1
|
Li D, Huang LT, Zhang F, Wang JH. Comparative effectiveness of ehealth self-management interventions for patients with heart failure: A Bayesian network meta-analysis. PATIENT EDUCATION AND COUNSELING 2024; 124:108277. [PMID: 38613991 DOI: 10.1016/j.pec.2024.108277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE This study evaluated the effectiveness of electronic self-management support interventions in reducing all-cause mortality, cardiovascular mortality, readmission rates, and HF-related readmission in heart failure patients. METHODS Following the PRISMA-P guidelines and PRISMS taxonomy, we searched Pubmed, Cochrane Library, and Embase for RCTs and trials of electronic health technologies for heart failure interventions. Develop support programs in advance for education, monitoring, reminders, or a combination of these to screen and categorize studies. The Cochrane ROB2 tool was used to assess the risk of bias. RESULTS The monitoring interventions may improve all-cause mortality (OR 0.77, 95% CI 0.63 to 0.93) and cardiovascular mortality (OR 0.75, 95% CI 0.61 to 0.93) compared to usual care. Reminder interventions were associated with significantly reducing readmission rates (OR 0.07, 95% CI 0.00 to 0.94). Mixed interventions were most effective in reducing HF-related readmission rates (OR 0.75, 95% CI 0.56 to 0.99). CONCLUSION Electronic self-management interventions, particularly monitoring and reminders, can potentially improve outcomes of heart failure patients, including reducing all-cause mortality, cardiovascular mortality, and readmission rates. PRACTICE IMPLICATIONS The eHealth model and the combination of self-management are significant for long-term intervention in patients with HF to improve their quality of life and prognosis.
Collapse
Affiliation(s)
- Dan Li
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Le-Tian Huang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Fei Zhang
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Jia-He Wang
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, PR China.
| |
Collapse
|
2
|
Ma Y, Huang H, Qian H, Wu Y, Gao Z. Association of urinary bisphenol A levels with heart failure risk in U.S. adults from the NHANES (2003-2016). Front Cardiovasc Med 2024; 11:1329586. [PMID: 38766304 PMCID: PMC11099872 DOI: 10.3389/fcvm.2024.1329586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Although heart failure (HF) has been linked to bisphenol A (BPA), few studies have investigated the cut-off values for the effects of urinary BPA levels on heart failure risk. The association between urinary BPA levels and HF prognosis has not been investigated. Methods This study included 11,849 adults over 20 years old using information from the National Health and Nutrition Examination Survey (NHANES), which was conducted from 2003 to 2016. The relationship between urinary BPA levels and the risk of HF was determined via a multivariable logistic regression model, and restricted cubic spline (RCS) methods were used to determine the cut-off for the effect of BPA levels on HF risk. Based on the available NT-proBNP concentration data from the NHANES (2003-2004), multivariable linear regression was applied to determine the linear association between the NT-proBNP concentration and urinary BPA concentration. Results The results revealed a positive correlation between a urinary BPA concentration in the fourth quartile and the occurrence of heart failure [OR 1.49, 95% CI (1.09, 2.04), p = 0.012]. A one-unit increase (1 ng/mg creatinine) in the ln-transformed BPA concentration was linked to a 15% increase in the incidence of HF [OR 1.15, 95% CI (1.03, 1.29), p = 0.014]. The cut-off urinary BPA concentration for HF risk was 1.51 ng/mg creatinine. There was a positive correlation between urinary BPA and NT-proBNP concentrations [β = 0.093, 95% CI (0.014, 0.171), p = 0.02] in males, but there was no linear association [β = 0.040, 95% CI (-0.033, 0.113), p = 0.283] in females. Discussion Increased urinary BPA levels are linked to an increased risk of heart failure and poor prognosis. There is a significant increase in the risk of heart failure if the urinary concentration of BPA exceeds 1.51 ng/mg creatinine.
