to examine whether greater frequency of depressive symptoms associates with increased risk of incident heart failure (HF). BACKGROUND Depressive symptoms associate with adverse prognosis in patients with prevalent HF. Their association with incident HF is less studied, particularly in low-income and minority individuals. METHODS We studied 23,937 Black or White Southern Community Cohort Study participants (median age: 53 years, 70% Black, 64% women) enrolled between 2002 and 2009, without prevalent HF, receiving Centers for Medicare and Medicaid Services coverage. Cox models adjusted for traditional HF risk factors, socioeconomic and behavioral factors, social support, and antidepressant medications were used to quantify the association between depressive symptoms assessed at enrollment via the Center for Epidemiologic Studies Depression Scale (CESD-10) and incident HF ascertained from Centers for Medicare and Medicaid Services International Classification of Diseases-9th Revision (ICD-9) (code: 428.x) and ICD-10 (codes: I50, I110) codes through December 31, 2016. RESULTS The median CESD-10 score was 9 (IQR: 5 to 13). Over a median 11-year follow-up, 6,081 (25%) participants developed HF. The strongest correlates of CESD-10 score were antidepressant medication use, age, and socioeconomic factors, rather than traditional HF risk factors. Greater frequency of depressive symptoms associated with increased incident HF risk (per 8-U higher CESD-10 HR: 1.04; 95% CI: 1.00 to 1.09; P = 0.038) without variation by race or sex. The association between depressive symptoms and incident HF varied by antidepressant use (interaction-P = 0.03) with increased risk among individuals not taking antidepressants. CONCLUSIONS In this high-risk, low-income, cohort of predominantly Black participants, greater frequency of depressive symptoms significantly associates with higher risk of incident HF.
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Affiliation(s)
- Debra D Dixon
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meng Xu
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elvis A Akwo
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Thomas J Wang
- Department of Medicine, UT-Southwestern Medical Center, Dallas, Texas, USA
| | - William J Blot
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Loren Lipworth
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee, USA; Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Deepak K Gupta
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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52
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Manabe O, Naya M. Potential of 18F-FDG PET to evaluate the cardiocerebral interaction. J Nucl Cardiol 2022; 29:489-491. [PMID: 32737840 DOI: 10.1007/s12350-020-02302-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Osamu Manabe
- Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-shi, Saitama-Ken, 330-8503, Japan.
| | - Masanao Naya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, ÄŚelutkienÄ— J, Chioncel O, Cleland JG, Coats AJ, Crespo-Leiro MG, Farmakis D, Gilard M, Heyman S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CS, Lyon AR, McMurray JJ, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GM, Ruschitzka F, Skibelund AK. GuĂa ESC 2021 sobre el diagnĂłstico y tratamiento de la insuficiencia cardiaca aguda y crĂłnica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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54
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Brain-heart communication in health and diseases. Brain Res Bull 2022; 183:27-37. [PMID: 35217133 DOI: 10.1016/j.brainresbull.2022.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/19/2022]
Abstract
Tight connections between the brain and heart have attracted a considerable amount of attention. This review focuses on the anatomical (extrinsic cardiac autonomic nervous system and intrinsic cardiac autonomic nervous system) and functional (neuroendocrine-heart axis and neuroimmune-heart axis) connections between the brain and heart, the linkage between central nervous system diseases and cardiovascular diseases, the harm of sympathetic hyperactivity to the heart, and current neuromodulation therapies. Depression is a comorbidity of cardiovascular diseases, and the two are causally related. This review summarizes the mechanisms and treatment of depression and cardiovascular diseases, providing theoretical evidence for basic research and clinical studies to improve treatment options.
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55
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An updated systematic review on heart failure treatments for patients with renal impairment: the tide is not turning. Heart Fail Rev 2022; 27:1761-1777. [DOI: 10.1007/s10741-022-10216-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/11/2022]
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Freedland KE, Steinmeyer BC, Carney RM, Skala JA, Chen L, Rich MW. Depression and Hospital Readmissions in Patients with Heart Failure. Am J Cardiol 2022; 164:73-78. [PMID: 34876275 DOI: 10.1016/j.amjcard.2021.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022]
Abstract
Depression increases the risk of mortality in patients with heart failure (HF). Less is known about whether depression predicts multiple readmissions or whether multiple hospitalizations worsen depression in patients with HF. This study aimed to test the hypotheses that depression predicts multiple readmissions in patients hospitalized with HF, and conversely that multiple readmissions predict persistent or worsening depression. All-cause readmissions were ascertained over a 2-year follow-up of a cohort of 400 patients hospitalized with HF. The Patient Health Questionnaire-9 was used to assess depression at index and 3-month intervals. At enrollment in the study, 21% of the patients were mildly depressed and 22% were severely depressed. Higher Patient Health Questionnaire-9 depression scores predicted a higher rate of readmissions (adjusted hazard ratio 1.02, 95% confidence interval 1.00 to 1.04, p = 0.03). The readmission rate was higher in those who were severely depressed than in those without depression (p = 0.0003), but it did not differ between patients who were mildly depressed and patients without depression. Multiple readmissions did not predict persistent or worsening depression, but younger patients in higher New York Heart Association classes were more depressed than other patients. Depression is an independent risk factor for multiple all-cause readmissions in patients hospitalized with HF. Severe depression is a treatable psychiatric co-morbidity that warrants ongoing clinical attention in patients with HF.
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Affiliation(s)
| | | | | | | | | | - Michael W Rich
- Cardiovascular Division of the Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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57
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022; 24:4-131. [PMID: 35083827 DOI: 10.1002/ejhf.2333] [Citation(s) in RCA: 770] [Impact Index Per Article: 385.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.
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Hughes JW, Serber ER, Kuhn T. Psychosocial management in cardiac rehabilitation: Current practices, recommendations, and opportunities. Prog Cardiovasc Dis 2022; 73:76-83. [PMID: 35016916 DOI: 10.1016/j.pcad.2021.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
Psychosocial management is a core component of outpatient Phase-II cardiac rehabilitation (CR) and includes psychosocial assessment, providing interventions, measuring outcomes, and care coordination. Psychosocial management contributes to the effectiveness of comprehensive CR, but the implementation is not always consistent or clearly described in the literature, in part due to the availability of behavioral health specialists. Patients in CR have many psychosocial needs including anxiety, depression, substance use disorders, sleep problems, psychosocial stress, and cognitive impairment. Behavioral considerations are inherent in many other aspects of CR,such as participation in CR, health behaviors, adherence, and tobacco cessation. Evaluation, or psychosocial assessment, should identify significant issues, record related medications, and incorporate findings in the individual treatment plan. Some patients require further evaluation and treatment by a qualified behavioral health specialist. Psychosocial interventions provided to all patients include patient education, counseling, stress-management, a supportive environment, and exercise. Measuring outcomes entails repeating the psychosocial assessment when patients finish CR and documenting changes. Coordinating care requires understanding available local mental health infrastructure and procedures for making referrals, and may entail identifying additional resources. Interventions provided concurrently with CR to a subset of patients with more extensive needs are typically pharmacotherapy, psychotherapy, or addictions counseling, which are beyond the scope of practice for most CR professionals. The way psychosocial management is implemented suggests clinical and research opportunities. For example, the combined effects of antidepressants and CR on depression and anxiety are not known. A prominent clinical opportunity is to fully implement psychosocial assessment, as required by statute and the core components. This could involve referring patients for whom clinically significant psychosocial concerns are identified during the evaluation for a more thorough assessment by a behavioral health specialist using an appropriate billing model. A research priority is a contemporary description of behavioral health services available to CR programs, including how psychosocial management is implemented. As delivery of CR comes to include more alternative models (e.g., home-based), research is needed on how that affects the delivery of psychosocial management. Increased use of telehealth may broaden clinical opportunities for psychosocial management.
