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Abdelhamid M, Al Ghalayini K, Al‐Humood K, Altun B, Arafah M, Bader F, Ibrahim M, Sabbour H, Shawky Elserafy A, Skouri H, Yilmaz MB. Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey. ESC Heart Fail 2023; 10:2773-2787. [PMID: 37530028 PMCID: PMC10567674 DOI: 10.1002/ehf2.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023] Open
Abstract
Although epidemiological data on heart failure (HF) with preserved ejection fraction (HFpEF) are scarce in the Middle East, North Africa and Turkey (MENAT) region, Lancet Global Burden of Disease estimated the prevalence of HF in the MENAT region in 2019 to be 0.78%, versus 0.71% globally. There is also a high incidence of HFpEF risk factors and co-morbidities in the region, including coronary artery disease, diabetes, obesity, hypertension, anaemia and chronic kidney disease. For instance, 14.5-16.2% of adults in the region reportedly have diabetes, versus 7.0% in Europe. Together with increasing life expectancy, this may contribute towards a higher burden of HFpEF in the region than currently reported. This paper aims to describe the epidemiology and burden of HFpEF in the MENAT region, including unique risk factors and co-morbidities. It highlights challenges with diagnosing HFpEF, such as the prioritization of HF with reduced ejection fraction (HFrEF), the specific profile of HFpEF patients in the region and barriers to effective management associated with the healthcare system. Guidance is given on the diagnosis, prevention and management of HFpEF, including the emerging role of sodium-glucose co-transporter-2 inhibitors. Given the high burden of HFpEF coupled with the fact that its prevalence is likely to be underestimated, healthcare professionals need to be alert to its signs and symptoms and to manage patients accordingly. Historically, HFpEF treatments have focused on managing co-morbidities and symptoms, but new agents are now available with proven effects on outcomes in patients with HFpEF.
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Affiliation(s)
| | | | | | - Bülent Altun
- Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | | | - Feras Bader
- Cleveland ClinicAbu DhabiUnited Arab Emirates
| | | | | | | | - Hadi Skouri
- Sheikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
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Hadidi SE, Bazan NS, Byrne S, Darweesh E, Bermingham M. Factors influencing prescribing by critical care physicians to heart failure patients in Egypt: a cross-sectional survey. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2022. [DOI: 10.1186/s43094-022-00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Heart failure (HF) guideline-led prescribing improves patient outcomes; however, little is known about the factors influencing guideline-led prescribing in critical care settings. This study used a cross-sectional survey to assess the factors that influence physicians when prescribing to heart failure patients in a critical care setting in Egypt.
Results
The response rate was 54.8%. The international HF guidelines were the primary source of prescribing information for 84.2% of respondents. Staff were more familiar with the latest guideline recommendations than associate staff (86.7% vs 36.8%, p = 0.012) and considered patient’s perspectives more often (86.7% vs 26.3%, p = 0.036). Renal function was the clinical factor that most frequently influenced the prescribing of loop diuretics or renin–angiotensin–aldosterone system inhibitors. Pulmonary function influenced beta-blockers prescription. The most frequently cited barrier to guideline-led prescribing was the absence of locally drafted guidelines. A majority of prescribers agreed that implementation of clinical pharmacy services, physician education and electronic reminders may improve the implementation of guideline-led prescribing.
Conclusions
Although experienced physicians are familiar with and use international guidelines, physicians would welcome local guidance on HF prescribing and greater clinical pharmacist input.