Collapse
Affiliation(s)
- Yuanyuan Ma
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Haobin Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Haiyun Qian
- Department of Cardiothoracic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Yanhu Wu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhe Gao
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
3
|
Oraii A, Chaumont C, Marchlinski FE, Hyman MC. Rate-adaptive pacing in heart failure with preserved ejection fraction: Too much of a good thing? Heart Rhythm O2 2024; 5:334-337. [PMID: 38840761 PMCID: PMC11148503 DOI: 10.1016/j.hroo.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Affiliation(s)
- Alireza Oraii
- Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Corentin Chaumont
- Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E. Marchlinski
- Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C. Hyman
- Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Garred CH, Malmborg M, Malik ME, Zahir D, Christensen DM, Arulmurugananthavadivel A, Fosbøl EL, Gislason G, McMurray JJV, Petrie MC, Andersson C, Køber L, Schou M. Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study. THE LANCET. HEALTHY LONGEVITY 2024; 5:e326-e335. [PMID: 38705151 DOI: 10.1016/s2666-7568(24)00029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups. METHODS Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years). FINDINGS 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]). INTERPRETATION Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure. FUNDING None. TRANSLATION For the Danish translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
| | - Morten Malmborg
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | | | - Deewa Zahir
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | | | | | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
| | - John J V McMurray
- School of Cardiovascular and Metabolic Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Charlotte Andersson
- Center for Advanced Heart Disease, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Oraii A, McIntyre WF, Parkash R, Kowalik K, Razeghi G, Benz AP, Belley-Côté EP, Conen D, Connolly SJ, Tang ASL, Healey JS, Wong JA. Atrial Fibrillation Ablation in Heart Failure With Reduced vs Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. JAMA Cardiol 2024:2817829. [PMID: 38656292 PMCID: PMC11044015 DOI: 10.1001/jamacardio.2024.0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/19/2024] [Indexed: 04/26/2024]
Abstract
Importance Catheter ablation is associated with reduced heart failure (HF) hospitalization and death in select patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). However, the benefit in patients with HF with preserved ejection fraction (HFpEF) is uncertain. Objective To investigate whether catheter ablation for AF is associated with reduced HF-related outcomes according to HF phenotype. Data Source A systematic search of MEDLINE, Embase, and Cochrane Central was conducted among studies published from inception to September 2023. Study Selection Parallel-group randomized clinical trials (RCTs) comparing catheter ablation with conventional rate or rhythm control therapies in patients with HF, New York Heart Association functional class II or greater, and a history of paroxysmal or persistent AF were included. Pairs of independent reviewers screened 7531 titles and abstracts, of which 12 RCTs and 4 substudies met selection criteria. Data Extraction and Synthesis Data were abstracted in duplicate according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Pooled effect estimates were calculated using random-effects Mantel-Haenszel models. Interaction P values were used to test for subgroup differences. Main Outcomes and Measures The primary outcome was HF events, defined as HF hospitalization, clinically significant worsening of HF, or unscheduled visits to a clinician for treatment intensification. Secondary outcomes included cardiovascular and all-cause mortality. Results A total of 12 RCTs with 2465 participants (mean [SD] age, 65.3 [9.7] years; 658 females [26.7%]) were included; there were 1552 participants with HFrEF and 913 participants with HFpEF. Compared with conventional rate or rhythm control, catheter ablation was associated with reduced risk of HF events in HFrEF (risk ratio [RR], 0.59; 95% CI, 0.48-0.72), while there was no benefit in patients with HFpEF (RR, 0.93; 95% CI, 0.65-1.32) (P for interaction = .03). Catheter ablation was associated with reduced risk of cardiovascular death compared with conventional therapies in HFrEF (RR, 0.49; 95% CI, 0.34-0.70) but a differential association was not detected in HFpEF (RR, 0.91; 95% CI, 0.46-1.79) (P for interaction = .12). Similarly, no difference in the association of catheter ablation with all-cause mortality was found between HFrEF (RR vs conventional therapies, 0.63; 95% CI, 0.47-0.86) and HFpEF (RR vs conventional therapies, 0.95; 95% CI, 0.39-2.30) groups (P for interaction = .39). Conclusions and Relevance This study found that catheter ablation for AF was associated with reduced risk of HF events in patients with HFrEF but had limited or no benefit in HFpEF. Results from ongoing trials may further elucidate the role of catheter ablation for AF in HFpEF.