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Affiliation(s)
- Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH 44242, United States of America.
| | - Eva R Serber
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Bio-behavioral Medicine, Charleston, SC 29425, United States of America
| | - Tyler Kuhn
- Department of Psychological Sciences, Kent State University, Kent, OH 44242, United States of America
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
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Huang KW, Bilgrami NL, Hare DL. Iron Deficiency in Heart Failure Patients and Benefits of Iron Replacement on Clinical Outcomes Including Comorbid Depression. Heart Lung Circ 2021; 31:313-326. [PMID: 34810088 DOI: 10.1016/j.hlc.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/14/2021] [Accepted: 10/16/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Iron deficiency and depression are prevalent comorbidities in the setting of heart failure. Both conditions are associated with poorer patient outcomes including mortality, hospitalisation and quality of life. Iron replacement has come to the fore as a means to improve patient outcomes. This review aims to assess the current literature regarding the benefits of iron supplementation for iron deficient heart failure patients including potential improvements in depression. METHODS AND RESULTS The databases of Medline, EMBASE, the Cochrane library of systematic reviews, Central Register of Controlled Trials, PubMed, Web of Science and ClinicalTrials.gov were searched for studies with relevant patient outcomes. A total of 18 studies were identified and included in the review. In essence, intravenous iron was found to be beneficial for New York Heart Association (NYHA) classification, quality of life measures, heart failure (HF) hospitalisation and aerobic capacity. Oral iron however was not beneficial. Research surrounding intravenous iron improving cardiovascular mortality, time to first hospitalisation and changes in depression status is lacking. CONCLUSIONS Further research is required to elucidate the advantages of intravenous iron for iron deficient heart failure patients on their depression, mortality and first admission to hospital. Consensus is required regarding which form of iron and the treatment regime that should be adopted for future clinical guidelines.
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Affiliation(s)
- Kevin W Huang
- University of Melbourne Medical School, Melbourne, Vic, Australia; Department of Cardiology Austin Health, Melbourne, Vic, Australia
| | - Nazar L Bilgrami
- Department of Cardiology Austin Health, Melbourne, Vic, Australia
| | - David L Hare
- Department of Cardiology Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
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Blumenthal JA, Smith PJ, Jiang W, Hinderliter A, Watkins LL, Hoffman BM, Kraus WE, Liao L, Davidson J, Sherwood A. Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease: The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients With Coronary Heart Disease (UNWIND) Randomized Clinical Trial. JAMA Psychiatry 2021; 78:1270-1278. [PMID: 34406354 PMCID: PMC8374738 DOI: 10.1001/jamapsychiatry.2021.2236] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Anxiety is common among patients with coronary heart disease (CHD) and is associated with worse health outcomes; however, effective treatment for anxiety in patients with CHD is uncertain. OBJECTIVE To determine whether exercise and escitalopram are better than placebo in reducing symptoms of anxiety as measured by the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) and in improving CHD risk biomarkers. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between January 2016 and May 2020 in a tertiary care teaching hospital in the US and included 128 outpatients with stable CHD and a diagnosed anxiety disorder or a HADS-A score of 8 or higher who were older than 40 years, sedentary, and not currently receiving mental health treatment. INTERVENTIONS Twelve weeks of aerobic exercise 3 times per week at an intensity of 70% to 85% heart rate reserve, escitalopram (up to 20 mg per day), or placebo pill equivalent. MAIN OUTCOMES AND MEASURES The primary outcome was HADS-A score. CHD biomarkers included heart rate variability, baroreflex sensitivity, and flow-mediated dilation, along with 24-hour urinary catecholamines. RESULTS The study included 128 participants. The mean (SD) age was 64.6 (9.6) years, and 37 participants (29%) were women. Participants randomized to the exercise group and escitalopram group reported greater reductions in HADS-A (exercise, -4.0; 95% CI, -4.7 to -3.2; escitalopram, -5.7; 95% CI, -6.4 to -5.0) compared with those randomized to placebo (-3.5; 95% CI, -4.5 to -2.4; P = .03); participants randomized to escitalopram reported less anxiety compared with those randomized to exercise (-1.67; 95% CI, -2.68 to -0.66; P = .002). Significant postintervention group differences in 24-hour urinary catecholamines were found (exercise z score = 0.05; 95% CI, -0.2 to 0.3; escitalopram z score = -0.24; 95% CI, -0.4 to 0; placebo z score = 0.36; 95% CI, 0 to 0.7), with greater reductions in the exercise group and escitalopram group compared with the placebo group (F1,127 = 4.93; P = .01) and greater reductions in the escitalopram group compared with the exercise group (F1,127 = 4.37; P = .04). All groups achieved comparable but small changes in CHD biomarkers, with no differences between treatment groups. CONCLUSIONS AND RELEVANCE Treatment of anxiety with escitalopram was safe and effective for reducing anxiety in patients with CHD. However, the beneficial effects of exercise on anxiety symptoms were less consistent. Exercise and escitalopram did not improve CHD biomarkers of risk, which should prompt further investigation of these interventions on clinical outcomes in patients with anxiety and CHD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02516332.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Wei Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Alan Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Benson M. Hoffman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - William E. Kraus
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lawrence Liao
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jonathan Davidson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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Lee EJ, Kim JS, Chang DI, Park JH, Ahn SH, Cha JK, Heo JH, Sohn SI, Lee BC, Kim DE, Kim HY, Kim S, Kwon DY, Kim J, Seo WK, Lee J, Park SW, Koh SH, Kim JY, Choi-Kwon S, Kim MS, Lee JS. Post-Stroke Depressive Symptoms: Varying Responses to Escitalopram by Individual Symptoms and Lesion Location. J Geriatr Psychiatry Neurol 2021; 34:565-573. [PMID: 32912058 DOI: 10.1177/0891988720957108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The efficacy of antidepressants in post-stroke depressive symptoms (PSD) varies. We aimed to examine whether the effect of escitalopram on PSD differs according to individual depressive symptoms and stroke lesion location. METHODS This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram on depression in acute stroke patients (237 with placebo, 241 with escitalopram). Depressive symptoms were evaluated with the 10-item Montgomery-Ă…sberg Depression Rating Scale (MADRS). Changes in MADRS and individual item scores at 12 weeks were compared between the treatment groups and among the stroke lesion location groups. Stroke lesion locations were grouped according to the anatomical distribution of serotonin fibers that originate from the midbrain/pons and spread to the forebrain via subcortical structures: "Midbrain-Pons," "Frontal-Subcortical," and "Others." Least-squares means were calculated to demonstrate the independent effect of lesion location. RESULTS Total MADRS scores decreased more significantly in the escitalopram than in the placebo group, while a significant effect of escitalopram was observed in only 3 items: apparent sadness, reported sadness, pessimistic thoughts. In the lesion location analyses, escitalopram users in the Frontal-Subcortical group showed significant improvement in total MADRS scores (placebo [n = 130] vs. escitalopram [n = 148], least-square mean [95% CI]: -2.3 [-3.5 to -0.2] vs. -4.5 [-5.5 to -3.4], p = .005), while those in the Midbrain-Pons and Others groups did not. CONCLUSIONS The effect of escitalopram on PSD may be more prominent in patients with particular depressive symptoms and stroke lesion locations, suggesting the need for tailored treatment strategies.
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Affiliation(s)
- Eun-Jae Lee
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, KyungHee University, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Goyang, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University, Gwangju, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Busan, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University, Seoul, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University, Daegu, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University, Pyungchon, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University, Goyang, Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University, Seoul, Korea
| | - Seongheon Kim
- Department of Neurology, Kangwon National University, Chuncheon, Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University, Ansan, Korea
| | - Jei Kim
- Department of Neurology, Chungnam University, Daejeon, Korea
| | - Woo-Keun Seo
- Department of Neurology, Sungkyunkwan University, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University, Daegu, Korea
| | - Sang-Won Park
- Department of Neurology, Daegu Fatima Hospital, Daegu, Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University, Guri, Korea
| | - Jin Young Kim
- Department of Psychiatry, Hyundai Hospital, Eumseong, Korea
| | - Smi Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea
| | - Min-Sun Kim
- College of Medicine, Michigan State University, MI, USA
| | - Ji-Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
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Depression and the use of antidepressants in cardiovascular diseases from a cardiologist’s perspective. CURRENT PROBLEMS OF PSYCHIATRY 2021. [DOI: 10.2478/cpp-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Cardiovascular diseases, especially coronary heart disease or heart failure, are often chronic.