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Abdelhamid M, Kandil H, Hassanin M, Shaheen S, Sobhy M, ElEtreby A, Hasan‐Ali H, Mahfouz H, Nasr G, Shawky I, Emil S, ElSetiha M, Hasssan M, Sadek Y, Karim MA, Asham A, Ghaleb M, Samir A, Shokry K. Egyptian expert opinion for the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2022; 9:800-811. [PMID: 35118822 PMCID: PMC8934981 DOI: 10.1002/ehf2.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the risk of serious heart failure events, specifically the risk of hospitalization for heart failure, and cardiovascular death. The benefit is most apparent in patients with a heart failure with reduced ejection fraction (HFrEF). Dapagliflozin and empagliflozin reduced the risk of cardiovascular death and hospitalizations for heart failure in patients with established HFrEF, including those without diabetes. Considering the magnitude of the problem and the expected benefit on the target population, an Egyptian consensus document was conducted to demonstrate the importance of and the critical knowledge needed for effective and safe implementation of SGLT2i in the daily practice for the management of patients with HFrEF.
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Affiliation(s)
- Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy, Cardiology DepartmentCairo UniversityCairoEgypt
| | - Hossam Kandil
- Faculty of Medicine, Kasr Al Ainy, Cardiology DepartmentCairo UniversityCairoEgypt
| | | | | | - Mohamed Sobhy
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | | | - Hala Mahfouz
- Faculty of MedicineMenoufia UniversityShibin Al KawmEgypt
| | - Gamila Nasr
- Faculty of MedicineSuiz Canal UniversityIsmailiaEgypt
| | - Islam Shawky
- Faculty of MedicineAl Azhar UniversityCairoEgypt
| | - Sameh Emil
- Armed Forces College of Medicine, Cardiology DepartmentCairoEgypt
| | | | - Mohamed Hasssan
- Faculty of Medicine, Kasr Al Ainy, Cardiology DepartmentCairo UniversityCairoEgypt
| | | | | | - Ayman Asham
- Faculty of MedicineAswan UniversityAswanEgypt
| | - Mohamed Ghaleb
- Cardiology UnitResearch Institute of OphthalmologyCairoEgypt
| | - Ahmad Samir
- Faculty of Medicine, Kasr Al Ainy, Cardiology DepartmentCairo UniversityCairoEgypt
| | - Khaled Shokry
- Armed Forces College of Medicine, Cardiology DepartmentCairoEgypt
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Gtif I, Bouzid F, Charfeddine S, Abid L, Kharrat N. Heart failure disease: An African perspective. Arch Cardiovasc Dis 2021; 114:680-690. [PMID: 34563468 DOI: 10.1016/j.acvd.2021.07.001] [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: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.
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Affiliation(s)
- Imen Gtif
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia.
| | - Fériel Bouzid
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
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Kocabaş U, Kıvrak T, Yılmaz Öztekin GM, Tanık VO, Özdemir İ, Kaya E, Yüce Eİ, Avcı Demir F, Doğduş M, Altınsoy M, Üstündağ S, Özyurtlu F, Karagöz U, Karakuş A, Urgun OD, Sinan ÜY, Mutlu İ, Şen T, Astarcıoğlu MA, Kınık M, Özden Tok Ö, Uygur B, Yeni M, Alan B, Dalgıç O, Altay H, Pehlivanoğlu S. Gender-related clinical and management differences in patients with chronic heart failure with reduced ejection fraction. Int J Clin Pract 2021; 75:e13765. [PMID: 33063424 DOI: 10.1111/ijcp.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/08/2020] [Accepted: 10/04/2020] [Indexed: 12/28/2022] Open
Abstract
AIM Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard. METHODS We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019. RESULTS Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 ± 11 years vs 69 ± 12 years, P < .001), suffered more hospitalisations and presented more frequently with NYHA class III or IV symptoms. Ischaemic heart disease was more frequent in men, whereas anaemia, thyroid disease and depression were more frequent in women. No difference was seen between genders in the use rate of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or ivabradine, or in the proportion of patients achieving target doses of these drugs. Regarding device therapies, men were more often treated with an implantable cardioverter-defibrillator (ICD) and women received more cardiac resynchronisation therapy. CONCLUSION In summary, although management seemed to be equivalent between genders, women tended to present with more symptoms, require hospitalisation more frequently and have different comorbidities than men. These results highlight the importance of gender-related differences in HFrEF and call for further research to clarify the causes of these disparities. Gender-specific recommendations should be included in future guidelines in HFrEF.