Collapse
Affiliation(s)
- Alireza Oraii
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - William F. McIntyre
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Krzysztof Kowalik
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ghazal Razeghi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Emilie P. Belley-Côté
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J. Connolly
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anthony S. L. Tang
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jorge A. Wong
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Zhao X, Wu S, Luo N, Lin Q, Zhao X, Li K. Care models for patients with heart failure at home: A systematic review. J Clin Nurs 2024; 33:1295-1305. [PMID: 38178563 DOI: 10.1111/jocn.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
AIMS The aim of this study is to evaluate the relative merits of various heart failure models of care with regard to a variety of outcomes. DESIGN Systematic review. DATA SOURCES Five databases including PubMed, Web of Science, Medline, Embase and Science Direct were searched from the inception date of databases to August 20, 2022. REVIEW METHODS This review used the Cochrane Collaboration's 'Risk of Bias' tool to assess quality. Only randomised controlled trails were included in this review that assessed all care models in the management of adults with heart failure. A categorical summary of the pattern of the papers was found, followed by extraction of outcome indicators. RESULTS Twenty articles (19 studies) were included. Seven examined nurse-led care, two examined multidisciplinary specialist care, nine (10 articles) examined patient self-management, and one examined nurse and physiotherapist co-led care. Regarding outcomes, this review examined how well the four models performed with regard to quality of life, health services use, HF self-care, and anxiety and depression for heart failure patients. The model of patient self-management showed more beneficial results than nurse-led care, multidisciplinary specialist care, and nurse and physiotherapist co-led care in reducing hospital days, improving symptoms, promoting self-care behaviours of HF patients, enhancing the quality of life, and strengthening self-care ability. CONCLUSIONS This systematic review synthesises the different care models and their relative effectiveness. Four different models of care were summarised. Of these models, the self-management model demonstrated better outcomes. IMPACT The self-management model is more effective in increasing self-management behaviours and self-management abilities, lowering the risk of hospitalisation and death, improving quality of life, and relieving anxiety and depression than other models. NO PATIENT OR PUBLIC CONTRIBUTION There was no funding to remunerate a patient/member of the public for this review.
Collapse
Affiliation(s)
- Xuetong Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Wu
- School of Nursing, Jilin University, Changchun, China
| | - Nan Luo
- Medical Records Library, The Second Hospital of Jilin University, Changchun, China
| | - Qiuxia Lin
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Xinyi Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
| |
Collapse
|
7
|
Triposkiadis F, Xanthopoulos A, Drakos SG, Boudoulas KD, Briasoulis A, Skoularigis J, Tsioufis K, Boudoulas H, Starling RC. Back to the basics: The need for an etiological classification of chronic heart failure. Curr Probl Cardiol 2024; 49:102460. [PMID: 38346611 DOI: 10.1016/j.cpcardiol.2024.102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
The left ventricular (LV) ejection fraction (LVEF), despite its severe limitations, has had an epicentral role in heart failure (HF) classification, management, and risk stratification for decades. The major argument favoring the LVEF based HF classification has been that it defines groups of patients in which treatment is effective. However, this reasoning has recently collapsed, since medical treatment with neurohormonal inhibitors, has proved beneficial in most HF patients regardless of the LVEF. In addition, there has been compelling evidence, that the LVEF provides poor guidance for device treatment of chronic HF (implantation of cardioverter defibrillator, cardiac resynchronization therapy) since sudden cardiac death may occur and cardiac dyssynchronization may be disastrous in all HF patients. The same holds true for LV assist device implantation, in which the LVEF has been used as a surrogate for LV size. In this review article we update the evidence questioning the use of LVEF-based HF classification and argue that guidance of chronic HF treatment should transition to more contemporary concepts. Specifically, we propose an etiologic chronic HF classification predominantly based on epidemiological data, which will be foundational for further higher resolution phenotyping in the emerging era of precision medicine.
Collapse
Affiliation(s)
- Filippos Triposkiadis
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece.