Aim and method: The aim of this study was to review the literature on the prevalence of depressive disorders and the use of antidepressants in cardiovascular disease. For this purpose, articles available in PubMed and Google Scholar databases were used.
Results: About one in five patients with cardiovascular disease suffers from major depressive disorder. Psychosocial stress, depression and anxiety, are associated with poorer prognosis and make it more difficult for patients to make positive lifestyle changes and comply with medical recommendations. Conversely, depressive symptoms are associated with an increased risk of cardiovascular incidents. Regarding pharmacotherapy, selective serotonin reuptake inhibitors (SSRIs) are considered safe drugs, while tricyclic antidepressants are not recommended. In the treatment of depression and cardiovascular diseases, supplementation or a diet rich in omega-3 fatty acids is worth mentioning.
Conclusions: The above literature review highlights the need for a multidirectional approach that is essential to diagnose, understand and then treat these, often comorbid, conditions of cardiovascular disease and depression.
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Rollman BL, Anderson AM, Rothenberger SD, Abebe KZ, Ramani R, Muldoon MF, Jakicic JM, Herbeck Belnap B, Karp JF. Efficacy of Blended Collaborative Care for Patients With Heart Failure and Comorbid Depression: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:1369-1380. [PMID: 34459842 PMCID: PMC8406216 DOI: 10.1001/jamainternmed.2021.4978] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Depression is often comorbid in patients with heart failure (HF) and is associated with worse clinical outcomes. However, depression generally goes unrecognized and untreated in this population. OBJECTIVE To determine whether a blended collaborative care program for treating both HF and depression can improve clinical outcomes more than collaborative care for HF only and physicians' usual care (UC). DESIGN, SETTING, AND PARTICIPANTS This 3-arm, single-blind, randomized effectiveness trial recruited 756 participants with HF with reduced left ventricular ejection fraction (<45%) from 8 university-based and community hospitals in southwestern Pennsylvania between March 2014 and October 2017 and observed them until November 2018. Participants included 629 who screened positive for depression during hospitalization and 2 weeks postdischarge and 127 randomly sampled participants without depression to facilitate further comparisons. Key analyses were performed November 2018 to March 2019. INTERVENTIONS Separate physician-supervised nurse teams provided either 12 months of collaborative care for HF and depression ("blended" care) or collaborative care for HF only (enhanced UC [eUC]). MAIN OUTCOMES AND MEASURES The primary outcome was mental health-related quality of life (mHRQOL) as measured by the Mental Component Summary of the 12-item Short Form Health Survey (MCS-12). Secondary outcomes included mood, physical function, HF pharmacotherapy use, rehospitalizations, and mortality. RESULTS Of the 756 participants (mean [SD] age, 64.0 [13.0] years; 425 [56%] male), those with depression reported worse mHRQOL, mood, and physical function but were otherwise similar to those without depression (eg, mean left ventricular ejection fraction, 28%). At 12 months, blended care participants reported a 4.47-point improvement on the MCS-12 vs UC (95% CI, 1.65 to 7.28; P = .002), but similar scores as the eUC arm (1.12; 95% CI, -1.15 to 3.40; P = .33). Blended care participants also reported better mood than UC participants (Patient-Reported Outcomes Measurement Information System-Depression effect size, 0.47; 95% CI, 0.28 to 0.67) and eUC participants (0.24; 95% CI, 0.07 to 0.41), but physical function, HF pharmacotherapy use, rehospitalizations, and mortality were similar by both baseline depression and randomization status. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of patients with HF and depression, telephone-delivered blended collaborative care produced modest improvements in mHRQOL, the primary outcome, on the MCS-12 vs UC but not eUC. Although blended care did not differentially affect rehospitalization and mortality, it improved mood better than eUC and UC and thus may enable organized health care systems to provide effective first-line depression care to medically complex patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02044211.
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Affiliation(s)
- Bruce L Rollman
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amy M Anderson
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott D Rothenberger
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ravi Ramani
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew F Muldoon
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John M Jakicic
- Healthy Lifestyle Institute & Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bea Herbeck Belnap
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Now with Department of Psychiatry, University of Arizona College of Medicine, Tucson
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Malik J, Shahid AW, Shah M, Rana G, Kamal A, Naeem H. Outcome of angiotensin receptor-neprilysin inhibitor on anxiety and depression in heart failure with reduced ejection fraction vs. heart failure with preserved ejection fraction. J Community Hosp Intern Med Perspect 2021; 11:629-634. [PMID: 34567453 PMCID: PMC8462846 DOI: 10.1080/20009666.2021.1942623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: In patients with heart failure (HF), anxiety and depression are commonly observed and confer an adverse outcome. The first-in-class member of angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril/valsartan has been demonstrated to improve functional class and decrease mortality in patients with heart failure with reduced ejection fraction (HFrEF) and reduce the readmission of heart failure with preserved ejection fraction (HFpEF). However, its effects on anxiety and depression levels remain unknown.Methods: Sacubitril/valsartan was started on 764 symptomatic patients with HFrEF and HFpEF who were receiving guideline-directed medical therapy (GDMT) with an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). Patients were evaluated using Hamilton's depression rating scale (HDRS) and the hospital anxiety and depression scale (HADS) for their levels of depression and anxiety before and after treatment at a six-month follow-up.Results: A significant reduction in HADS and HDRS scores was observed in patients with HFrEF (9.7 ± 1.3 to 6.4 ± 0.7, p = 0.032 and 19.2 ± 2.2 to 8.9 ± 1.6, p < 0.001, respectively) compared with HFpEF (p = 0.161 and 0.273, respectively). The six-minute walk test (6-MWT) significantly increased HFrEF from 195 ± 68 to 321 ± 97 (p < 0.001). There was an overall improvement in the functional class of all patients.Conclusion: Patients with HFrEF have the additional advantage of using sacubitril/valsartan in the form of decreased anxiety and depression symptoms in addition to an improvement in functional class. However, patients with HFpEF did not exhibit significant improvement in their psychological scores.
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Affiliation(s)
- Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Abdul Wahab Shahid
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Mohsin Shah
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Ghazanfar Rana
- Department of Cardiology, Saint Luke's General Hospital, Kilkenny, Ireland
| | - Ahmed Kamal
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Hesham Naeem
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 191] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42:3599-3726. [PMID: 34447992 DOI: 10.1093/eurheartj/ehab368] [Citation(s) in RCA: 4764] [Impact Index Per Article: 1588.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ewnetu Tarekegn G, Derseh Gezie L, Yemanu Birhan T, Ewnetu F. Health-Related Quality of Life Among Heart Failure Patients Attending an Outpatient Clinic in the University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2020: Using Structural Equation Modeling Approach. Patient Relat Outcome Meas 2021; 12:279-290. [PMID: 34483692 PMCID: PMC8409769 DOI: 10.2147/prom.s322421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic heart failure is one of the most important public health concerns in the industrialized and developing world having increasing prevalence. Measuring quality of life using rigorous statistical methods may be helpful to provide input for decision-makers and the development of guidelines. This study aimed to assess health-related quality of life and associated factors among heart failure patients attending the University of Gondar Specialized Hospital. Methods A cross-sectional study was employed to select 469 heart failure patients who have follow-up at the University of Gondar Specialized Hospital consecutively from March 01 to 30, 2020. Data were entered to Epi Info 7 and exported to STATA version 15 for further statistical analysis. The quality-of-life domains were measured with World Health Organization Quality of Life BREF. Structural equation modeling was employed to estimate the relationships among exogenous, mediating, and endogenous variables simultaneously. Results Chronic heart failure patients had a significantly lower mean score in physical health domain (31.70 mean score), environmental health domain (38.35 mean score), and in overall quality of life domain (41.61 mean score) moderate in social relation domain (46.22 mean score), and in psychological health domain (50.21 mean score) of health-related quality of life (p-value <0.0001). Age had a direct positive effect on health-related quality of life. Residency also had a direct negative effect on both physical and environmental health-related quality of life domain. Duration of heart failure had a direct negative effect on psychological health. Conclusion The finding of this study indicated that poor health-related quality of life in the physical health domain, moderately poor in overall health-related quality of life, and moderate health-related quality of life in the psychological health domain among Chronic heart failure patients. Age, residence, marital status, income, and duration of HF were significantly associated factors for quality of life among HF patients.