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Affiliation(s)
- Umut Kocabaş
- Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey
| | - Tarık Kıvrak
- Department of Cardiology, School of Medicine Hospital, Firat University, Elazığ, Turkey
| | - Gülsüm Meral Yılmaz Öztekin
- Department of Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Veysel O Tanık
- Department of Cardiology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - İbrahim Özdemir
- Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey
| | - Ersin Kaya
- Department of Cardiology, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
| | - Elif İlkay Yüce
- Department of Cardiology, Kelkit State Hospital, Gümüşhane, Turkey
| | - Fulya Avcı Demir
- Department of Cardiology, Elmalı State Hospital, Antalya, Turkey
| | - Mustafa Doğduş
- Department of Cardiology, Karaman State Hospital, Karaman, Turkey
| | - Meltem Altınsoy
- Department of Cardiology, University of Health Sciences Ankara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Songül Üstündağ
- Department of Cardiology, Erzincan Binali Yıldırım Unıversıty, Mengücek Gazi Educatıon and Research Hospıtal, Erzincan, Turkey
| | - Ferhat Özyurtlu
- Department of Cardiology, Grandmedical Hospital, Manisa, Turkey
| | - Uğur Karagöz
- Department of Cardiology, Izmir Katip Celebi University Atatürk Education and Research Hospital, Izmir, Turkey
| | - Alper Karakuş
- Department of Cardiology, Besni State Hospital, Adıyaman, Turkey
| | - Orsan Deniz Urgun
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Ümit Yaşar Sinan
- Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Istanbul University, Istanbul, Turkey
| | - İnan Mutlu
- Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Taner Şen
- Department of Cardiology, School of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Mehmet Ali Astarcıoğlu
- Department of Cardiology, School of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Mustafa Kınık
- Department of Cardiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
| | - Özge Özden Tok
- Department of Cardiology, Memorial Hospital, Istanbul, Turkey
| | - Begüm Uygur
- Department of Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehtap Yeni
- Department of Cardiology, Isparta State Hospital, Isparta, Turkey
| | - Bahadır Alan
- Department of Cardiology, School of Medicine, Okan University, Istanbul, Turkey
| | - Onur Dalgıç
- Department of Cardiology, Life Park Hospital, Sivas, Turkey
| | - Hakan Altay
- Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey
| | - Seçkin Pehlivanoğlu
- Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey
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Nicolaou PA. Sex differences in heart failure medications targeting the renin-angiotensin-aldosterone system. Eur J Pharmacol 2021; 897:173961. [PMID: 33617824 DOI: 10.1016/j.ejphar.2021.173961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) is a major healthcare problem. Sex-related differences in clinical manifestations, outcomes, risk factors and symptoms in HF have been described in the literature. Sex-related differences have also been described in the regulation of the renin-angiotensin-aldosterone system (RAAS), which is at the core of the pathophysiology of HF. Considering that drugs targeting RAAS are cornerstones in the treatment of HF, it is important to determine whether sex-related differences exist in the use of angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs) and ARB/neprilysin inhibitors (ARNIs). In regards to the relative efficacy of RAAS drugs in men vs. women in HF, there are conflicting results, which may stem from the fact that a lot of clinical trials were not specifically designed to investigate sex differences, with many of them having an underrepresentation of women. With respect to optimal dosage of RAAS drugs, even though, current HF guidelines, recommend up-titration to the same target dose in both men and women, evidence suggests that lower doses could be used in women. Furthermore, several studies have reported underutilization of guideline-directed medical therapy in women, including ACEIs, ARBs and MRAs, which may be at least partially attributed to increased prevalence of HF with a preserved ejection fraction and increased propensity for adverse effects in women. Overall, these investigations have shed some light on sex-related differences but there is scope for conducting further studies to determine the optimal use of RAAS drugs in men and women with failing hearts.