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Affiliation(s)
- Gebrekidan Ewnetu Tarekegn
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Frew Ewnetu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 2080] [Impact Index Per Article: 693.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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77
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Zhou ZF, Wang DJ, Li XM, Zhang CL, Wu CY. Effects of enhanced external counterpulsation on exercise capacity and quality of life in patients with chronic heart failure: A meta-analysis. Medicine (Baltimore) 2021; 100:e26536. [PMID: 34232191 PMCID: PMC8270628 DOI: 10.1097/md.0000000000026536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to synthesize randomized controlled trials to evaluate the effects of enhanced external counterpulsation (EECP) on exercise capacity and quality of life in patients with chronic heart failure (CHF). METHODS Both English and Chinese databases were searched from their inception to June 30, 2020 (PubMed, EMBASE, Cochrane Library, CINAHL (EBSCO), Web of Science for English publications and Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Data for Chinese publication). Titles, abstracts, and full-text articles were screened against study inclusion criteria: randomized controlled trials studying EECP intervention for patients with CHF. The meta-analysis was conducted with Revman 5.3 or STATA 16.0. RESULTS Eight randomized controlled trials were included. EECP induced significant improvement in 6-min walking distance (WMD=84.79 m; 95% CI, 47.64 to 121.95; P < .00001). Moreover, EECP was beneficial for left ventricular ejection fraction (SMD = 0.64; 95% CI,0.29 to 1.00; P = .0004), and N-terminal pro brain natriuretic peptide (SMD = -0.61; 95%CI, -1.20 to -0.01; P = 0.04).However, compared with the control groups, EECP did not significantly reduce the Minnesota Living with Heart Failure Questionnaire scores(WMD, -9.28; 95% CI, -19.30 to 0.75; P = 0.07). CONCLUSIONS Despite heterogeneity and risk of bias, this meta-analysis confirms that EECP can improve exercise capacity in CHF patients, especially the elderly. However, the evidence that EECP improves the quality of life in patients with CHF is still insufficient. More and larger well-designed randomized controlled trials are still warranted. REGISTRATION INFORMATION PROSPERO registration no. CRD 42020188848.
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78
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He W, Zhou Y, Ma J, Wei B, Fu Y. Effect of antidepressants on death in patients with heart failure: a systematic review and meta-analysis. Heart Fail Rev 2021; 25:919-926. [PMID: 31529170 DOI: 10.1007/s10741-019-09850-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Depression is associated with an increased risk of death in patients with heart failure (HF); however, the association between the use of antidepressants and HF prognoses remains controversial. Therefore, this meta-analysis aimed to evaluate the effect of antidepressants on the risk of death in HF patients. We retrieved data from the PubMed and EMBASE databases until August 2019 for studies reporting the use of antidepressants in HF patients. Data were extracted from the eligible articles, and a random effects model was used to pool the effect estimates (risk ratios (RRs) and 95% confidence intervals (CIs)). A total of 8 studies were included in this meta-analysis. Overall, the use of antidepressants was associated with increased risks of all-cause death (RR = 1.27; 95% CI, 1.21-1.34) and cardiovascular death (RR = 1.14; 95% CI, 1.08-1.20) in HF patients with or without depression. Specifically, HF patients with depression taking antidepressants had increased risks of all-cause death (RR = 1.21; 95% CI, 1.16-1.27) and cardiovascular death (RR = 1.21; 95% CI, 1.13-1.30). Compared with nonusers, the use of selective serotonin reuptake inhibitors (SSRIs), tricyclics (TCAs), and selective serotonin reuptake inhibitors (SNRIs) significantly increased the rate of all-cause death (SSRIs (RR = 1.26; 95% CI, 1.19-1.32), TCAs (RR = 1.30; 95% CI, 1.16-1.46), and SNRIs (RR = 1.17; 95% CI, 1.08-1.26)) but not cardiovascular death (SSRIs (RR = 1.03; 95% CI, 0.84-1.26), TCAs (RR = 1.02; 95% CI, 0.86-1.21), and SNRIs (RR = 0.92; 95% CI, 0.48-1.78)). Based on current publications, the use of antidepressants could increase the risk of all-cause death in HF patients, regardless of whether they have depression or the type of antidepressants they use. Further study is needed to determine the relationship between antidepressant use and cardiovascular death.
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Affiliation(s)
- Wenfeng He
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yue Zhou
- Department of Children's Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Bo Wei
- Department of Psychiatry, Jiangxi Mental Hospital, Nanchang, 330029, Jiangxi, China
| | - Yonghui Fu
- Department of Psychiatry, Jiangxi Mental Hospital, Nanchang, 330029, Jiangxi, China.
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79
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Moradi M, Daneshi F, Behzadmehr R, Rafiemanesh H, Bouya S, Raeisi M. Quality of life of chronic heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2021; 25:993-1006. [PMID: 31745839 DOI: 10.1007/s10741-019-09890-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite various individual studies on the quality of life (QOL) in patients with CHF, a comprehensive study has not yet been conducted; therefore, this study aims to assess the QOL of CHF patients. In the present systematic review and meta-analysis, PubMed, Scopus, and the Web of science databases were searched from January 1, 2000, to December 31, 2018, using QOL and heart failure as keywords. The searches, screenings, quality assessments, and data extractions were conducted separately by two researchers. A total of 70 studies including 25,180 participants entered the final stage. The mean QOL score was 44.1 (95% confidence interval (CI) 40.6, 47.5; I2 = 99.3%) using a specific random effects method in 40 studies carried out on 12,520 patients. Moreover, according to the geographical region, heart failure patients in the Americas had higher scores. In 14 studies, in which a general SF-36 survey was implemented, the average physical component score (PCS) and mental component score (MCS) were 33.3 (95% CI 31.9, 34.7; I2 = 88.0%) and 50.6 (95% CI 43.8, 57.4; I2 = 99.3%), respectively. The general and specific tools used in this study indicated moderate and poor QOL, respectively. Therefore, it is necessary to carry out periodic QOL measurements using appropriate tools as part of the general care of CHF patients.
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Affiliation(s)
- Mandana Moradi
- Clinical Pharmacy Department, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Fereshteh Daneshi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Razieh Behzadmehr
- Associate Professor of Radiology, Department of Radiology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Hosien Rafiemanesh
- Student Research Committee, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salehoddin Bouya
- Internal Medicine and Nephrology, Clinical Immunology Research Center, Ali-ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mohammad Raeisi
- Varamin-Pishva Branch, Islamic Azad University, Varamin, Iran
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80
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Levy S, Cole G, Pabari P, Dani M, Barton C, Mayet J, McDonagh T, Baxter J, Plymen C. New horizons in cardiogeriatrics: geriatricians and heart failure care-the custard in the tart, not the icing on the cake. Age Ageing 2021; 50:1064-1068. [PMID: 33837764 DOI: 10.1093/ageing/afab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Indexed: 01/10/2023] Open
Abstract
Heart failure (HF) can be considered a disease of older people. It is a leading cause of hospitalisation and is associated with high rates of morbidity and mortality in the over-65s. In 2012, an editorial in this journal detailed the latest HF research and guidelines, calling for greater integration of geriatricians in HF care. This current article reflects upon what has been achieved in this field in recent years, highlighting some future challenges and promising areas. It is written from the perspective of one such integrated team and explores the new role of cardiogeriatrician, working in a multidisciplinary team to deliver and improve care to increasingly complex, older, frail patients with multiple comorbidities who present with primary cardiology problems, especially decompensated HF. Geriatric liaison has improved the care of frail patients in orthopaedics, cancer services, stroke, acute medicine and numerous community settings. We propose that this vital role should now be extended to cardiology teams in general and to HF in particular.
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Affiliation(s)
- Shuli Levy
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine for the Elderly, Imperial College Healthcare NHS Trust, London, UK
| | - Graham Cole
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Punam Pabari
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Melanie Dani
- Department of Medicine for the Elderly, Imperial College Healthcare NHS Trust, London, UK
| | - Carys Barton
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Jamil Mayet
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Theresa McDonagh
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, London, UK
| | - John Baxter
- Department of Medicine for the Elderly, Sunderland Royal Hospital, Sunderland, UK
| | - Carla Plymen
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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81
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TaiChi and Qigong for Depressive Symptoms in Patients with Chronic Heart Failure: A Systematic Review with Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5585239. [PMID: 34326885 PMCID: PMC8302391 DOI: 10.1155/2021/5585239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
Background Depression is a debilitating comorbidity of heart failure (HF) that needs assessment and management. Along with mind-body exercise to deal with HF with depression, the use of TaiChi and/or Qigong practices (TQPs) has increased. Therefore, this systematic review assesses the effects of TQPs on depression among patients with HF. Methods Randomized controlled trials (RCTs) that examined the effect of TQPs on depression in patients with HF were searched by five databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI)). With standardized mean difference (SMD) and 95% confidence intervals (95% CI), random-effects meta-analyses of the effect of TQPs on depressive symptoms were performed. Results Of eight included RCTs, seven (481 patients) provided data for the meta-analysis. The pooling revealed that TQPs contribute to depression remission in HF (SMD -0.66; 95% CI -0.98 to -0.33, P < 0.0001; I 2 = 64%). Its antidepressive effect was not influenced by intervention duration or exercise setting, but rather by ejection fraction subtype, depressive severity, and depression instruments. The beneficial effects were preserved when the study with the largest effect was removed. Conclusion This study suggests that TQPs might be a good strategy for alleviating depressive symptoms in patients with HF. And rigorous-design RCTs, which focus on the identified research gaps, are needed to further establish the therapeutic effects of TQPs for depression in HF.
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82
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Chouairi F, Fuery MA, Mullan CW, Caraballo C, Sen S, Maulion C, Wilkinson ST, Surti T, McCullough M, Miller PE, Pacor J, Leifer ES, Felker GM, Velazquez EJ, Fiuzat M, O'Connor CM, Januzzi JL, Desai NR, Ahmad T. The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial. J Card Fail 2021; 27:1359-1366. [PMID: 34166799 DOI: 10.1016/j.cardfail.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/04/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND It remains unclear why depression is associated with adverse outcomes in patients with heart failure (HF). We examine the relationship between depression and clinical outcomes among patients with HF with reduced ejection fraction managed with guideline-directed medical therapy (GDMT). METHODS AND RESULTS Using the GUIDE-IT trial, 894 patients with HF with reduced ejection fraction were stratified according to a history of depression, and Cox proportional hazards regression modeling was used to examine the association with outcomes. There were 140 patients (16%) in the overall cohort who had depression. They tended to be female (29% vs 46%, P < .001) and White (67% vs 53%, P = .002). There were no differences in GDMT rates at baseline or at 90 days; nor were there differences in target doses of these therapies achieved at 90 days (NS, all). amino-terminal pro-B-type natriuretic peptide levels at all time points were similar between the cohorts (P > .05, all). After adjustment, depression was associated with all-cause hospitalizations (hazard ratio, 1.42, 95% confidence interval 1.11-1.81, P < .01), cardiovascular death (hazard ratio, 1.69, 95% confidence interval 1.07-2.68, P = .025), and all-cause mortality (hazard ratio, 1.54, 95% confidence interval 1.03-2.32, P = .039). CONCLUSIONS Depression impacts clinical outcomes in HF regardless of GDMT intensity and amino-terminal pro-B-type natriuretic peptide levels. This finding underscores the need for a focus on mental health in parallel to achievement of optimal GDMT in these patients. TRIAL REGISTRATION NCT01685840, https://clinicaltrials.gov/ct2/show/NCT01685840.
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Affiliation(s)
- Fouad Chouairi
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Duke University University School of Medicine, Durham, North Carolina
| | - Michael A Fuery
- Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Clancy W Mullan
- Department of Cardiac Surgery, Yale University School of Medicine, New Haven, CT
| | - Cesar Caraballo
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research & Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Christopher Maulion
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Samuel T Wilkinson
- Center for Outcomes Research & Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry Yale University School of Medicine, New Haven, Connecticut
| | - Toral Surti
- Center for Outcomes Research & Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry Yale University School of Medicine, New Haven, Connecticut
| | | | - P Elliott Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Justin Pacor
- Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Eric S Leifer
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Eric J Velazquez
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Mona Fiuzat
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research & Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut.
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83
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Bierle RS, Vuckovic KM, Ryan CJ. Integrating Palliative Care Into Heart Failure Management. Crit Care Nurse 2021; 41:e9-e18. [PMID: 34061196 DOI: 10.4037/ccn2021877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families through the prevention and relief of suffering by assessment and treatment of physical, psychosocial, and spiritual problems. Any patient with chronic debilitating disease, including heart failure, is a candidate for interdisciplinary palliative care to manage their complex physical and psychosocial needs. CLINICAL RELEVANCE The philosophy of palliative care has evolved to include a vision of holistic care extended to all individuals with serious illness and their families or caregivers that should be integrated throughout the continuum of care, including the acute phase. The critical care nurse will likely encounter patients with heart failure who are receiving or are eligible to receive palliative care at various time points during their illness. Critical care nurses therefore play a pivotal role in symptom palliation affecting the heart failure patient's quality of life. PURPOSE To review the models of palliative care and the role that the critical care nurse plays in symptom palliation and preparation of the patient and their family for transition to other levels and settings of care. CONTENT COVERED This review addresses the principles and models of palliative care along with how to integrate these principles into all phases of the heart failure disease continuum. Also included are recommendations for palliation of symptoms specific to heart failure patients as well as a discussion of the role of the critical care nurse and the importance of shared decision-making.
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Affiliation(s)
- Rebecca Schuetz Bierle
- Rebecca (Schuetz) Bierle is a nurse practitioner in cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota
| | - Karen M Vuckovic
- Karen M. Vuckovic is a clinical associate professor, College of Nursing, Department of Biobehavioral Health Sciences, University of Illinois at Chicago; and an advanced practice nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, Chicago
| | - Catherine J Ryan
- Catherine J. Ryan is a clinical associate professor, College of Nursing, Department of Biobehavioral Health Sciences, University of Illinois at Chicago
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84
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the relationship between cardiovascular disease (CVD) and depression, both as a cause of and a result of CVD. RECENT FINDINGS The prevalence of depression seems to be increasing in the general population.It is likely that depression will be even more of a problem for CVD patients in the post-COVID-19 pandemic era.New studies confirm the independent association of depression with later incident CVD, although perhaps not as strong as suggested by some previous studies.Depression seems to be becoming even more prevalent in CVD patients, with new data for stroke and peripheral arterial disease patients.Cardiologists rarely screen for depression and most do not believe that they have a responsibility for detecting or treating depression.There are new data suggesting that patients who are more in control of their lives have better outcomes and that change is possible. SUMMARY Depression is preventable and treatable. It is imperative to detect and manage depression in CVD patients. Additional research is required to see whether or not comprehensive patient screening for depression translates into both better quality of life and improved clinical outcomes.
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Affiliation(s)
- David L Hare
- Department of Cardiology, Austin Health, Heidelberg
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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85
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Thyagaturu HS, Thangjui S, Shah K, Naik RV, Bondi G. Association of Major Depressive Disorder on Heart Failure With Reduced and Preserved Ejection Fraction: Analysis of National Readmission Database 2018. Cureus 2021; 13:e15107. [PMID: 34026388 PMCID: PMC8133512 DOI: 10.7759/cureus.15107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The effect of major depressive disorder (MDD) on heart failure types is unclear. We aimed to assess the association of depression in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) readmissions using the Nationwide Readmission Database (NRD) 2018. Methods We identified hospitalizations with a primary discharge diagnosis of HFrEF and HFpEF by appropriate ICD-10-CM codes. We acquired mortality and readmission data with and without MDD at 30 days. We used multivariate logistic regression analysis to estimate the adjusted odds ratio (aOR). Results Among 102,997 patients admitted with heart failure as a primary diagnosis, 11% had MDD. We found a similar prevalence of HFpEF with MDD compared to HFrEF at 13.9% and 10%, respectively. Both HFrEF and HFpEF patients with MDD had similar combined outcomes of 30-day mortality and rehospitalization compared to patients without MDD with aOR 0.94 (95% CI: 0.85-1.04) and 0.93 (95% CI: 0.81-1.07), respectively. Both types of HF with MDD were associated with lesser mortality. Conclusion MDD was associated with similar combined 30-day mortality and readmissions for both HFrEF and HFpEF. However, MDD was associated with decreased 30-day mortality in both groups of heart failure (HF) patients. Further studies with robust medications and treatment data are needed to verify the results of our study.