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Affiliation(s)
- Persoulla A Nicolaou
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia, Cyprus; Honorary Senior Lecturer, St. George's, University of London, UK.
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Guideline-led prescribing to ambulatory heart failure patients in a cardiology outpatient service. Int J Clin Pharm 2021; 43:1082-1089. [PMID: 33411177 DOI: 10.1007/s11096-020-01220-z] [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: 06/05/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Background Guidelines recommend heart failure (HF) patients be treated with multiple medications at doses proven to improve clinical outcomes. Objective To study guideline-led prescribing in an Irish outpatient HF population. Setting Cardiology Outpatient Clinic, Mercy University Hospital, Cork, Ireland. Methods Guideline-led prescribing was assessed using the Guideline Adherence Index (GAI-3), that considered the prescribing of ACE inhibitors and angiotensin receptor blockers; beta-blockers and mineralocorticoid receptor antagonists. The GAI-based target dose was calculated based on the prescription of ≥ 50% of the guideline-recommended target dose of each of the three GAI medications to HF patients with ejection fraction ≤ 40%. High-GAI was achieved by prescription of ≥ 2 GAI medicines. Potentially inappropriate prescribing was assessed using a HF-specific tool. Main outcome measure Heart failure guideline-led prescribing assessed using the GAI-3. Results A total of 127 HF patients, mean age 71.7 ± 13.1 years, were identified in the study. Seventy-one patients had ejection fraction ≤ 40%. Population mean GAI-3 was 65.8%. When contraindications to therapy are considered, the adjusted GAI-3 increased to 72.9%. The target dose GAI was 18.5%. High-GAI management was prescribed to 54 patients (76.1%). A potentially inappropriate medicine in HF was prescribed to 14 (19.7%) patients. Conclusion Most HF patients with ejection fraction ≤ 40% in this setting received optimal guideline-led prescribing however the proportion of patients achieving the target doses of these agents was suboptimal.
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Hassanin A, Hassanein M, Bendary A, Maksoud MA. Demographics, clinical characteristics, and outcomes among hospitalized heart failure patients across different regions of Egypt. Egypt Heart J 2020; 72:49. [PMID: 32789717 PMCID: PMC7426340 DOI: 10.1186/s43044-020-00082-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Regional level data on hospitalized heart failure (HHF) patients in Egypt is scarce. The aim of this study was to compare the demographics, clinical characteristics, and outcomes of HHF patients from four distinct geographical regions of Egypt. Results Study participants were part of the European Society of Cardiology Heart Failure Long Term (ESC-HF-LT) Registry, which enrolled patients from April 2011 to February 2014. A total of 1661 HHF patients from Egypt were enrolled, of whom 1645 were eligible for analysis: 914 from Alexandria, 249 from Cairo, 409 from the Delta region, and 73 from Upper Egypt. The mean age ranged from 52.2 to 62.8 years and differed significantly between the 4 groups (P < 0.01). Females represented one-third of the cohort (P = 0.5 between groups). The prevalence of obesity, diabetes, and hypertension also varied significantly across the groups (P < 0.01). The most common etiology of heart failure (HF) was ischemic heart disease. HF with reduced systolic function was the leading type of HF in the 4 groups (P = 0.6). The most common valvular abnormality in all regions was mitral regurgitation. For patients with prior history of HF, community-acquired infection was the most common reason for a HF exacerbation in all 4 groups. In-hospital mortality ranged from 2.9 to 7.7% in the 4 groups (P = 0.06). Only Alexandria and Delta groups provided reliable 1-year follow-up data, given low patient retention in Cairo and Upper Egypt groups. At one-year, 32% of patients from Alexandria compared to 22.6% from Delta were re-hospitalized for HF (P < 0.01). Mortality at 1 year was also significantly higher in Alexandria compared to Delta, 31.8 vs 13.2% respectively (P < 0.01). Conclusions HHF patients from different geographic regions of Egypt differed significantly in their demographics, clinical characteristics, and outcomes. Those differences underscore the importance of region-specific HF prevention and management strategies.