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Affiliation(s)
| | | | - Kashyap Shah
- Internal Medicine, Saint Luke's University Hospital, Bethlehem, USA
| | - Riddhima V Naik
- Internal Medicine, Bassett Healthcare Network, Cooperstown, USA
| | - Gayatri Bondi
- Internal Medicine, Bassett Healthcare Network, Cooperstown, USA
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86
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Schulz SM, Ritter O, Zniva R, Nordbeck P, Wacker C, Jack M, Groschup G, Deneke T, Puppe F, Ertl G, Angermann C, Störk S, Pauli P. Efficacy of a web-based intervention for improving psychosocial well-being in patients with implantable cardioverter-defibrillators: the randomized controlled ICD-FORUM trial. Eur Heart J 2021; 41:1203-1211. [PMID: 30957867 PMCID: PMC9597328 DOI: 10.1093/eurheartj/ehz134] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/28/2018] [Accepted: 02/25/2019] [Indexed: 11/16/2022] Open
Abstract
Aims Anxiety, depression, and reduced quality of life (QoL) are common in patients with implantable cardioverter-defibrillators (ICDs). Treatment options are limited and insufficiently defined. We evaluated the efficacy of a web-based intervention (WBI) vs. usual care (UC) for improving psychosocial well-being in ICD patients with elevated psychosocial distress. Methods and results This multicentre, randomized controlled trial (RCT) enrolled 118 ICD patients with increased anxiety or depression [≥6 points on either subscale of the Hospital Anxiety and Depression Scale (HADS)] or reduced QoL [≤16 points on the Satisfaction with Life Scale (SWLS)] from seven German sites (mean age 58.8 ± 11.3 years, 22% women). The primary outcome was a composite assessing change in heart-focused fear, depression, and mental QoL 6 weeks after randomization to WBI or UC, stratified for age, gender, and indication for ICD placement. Web-based intervention consisted of 6 weeks’ access to a structured interactive web-based programme (group format) including self-help interventions based on cognitive behaviour therapy, a virtual self-help group, and on-demand support from a trained psychologist. Linear mixed-effects models analyses showed that the primary outcome was similar between groups (η
 p
 2 = 0.001). Web-based intervention was superior to UC in change from pre-intervention to 6 weeks (overprotective support; P = 0.004, η
 p
 2 = 0.036), pre-intervention to 1 year (depression, P = 0.004, η
 p
 2 = 0.032; self-management, P = 0.03, η
 p
 2 = 0.015; overprotective support; P = 0.02, η
 p
 2 = 0.031), and 6 weeks to 1 year (depression, P = 0.02, η
 p
 2 = 0.026; anxiety, P = 0.03, η
 p
 2 = 0.022; mobilization of social support, P = 0.047, η
 p
 2 = 0.018). Conclusion Although the primary outcome was neutral, this is the first RCT showing that WBI can improve psychosocial well-being in ICD patients. ![]()
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Affiliation(s)
- Stefan M Schulz
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of WĂĽrzburg, MarcusstraĂźe 9-11, BY, 97070 WĂĽrzburg, Germany.,Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, WallstraĂźe 3, RP, 55122 Mainz, Germany
| | - Oliver Ritter
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany.,Department of Cardiologoephrology and Pulmology, Brandenburg Medical School, University Hospital Brandenburg, HochstraĂźe 29, BB, 14770 Brandenburg an der Havel, Germany
| | - Richard Zniva
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital WĂĽrzburg, OberdĂĽrrbacher StraĂźe 6, BY, 97080 WĂĽrzburg, Germany
| | - Christian Wacker
- Division of Cardiology, Department of Medicine, ANregiomed-Hospital Rothenburg ob der Tauber, Ansbacher StraĂźe 131, BY, 91541 Rothenburg ob der Tauber, Germany
| | - Mary Jack
- Hospital Bad Wörishofen, Tannenbaum 2, BY, 86825 Bad Wörishofen, Germany
| | - Guido Groschup
- Division of Rhythmology, Department of Medicine I, City Hospital Aschaffenburg, Am Hasenkopf 1, BY, 63739 Aschaffenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Centre GmbH, Schlossplatz 1, BY, 97616 Bad Neustadt a. d. Saale, Germany
| | - Frank Puppe
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany.,Chair of Computer Science VI, University of WĂĽrzburg, Am Hubland, BY, 97074 WĂĽrzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany
| | - Christiane Angermann
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital WĂĽrzburg, OberdĂĽrrbacher StraĂźe 6, BY, 97080 WĂĽrzburg, Germany
| | - Paul Pauli
- Comprehensive Heart Failure Center, University and University Hospital WĂĽrzburg, Am Schwarzenberg 15, BY, 97078 WĂĽrzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of WĂĽrzburg, MarcusstraĂźe 9-11, BY, 97070 WĂĽrzburg, Germany
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87
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Langhammer R, Wachter R. [New treatment options of heart failure with reduced ejection fraction]. MMW Fortschr Med 2021; 163:28-37. [PMID: 33950447 DOI: 10.1007/s15006-021-9806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Romy Langhammer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Rolf Wachter
- - Abt. Kardiologie -, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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88
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Gale SE, Mardis A, Plazak ME, Kukin A, Reed BN. Management of noncardiovascular comorbidities in patients with heart failure with reduced ejection fraction. Pharmacotherapy 2021; 41:537-545. [PMID: 33876451 DOI: 10.1002/phar.2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/07/2022]
Abstract
Patients with heart failure with reduced ejection fraction often have one or more noncardiovascular comorbidities. The presence of concomitant disease states is associated with worse outcomes, including increased risk of mortality, decreased quality of life, and increased healthcare resource utilization. Additionally, the presence of heart failure with reduced ejection fraction complicates the management of these comorbidities, including varying safety and efficacy of therapies compared to those without heart failure. This article will review the literature on the pharmacologic management of common noncardiovascular comorbidities-including chronic obstructive pulmonary disease, depression, diabetes mellitus, gout, chronic kidney disease, and iron deficiency-in patients with heart failure with reduced ejection fraction, as well as provide recommendations for appropriate treatment selection in this population.
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Affiliation(s)
- Stormi E Gale
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | | | | | - Alina Kukin
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brent N Reed
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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89
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Sun N, Mei Y, Hu Z, Xing W, Lv K, Hu N, Zhang T, Wang D. Ghrelin attenuates depressive-like behavior, heart failure, and neuroinflammation in postmyocardial infarction rat model. Eur J Pharmacol 2021; 901:174096. [PMID: 33848542 DOI: 10.1016/j.ejphar.2021.174096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
Depression after myocardial infarction (MI) and chronic heart failure (CHF) is a common condition that is resistant to anti-depressive drugs. Ghrelin (a peptide hormone) shows dual protective effects on heart and brain. Whether ghrelin treatment attenuated depression after MI was investigated. Coronary artery occlusion was performed to induce MI and subsequent CHF in rats. Ghrelin (100Â ÎĽg/kg in 0.5Â ml of saline) or vehicle (0.5Â ml of saline) was injected subcutaneously twice a day for 4 weeks. At week 5, all the animals underwent behavioral assessments including sucrose preference test (SPT), elevated plus maze test (EPM), and open field test (OFT). After cardiac function analysis, brain tissues were processed to determine inflammatory cytokines and microglial activations in hippocampus. Results showed that ghrelin substantially improved cardiac dysfunction, infarction size, and cardiac remodeling and modulated the release of inflammatory cytokines and the increase of Iba-1 positive microglia and glial fibrillary acidic protein-positive astrocytes in the CA1 area of hippocampus. Behavioral tests revealed that this treatment remarkably increased sucrose preference and mobile times and numbers. These findings provided evidence that peripheral ghrelin administration inhibits depression-like behavior and neuroinflammation and thus could be a new approach for the treatment of CHF-associated depression.