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Affiliation(s)
- Ahmed Hassanin
- Westchester Medical Center, New York Medical College, Valhalla, USA.
| | | | | | - Madiha Abdel Maksoud
- Colorado School of Public Health, University of Colorado School of Medicine, Aurora, USA
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Carlson B, Hoyt H, Kunath J, Bratzke LC. Gender Differences in Hispanic Patients of Mexican Origin Hospitalized with Heart Failure. Womens Health Issues 2020; 30:384-392. [PMID: 32660828 DOI: 10.1016/j.whi.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND More than 3 million women in the United States die of heart failure (HF) annually. Women are significantly underrepresented in studies that inform practice guidelines, especially women hospitalized for HF despite the associated negative outcomes. HF is common in Hispanic people, the largest ethnic minority group in the United States, who are mostly of Mexican origin. There are no studies of gender differences in Mexican-Hispanic persons hospitalized for HF. We sought to describe gender differences in demographic and clinical characteristics, clinical presentation, treatment, in-hospital outcomes, and discharge status in Mexican-Hispanic patients hospitalized for HF. METHODS We conducted a secondary analysis of data collected for a study examining readmission in patients hospitalized with HF in a 107-bed community; hospital near the U.S.-Mexico border. RESULTS Of 155 self-identified Hispanic patients, 43.2% (n = 67) were women. Compared with men, women were equally affected by obesity, on average 6 years older (p < .01), and more likely to be widowed (31% vs 6%; p < .001). Women had significantly higher ejection fractions, more total comorbid conditions, more hyperlipidemia, more arthritis, more anxiety, and were less likely to be treated with digoxin and more likely to be treated with calcium channel blockers. At discharge, women were significantly less likely to receive an angiotensin-converting enzyme inhibitor or an aldosterone receptor blocker and had a higher systolic blood pressure. CONCLUSIONS Key gender differences in chronic illness burden, treatment, and discharge status were found, highlighting the heterogeneity of women with HF and the need for further gender-specific research to develop care strategies specific to women of all races and ethnicities.
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Affiliation(s)
- Beverly Carlson
- San Diego State University, School of Nursing, San Diego, California.
| | - Helina Hoyt
- San Diego State University, School of Nursing, San Diego, California
| | - Julie Kunath
- San Diego State University, School of Nursing, San Diego, California; Pioneers Memorial Hospital, Brawley, California
| | - Lisa C Bratzke
- University of Wisconsin - Madison, School of Nursing, Madison, Wisconsin
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Akintunde A, Aworanti O. PATTERN OF ANAEMIA AND ITS CORRELATES IN NIGERIANS WITH HEART FAILURE. Ann Ib Postgrad Med 2020; 18:51-59. [PMID: 33623494 PMCID: PMC7893304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Heart failure often coexists with many comorbidities, including anaemia. However, the pattern of anaemia in heart failure and its clinical and echocardiographic associations have not been adequately studied among Nigerians. OBJECTIVE To describe the pattern of anaemia, its clinical characteristics, and its echocardiographic associations among heart failure subjects in Nigeria. METHODOS One hundred and forty subjects with heart failure were recruited from the cardiology clinics of two teaching hospitals in southwest Nigeria: Ladoke Akintola University of Technology and Bowen University Teaching Hospitals, Ogbomoso. Complete blood analyses, among other tests, were done. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) 20.0. P <0.05 was taken as statistically significant. RESULTS Anaemia, as defined by the World Health Organisation, occurred in 106 (75.7%) of the heart failure patients. The patterns of anaemia among participants include combined anaemia of chronic diseases (ACD) with iron deficiency in 64 (45.7%) patients, and ACD alone in 40 (28.6%). Anaemia was more significantly associated with previous diagnosis of diabetes mellitus, presence of pulmonary hypertension, and heart failure with reduced ejection fraction. Mean systolic and diastolic blood pressures, ejection fraction, and fractional shortening were significantly lower among heart failure subjects with anaemia, while serum creatinine, left atrial dimension, left ventricular end diastolic dimension, and left ventricular mass index were significantly higher among heart failure subjects with anaemia compared to those without anaemia. CONCLUSION Anaemia occurs very frequently among heart failure patients in southwest Nigeria. It is associated with many poor prognostic factors, including diabetes mellitus, pulmonary hypertension, and kidney failure.