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Affiliation(s)
- Nan Sun
- Department of Gerontology, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, 241001, PR China; Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, Anhui, 241001, PR China
| | - Yong Mei
- Department of Gerontology, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, 241001, PR China; Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, Anhui, 241001, PR China
| | - Zhengtao Hu
- Department of Gerontology, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, 241001, PR China
| | - Wen Xing
- Department of Gerontology, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, 241001, PR China
| | - Kun Lv
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, Anhui, 241001, PR China
| | - Nengwei Hu
- Department of Gerontology, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, 241001, PR China; Department of Physiology and Neurobiology, Zhengzhou University School of Medicine, Zhengzhou, 450001, China; Department of Pharmacology & Therapeutics and Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - Ting Zhang
- Department of Psychology, Wannan Medical College, Wuhu, 241001, PR China.
| | - Deguo Wang
- Department of Gerontology, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, 241001, PR China; Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, Anhui, 241001, PR China.
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90
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Dunham S, Wilkening GL, Schwier NC. Which SSRI is safest for patients with CVD and major depressive disorder? JAAPA 2021; 34:18-19. [PMID: 33735134 DOI: 10.1097/01.jaa.0000735792.92508.a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Major depressive disorder is a common mood disorder and presents increased morbidity and mortality risks for patients with comorbid cardiovascular disease (CVD). Selective serotonin reuptake inhibitors (SSRIs) are a cornerstone of treatment for major depressive disorder, given their relative safety and affordability compared with other antidepressant classes, and SSRIs frequently are used in patients with CVD. However, clinicians should carefully weigh safety considerations before prescribing SSRIs in these patients. This article reviews the safety of SSRIs in patients with CVD and discusses SSRI selection.
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Affiliation(s)
- Sabrina Dunham
- Sabrina Dunham is a cardiology pharmacy specialty resident at HCA Tristar Centennial Medical Center/University of Tennessee College of Pharmacy in Nashville, Tenn. G. Lucy Wilkening is an associate professor in the Department of Clinical Psychopharmacology at Idaho State University's College of Pharmacy in Meridian, Idaho. Nicholas C. Schwier is an associate professor at the University of Oklahoma Health Sciences Center and a clinical pharmacy specialist in cardiology at OU Medicine Inc., both in Oklahoma City, Okla. The authors have disclosed no potential conflicts of interest, financial or otherwise
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91
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Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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92
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Hori M, Imamura T, Nakamura M, Nakagaito M, Kinugawa K. Therapeutic Strategy for a Patient with Advanced Heart Failure and Schizophrenia Without Cardiac Replacement Therapies. Int Heart J 2021; 62:441-444. [PMID: 33731533 DOI: 10.1536/ihj.20-624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We had a 58-year-old man with advanced heart failure and progressive end-organ dysfunction refractory to inotropes. Following detailed discussions, he decided not to receive ventricular assist device therapy considering his comorbidity of schizophrenia. A palliative care team initiated 2.5 mg of morphine together with low-dose anti-heart failure medications, which improved not only his heart failure symptoms but also the congestive heart failure itself. Aggressive commitments of the palliative care team might improve not only patients' quality of life but also advanced heart failure itself.
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Affiliation(s)
- Masakazu Hori
- Second Department of Internal Medicine, University of Toyama
| | | | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
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93
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Störk S, Angermann C, Bauersachs J, Frantz S. [Care of patients with chronic heart failure: an interdisciplinary challenge]. Dtsch Med Wochenschr 2021; 146:309-316. [PMID: 33647999 DOI: 10.1055/a-1235-0422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The diverse manifestations of heart failure led to complex treatment guidelines and care scenarios and therefore always require an integrated, multidisciplinary care approach. Patients with chronic heart failure suffer from a large number of cardiac and noncardiac comorbidities. For example, iron deficiency leads to decreased performance and exertional dyspnea and should be diagnosed. Psychological screening questionnaires should be used for the early detection of psychological comorbidities.ARNI and SGLT-inhibitors expand the pharmacotherapeutic possibilities and gain in importance. The constant development of diagnostic possibilities and therapeutic options must be implemented consistently into the care continuum in order to have a lasting effect. The challenge of interdisciplinary coordination can be significantly reduced through jointly agreed process logs (e. g. within the framework of integrated supply contracts or a Heart Failure Unit Network).
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94
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Liu J, Guo Z, Fan M, Liang W, He X, Wu D, Dong Y, Zhu W, Liu C. Major depression and clinical outcomes in patients with heart failure with preserved ejection fraction. Eur J Clin Invest 2021; 51:e13401. [PMID: 32910827 DOI: 10.1111/eci.13401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Limited data have been published concerning about depression in heart failure with preserved ejection fraction (HFpEF). Besides, among HFpEF patients with depression, the efficacy of antidepressants is poorly defined. Therefore, our current study was aimed to examine the relationship between major depression and clinical outcomes in HFpEF patients and further address the effects of antidepressants on prognosis in patients with major depression and HFpEF. METHODS A total of 1431 patients enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) were divided into 2 groups according to the baseline depression status. Major depression was diagnosed if the Patient Health Questionnaire-9 score (PHQ-9) ≥ 10. Univariable and multivariable Cox proportional hazards models tested the association of major depression with outcomes and the effects of antidepressants among HFpEF patients with major depression during a follow-up of 6 years. RESULTS 26.7% (382/1431) of patients were diagnosed with major depression. After multivariable adjustment, major depression at baseline was not significantly associated with cardiovascular outcomes (fully adjusted hazard ratio (aHR) 0.95 [0.76-1.18] for primary outcomes; aHR: 0.86 [0.67-1.10] for HF hospitalization; aHR: 1.06 [0.91-1.23] for any hospitalization; aHR: 1.00 [0.70-1.43] for cardiovascular death; aHR: 1.24 [0.96-1.61] for all-cause death). Additionally, among HFpEF patients with major depression, the use of antidepressants was not associated with adverse events (P > .05 for all analyses). CONCLUSIONS In HFpEF patients, major depression at baseline did not increase mortality or rehospitalization. Additionally, treatment with antidepressants might not improve prognosis among HFpEF patients with major depression. Future studies are warranted to explore the effects of antidepressants on HFpEF patients with depression.
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Affiliation(s)
- Jian Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.,Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Zejun Guo
- The hospital of South China Normal University, Guangzhou, PR China
| | - Meida Fan
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China.,Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Weihao Liang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Xin He
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Dexi Wu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Yugang Dong
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Wengen Zhu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Chen Liu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
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95
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Heart and brain interactions : Pathophysiology and management of cardio-psycho-neurological disorders. Herz 2021; 46:138-149. [PMID: 33544152 PMCID: PMC7966144 DOI: 10.1007/s00059-021-05022-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/22/2022]
Abstract
Cardiovascular diseases (CVD) and mental health disorders (MHD; e.g. depression, anxiety and cognitive dysfunction) are highly prevalent and are associated with significant morbidity and mortality and impaired quality of life. Currently, possible interactions between pathophysiological mechanisms in MHD and CVD are rarely considered during the diagnostic work-up, prognostic assessment and treatment planning in patients with CVD, and research addressing bidirectional disease mechanisms in a systematic fashion is scarce. Besides some overarching pathogenetic principles shared by CVD and MHD, there are specific syndromes in which pre-existing neurological or psychiatric illness predisposes and contributes to CVD development (as in Takotsubo syndrome), or in which the distorted interplay between innate immune and central nervous systems and/or pre-existing CVD leads to secondary MHD and brain damage (as in peripartum cardiomyopathy or atrial fibrillation). Clinical manifestations and phenotypes of cardio-psycho-neurological diseases depend on the individual somatic, psychosocial, and genetic risk profile as well as on personal resilience, and differ in many respects between men and women. In this article, we provide arguments on why, in such conditions, multidisciplinary collaborations should be established to allow for more comprehensive understanding of the pathophysiology as well as appropriate and targeted diagnosis and treatment. In addition, we summarize current knowledge on the complex interactions between the cardiovascular and central nervous systems in Takotsubo syndrome and peripartum cardiomyopathy, and on the neurological and psychiatric complications of atrial fibrillation.