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Affiliation(s)
- A.A. Akintunde
- Cardiology Unit, Department of Medicine, LAUTECH Teaching Hospital, Ogbomoso & Department of Medicine, Faculty of Clinical Sciences, LAUTECH, Osogbo, Nigeria.,Goshen Heart Clinic, Osogbo, Nigeria
| | - O.W. Aworanti
- Department of Haematology & Blood Transfusion, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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Elasfar A, Shaheen S, El-Sherbeny W, Elsokkary H, Elhefnawy S, Al-Setiha M. Preliminary results of the acute Heart Failure registry in the DELTA region of Egypt (DELTA-HF): a database and a quality initiative project. Egypt Heart J 2019; 71:27. [PMID: 31773423 PMCID: PMC6879686 DOI: 10.1186/s43044-019-0024-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/25/2019] [Indexed: 12/28/2022] Open
Abstract
Background Data about heart failure in Egypt is scarce. We aimed to describe the clinical characteristics and diagnostic and treatment options in patients with acute heart failure in the Delta region of Egypt and to explore the gap in the management in comparison to the international guidelines. Results DELTA-HF is a prospective observational cohort registry for all consecutive patients with acute heart failure (AHF) who were admitted to three tertiary care cardiac centers distributed in the Delta region of Egypt. All patients were recruited in the period from April 2017 to May 2018, during which, data were collected and short-term follow-up was done. A total of 220 patients (65.5% were males with a median age of 61.5 years and 50.9% had acute decompensation on top of chronic heart failure) was enrolled in our registry. The risk factors for heart failure included rheumatic valvular heart disease (10.9%), smoking (65.3%), hypertension (48.2%), diabetes mellitus (42.7%), and coronary artery disease (28.2%). Left ventricular ejection fraction (LVEF) was less than 40% in 62.6%. Etiologies of heart failure included ischemic heart disease (58.1%), valvular heart disease (16.3%), systemic hypertension (9.1%), and dilated non-ischemic cardiomyopathy (15.5%). Exacerbating factors included infections (28.1%), acute coronary syndromes (25.5%), non-compliance to HF medications (19.6%), and non-compliance to diet (23.2%) in acute decompensated heart failure (ADHF) patients. None of our patients had been offered heart failure device therapy and only 50% were put on beta-blockers upon discharge. In-hospital, 30 days and 90 days all-cause mortality were 18.2%, 20.7%, and 26% respectively. Conclusions There is a clear gap in the management of patients with acute heart failure in the Delta region of Egypt with confirmed under-utilization of heart failure device therapy and under-prescription of guideline-directed medical therapies particularly beta-blockers. The short-term mortality is high if compared with Western and other local registries. This could be attributed mainly to the low-resource health care system in this region and the lack of formal heart failure management programs.
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Affiliation(s)
- Abdelfatah Elasfar
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt. .,Madinah Cardiac Center, Madinah, Saudi Arabia.
| | - Sherif Shaheen
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Wafaa El-Sherbeny
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hatem Elsokkary
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Suzan Elhefnawy
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammed Al-Setiha
- Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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12
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Lee FY, Chen WK, Lin CL, Kao CH, Yang TY, Lai CY. Risk of aortic dissection, congestive heart failure, pneumonia and acute respiratory distress syndrome in patients with clinical vertebral fracture: a nationwide population-based cohort study in Taiwan. BMJ Open 2019; 9:e030939. [PMID: 31753874 PMCID: PMC6886957 DOI: 10.1136/bmjopen-2019-030939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Studies on the association between clinical vertebral fractures (CVFs) and the subsequent risk of cardiopulmonary diseases, including aortic dissection (AD), congestive heart failure (CHF), pneumonia and acute respiratory distress syndrome (ARDS) are scarce. Therefore, we used the National Health Insurance Research Database to investigate whether patients with CVF have a heightened risk of subsequent AD, CHF, pneumonia and ARDS. DESIGN The National Health Insurance Research Database was used to investigate whether patients with CVFs have an increased risk of subsequent AD, CHF, pneumonia and ARDS. PARTICIPANTS This cohort study comprised patients aged ≥18 years with a diagnosis of CVF and were hospitalised at any point during 2000-2010 (n=1 08 935). Each CVF patient was frequency-matched to a no-CVF hospitalised patients based on age, sex, index year and comorbidities (n=1 08 935). The Cox proportional hazard regressions model was used to estimate the adjusted effect of CVF on AD, CHF, pneumonia and ARDS risk. RESULTS The overall incidence of AD, CHF, pneumonia and ARDS was higher in the CVF group than in the no-CVF group (4.85 vs 3.99, 119.1 vs 89.6, 283.3 vs 183.5 and 9.18 vs 4.18/10 000 person-years, respectively). After adjustment for age, sex, comorbidities and Charlson comorbidity index score, patients with CVF had a 1.23-fold higher risk of AD (95% CI=1.03-1.45), 1.35-fold higher risk of CHF (95% CI=1.30-1.40), 1.57-fold higher risk of pneumonia (95% CI=1.54-1.61) and 2.21-fold higher risk of ARDS (95% CI=1.91-2.57) than did those without CVF. Patients with cervical CVF and SCI were more likely to develop pneumonia and ARDS. CONCLUSIONS Our study demonstrates that CVFs are associated with an increased risk of subsequent cardiopulmonary diseases. Future investigations are encouraged to delineate the mechanisms underlying this association.
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Affiliation(s)
- Feng-You Lee
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Taichung City, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung City, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Center of Augmented Intelligence in Healthcare, Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung City, Taiwan
| | - Tse-Yen Yang
- Department of Medical Research & Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung City, Taiwan
- Center for General Education & Master Program of Digital Health Innovation, China Medical University, Taichung City, Taiwan
| | - Ching-Yuan Lai
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung City, Taiwan
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13
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Mohammadi A, Emamgoli A, Shirinkalam M, Meftahi GH, Yagoobi K, Hatef B. The persistent effect of acute psychosocial stress on heart rate variability. Egypt Heart J 2019; 71:18. [PMID: 31659513 PMCID: PMC6821413 DOI: 10.1186/s43044-019-0009-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As stress occurs repetitively every day, the biological modifiers should also have enough time to restore the normal state of hemostasis; otherwise, chronic stress would be anticipated. The aim of the present study was to examine the persistence of stress based on subjective emotion, salivary cortisol, and linear and non-linear features of heart rate variability (HRV) in both genders. METHODS Thirty-three healthy young volunteers (23 men and 10 women) participating in this study were exposed to the Trier Social Stress Test (TSST). Moreover, the emotional visual analog scale (EVAS), salivary cortisol, and ECG recording in the rest state were taken before and after TSST as well as 20 min after recovery. RESULTS According to the results of the two-way mixed model ANOVA, all volunteers showed a significant increase in EVAS after TSST which was restored to the baseline state after recovery. Notably, the women's base of cortisol was significantly higher than men and the standard range of kit. Cortisol elevation was only observed in the men, and the significant increase of LF/HF ratio was observed in the women, while both did not retain to the baseline after recovery. The SD1 of Poincaré plot and spectral entropy decreased after stress in both genders. Moreover, there was a significant negative correlation between baseline level of cortisol and its elevation due to stress and some features of HRV. CONCLUSION The base of cortisol played a critical role in modifying the physiological response to stress. In addition, after recovery, no stressful emotion remained, while the non-linear features of HRV did not return to baseline.