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96
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Papathanasiou JV. Are the group-based interventions improving the functional exercise capacity and quality of life of frail subjects with chronic heart failure? J Frailty Sarcopenia Falls 2020; 5:102-108. [PMID: 33283076 PMCID: PMC7711733 DOI: 10.22540/jfsf-05-102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 01/25/2023] Open
Abstract
Objectives: Frail subjects with chronic heart failure (CHF) often demonstrate limited tolerance of exertion, shortness of breath, and reduced walking capacity resulting poor quality of life (QoL). The aim of this study was to quantify the improvements in functional exercise capacity (FEC) and QoL among Bulgarian frail subjects with CHF performed group-based high-intensity aerobic interval training (HIAIT)/m-Ullevaal intervention and to compare it with moderate intensity continuous training (MICT) protocol. Methods: One hundred and twenty (n=120) frail subjects with mean age of 63.73±6.68 years, in CHF and NYHA class II-IIIB, were enrolled in the single-center, prospective, two-arm randomized controlled clinical trial conducted at the Medical Center for Rehabilitation and Sports Medicine-I-Plovdiv. The baseline assessment included 6-minute walk test (6ΜWT), peak oxygen uptake (VO2peak), modified Borg Perceived Exertion Scale (mBPES), and Minnesota living with the Heart Failure Questionnaire (MLHFQ). Results: The improvement in 6MWT (P<0.001), VO2peak (P<0.001), mBPES (P<0.001), and MLHFQ (P<0.001) observed among frail subjects performed HIAIT/m-Ullevaal intervention was significantly greater compared to the improvement observed in the subjects performed MICT protocol (P<0.001). Conclusions: The group-based HIAIT/m-Ullevaal intervention is a new perspective and challenge for both, Bulgarian cardiac rehabilitation (CR), and frail patients with CHF.
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Affiliation(s)
- Jannis Vasileios Papathanasiou
- Department of Medical Imaging, Allergology and Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria.,Department Kinesitherapy of Faculty of Public Health, Medical University of Sofia, Bulgaria
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97
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Zwas DR, Keren A, Amir O, Gotsman I. Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression. J Clin Med 2020; 9:jcm9123967. [PMID: 33297471 PMCID: PMC7762354 DOI: 10.3390/jcm9123967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Few studies have evaluated the effect of pharmacologic treatment of anxiety on outcomes in heart failure (HF) patients. This study examined the impact of treatment with anxiolytics on clinical outcomes in a real-world sample of HF patients with and without depression. METHODS Patients diagnosed with HF were retrieved from a large HMO database. Patients prescribed anxiolytic medication and patients diagnosed with depression and/or prescribed anti-depressant medication were followed for cardiac-related hospitalizations and death. RESULTS The study cohort included 6293 HF patients. Treatment with anxiolytics was associated with decreased one-year survival compared to untreated individuals, with a greater reduction in survival seen in patients diagnosed with depression and/or treated with anti-depressants. Multi-variable analysis adjusting for age, sex, NYHA class, cardiac risk factors and laboratory parameters found that treatment with anxiolytics remained a predictor of mortality even when adjusting for depression. Depression combined with anxiolytic treatment was predictive of increased mortality, and treatment with anxiolytics alone, depression alone and anxiolytic treatment together with depression were each associated with an increased hazard ratio for a composite outcome of death and hospitalization. CONCLUSIONS In this real-world study of HF patients, both treatment with anxiolytics and depression were associated with increased mortality, and anxiolytic therapy remained a predictor of mortality when adjusting for depression. Treatment of anxiety together with depression was associated with the highest risk of mortality. Safe and effective treatment for anxiety and depression is warranted to alleviate the detrimental impact of these disorders on quality and of life and adverse events.
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Affiliation(s)
- Donna R. Zwas
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
- Correspondence: ; Tel.: +972-2-6776564; Fax: +972-2- 6411028
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
| | - Offer Amir
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
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98
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Dereli S, Kılınçel O, Çerik İB, Kaya A. Impact of sacubitril/valsartan treatment on depression and anxiety in heart failure with reduced ejection fraction. Acta Cardiol 2020; 75:774-782. [PMID: 32186467 DOI: 10.1080/00015385.2020.1730577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes. Sacubitril/valsartan, which is an angiotensin receptor neprilysin inhibitor (ARNI), has been shown to reduce mortality and hospitalisation in patients with heart failure with reduced ejection fraction (HFrEF). However, its effects on depression and anxiety levels remain unclear.Methods: Sacubitril/valsartan was initiated in 115 symptomatic patients with HFrEF receiving an optimal medical treatment with angiotensin inhibition. Patients underwent 6-minute walk test (6-MWT), The Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were administered at the switching to ARNI and at the third-month follow-up of the maximum sacubitril/valsartan dose.Results: A significant improvement was observed in BDI-II and BAI scores when compared before and after the sacubitril/valsartan treatment (13.7 ± 9.7 to 7.6 ± 3.8, p < 0.001 and 13.3 ± 8.9 to 8.1 ± 4.1, p < 0.001, respectively). The 6-MWT distance significantly increased from 213 ± 95 to 327 ± 118 mt (p < 0.001). Overall, the patients exhibited a significant functional improvement following the initiation of sacubitril/valsartan: 27% of the patients improved by two New York Heart Association (NYHA) classes, 52% improved by one NYHA functional class, and 31% remained stable.Conclusion: In patients with HFrEF, the switch from angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to sacubitril/valsartan resulted in a significant improvement in both depression, anxiety symptoms and functional statuses.
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Affiliation(s)
- Seçkin Dereli
- Deparment of Cardiology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | | | | | - Ahmet Kaya
- Deparment of Cardiology, Faculty of Medicine, Ordu University, Ordu, Turkey
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Chandra A, Alcala MA, Claggett B, Desai AS, Fang JC, Heitner JF, Liu J, Pitt B, Solomon SD, Pfeffer MA, Lewis EF. Associations Between Depressive Symptoms and HFpEF-Related Outcomes. JACC-HEART FAILURE 2020; 8:1009-1020. [DOI: 10.1016/j.jchf.2020.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022]
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Koehler J, Stengel A, Hofmann T, Wegscheider K, Koehler K, Sehner S, Rose M, Deckwart O, Anker SD, Koehler F, Laufs U. Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) study. Eur J Heart Fail 2020; 23:186-194. [PMID: 33063412 DOI: 10.1002/ejhf.2025] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/18/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Depression is a frequent comorbidity in patients with chronic heart failure (CHF). Telemonitoring has emerged as a novel option in CHF care. However, patients with depression have been excluded in most telemedicine studies. This pre-specified subgroup analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial investigates the effect of telemonitoring on depressive symptoms over a period of 12 months. METHODS AND RESULTS The TIM-HF study randomly assigned 710 patients with CHF to either usual care (UC) or a telemedical intervention (TM) using non-invasive devices for daily monitoring electrocardiogram, blood pressure and body weight. Depression was evaluated by the 9-item Patient Health Questionnaire (PHQ-9) with scores ≥10 defining clinically relevant depressive symptoms. Mixed model repeated measures were performed to calculate changes in PHQ-9 score. Quality of life was measured by the Short Form-36. At baseline, 156 patients had a PHQ-9 score ≥10 points (TM: 79, UC: 77) with a mean of 13.2 points indicating moderate depressiveness. Patients randomized to telemedicine showed an improvement of their PHQ-9 scores, whereas UC patients remained constant (P = 0.004). Quality of life parameters were improved in the TM group compared to UC. Adjustment was performed for follow-up, New York Heart Association class, medication, age, current living status, number of hospitalizations within the last 12 months and serum creatinine. In the study population without depression, the PHQ-9 score was similar at baseline and follow-up. CONCLUSION Telemedical care improved depressive symptoms and had a positive influence on quality of life in patients with CHF and moderate depression.
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Affiliation(s)
- Johanna Koehler
- Charité - Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany.,Universität Leipzig - Faculty of Medicine, Leipzig, Germany
| | - Andreas Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine; Charité Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Hofmann
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine; Charité Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kerstin Koehler
- Charité - Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Rose
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine; Charité Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Deckwart
- Charité - Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Friedrich Koehler
- Charité - Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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