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Affiliation(s)
- Alireza Mohammadi
- Neuroscience Research Center, Baqiyatallah University of Medical Science, Mollasadra, Tehran, Iran
| | - Asgar Emamgoli
- Neuroscience Research Center, Baqiyatallah University of Medical Science, Mollasadra, Tehran, Iran
| | | | - Golam Hossein Meftahi
- Neuroscience Research Center, Baqiyatallah University of Medical Science, Mollasadra, Tehran, Iran
| | - Keyvan Yagoobi
- Traditional and Complementary Medicine University of Iran and Armenia, Physiology Department, Islamic Azad University (IAUPS), Tehran, Iran
| | - Boshra Hatef
- Neuroscience Research Center, Baqiyatallah University of Medical Science, Mollasadra, Tehran, Iran.
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Hassanein M, Abdelhamid M, Ibrahim B, Sobhy M, Nasr G, Aboleineen MW, Reda A, Farag N, Elshazly A, Abdeldayem TK, Elmesseiry F, Boshra H, Sobhy H, Elbahry A, Youssef A, Ashmawy M, Abdelmoneim A, Saleh A, Elrakshy Y, Ebeid H. Gender differences in Egyptian patients hospitalized with heart failure: insights from the European Society of Cardiology Heart Failure Long-Term Registry. ESC Heart Fail 2018; 5:1159-1164. [PMID: 30175905 PMCID: PMC6300819 DOI: 10.1002/ehf2.12347] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022] Open
Abstract
Aims This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long‐Term Registry. Methods and results From April 2011 to September 2014, 1634 patients hospitalized with AHF were enrolled by 20 hospitals all over Egypt. Of these patients, 1112 (68%) patients were male and 522 (32%) were female. Women presented with a higher admission systolic blood pressure and resting heart rate. Compared with men, women had a higher body mass index (32.5 ± 9.0 vs. 29.3 ± 4.9, P < 0.001), more frequent atrial fibrillation (34.7% vs. 22.4%, P < 0.001), and anaemia defined by haemoglobin < 12 g/dL (83.1% vs. 58.4%, P < 0.001). Women were more likely to present with heart failure with preserved ejection fraction (29.7% vs. 10.6%, P < 0.001). Women had more frequent diabetes mellitus (48.1% vs. 41.6%, P < 0.05) and hypertension (48.7% vs. 39.3%, P < 0.001) than had men, whereas smoking was rare among them (8.8% vs. 82.9%, P < 0.005). There was no significant difference in the primary aetiology of heart failure between both sexes. ACE inhibitors, beta‐blockers, mineralocorticoid receptor antagonists, antiplatelets, statins, and nitrates were less frequently prescribed to women, whereas they more often received digoxin, amiodarone, anticoagulants, and calcium channel blockers. There was no significant difference in in‐hospital (5.7% vs. 4.6%, P = 0.39) and 1 year mortality (27.9% vs. 25.9%, P = 0.48) between women and men, respectively. Conclusions Men and women with AHF differ significantly in baseline clinical characteristics and management but not in adverse outcomes. These findings emphasize the importance of individualized management and need for more comprehensive recruitment of women in clinical trials.
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Affiliation(s)
- Mahmoud Hassanein
- Department of Cardiology, Faculty of Medicine, Alexandria University, Champillion Street, Azarita, Alexandria, Egypt
| | | | | | | | - Gamela Nasr
- Ismaileya Insurance Hospital, Ismaileya, Egypt
| | | | | | | | - Ahmed Elshazly
- Gamal Abdel Nasser Insurance Hospital, Alexandria, Egypt
| | | | | | | | | | | | | | | | | | | | | | - Hamdy Ebeid
- Damanhour General Hospital, Damanhour, Egypt
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