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Stavros G Drakos
- University of Utah Health and School of Medicine and Salt Lake VA Medical Center, Salt Lake City, UT 84108, USA
| | | | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, Hippokration Hospital, University of Athens, Athens 115 27, Greece
| | | | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| |
Collapse
|
8
|
Wang X, Yang J, Lu C, Hu Y, Xu Z, Wan Q, Zhang M, Shi T, Liu Z, Liu Y. Qifu Yixin Formula Improves Heart Failure by Enhancing β-Arrestin2 Mediated the SUMOylation of SERCA2a. Drug Des Devel Ther 2024; 18:781-799. [PMID: 38500692 PMCID: PMC10946281 DOI: 10.2147/dddt.s446324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose This study aimed to elucidate the protective mechanism of Traditional Chinese Medicine (TCM) Qifu Yixin formula (QFYXF) to improve heart failure (HF) by promoting β-arrestin2 (β-arr2)-mediated SERCA2a SUMOylation. Materials and Methods The transverse aortic constriction (TAC)-induced HF mice were treated with QFYXF or carvedilol for 8 weeks. β-arr2-KO mice and their littermate wild-type (WT) mice were used as controls. Neonatal rat cardiomyocytes (NRCMs) were used in vitro. Cardiac function was evaluated by echocardiography and serum NT-proBNP. Myocardial hypertrophy and myocardial fibrosis were assessed by histological staining. β-arr2, SERCA2a, SUMO1, PLB and p-PLB expressions were detected by Western blotting, immunofluorescence and immunohistochemistry. SERCA2a SUMOylation was detected by Co-IP. The molecular docking method was used to predict the binding ability of the main active components of QFYXF to β-arr2, SERCA2a, and SUMO1, and the binding degree of SERCA2a to SUMO1 protein. Results The HF model was constructed 8 weeks after TAC. QFYXF ameliorated cardiac function, inhibiting myocardial hypertrophy and fibrosis. QFYXF promoted SERCA2a expression and SERCA2a SUMOylation. Further investigation showed that QFYXF promoted β-arr2 expression, whereas Barbadin (β-arr2 inhibitor) or β-arr2-KO reduced SERCA2a SUMOylation and attenuated the protective effect of QFYXF improved HF. Molecular docking showed that the main active components of QFYXF had good binding activities with β-arr2, SERCA2a, and SUMO1, and SERCA2a had a high binding degree with SUMO1 protein. Conclusion QFYXF improves HF by promoting β-arr2 mediated SERCA2a SUMOylation and increasing SERCA2a expression.
Collapse
Affiliation(s)
- Xinting Wang
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Jiahui Yang
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Cheng Lu
- Department of Cardiology, Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, People’s Republic of China
| | - Yinqin Hu
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Zhaohui Xu
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Qiqi Wan
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Meng Zhang
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Tianyun Shi
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Zhirui Liu
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Yongming Liu
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| |
Collapse
|
9
|
Carrizales-Sepúlveda EF, Ordaz-Farías A, Vargas-Mendoza JA, Vera-Pineda R, Flores-Ramírez R. Initiation and Up-titration of Guideline-directed Medical Therapy for Patients with Heart Failure: Better, Faster, Stronger! Card Fail Rev 2024; 10:e03. [PMID: 38533397 PMCID: PMC10964286 DOI: 10.15420/cfr.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/27/2023] [Indexed: 03/28/2024] Open
Abstract
Treatment for heart failure has experienced a major revolution in recent years, and current evidence shows that a combination of four medications (angiotensin receptor-neprilysin inhibitors + β-blockers + mineralocorticoid receptor antagonists + sodium.glucose cotransporter 2 inhibitors) offer the greatest benefit to our patients with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality. Unfortunately, despite their proven benefits, the implementation of these therapies is still low. Clinical inertia, and unfounded fear of using these drugs might contribute to this. Recently, evidence from randomised clinical trials has shown that intensive implementation of these therapies in patients with heart failure is safe and effective. In this review, we attempt to tackle some of these misconceptions/fears regarding medical therapy for heart failure and discuss the available evidence showing the best strategies for implementation of these therapies.
Collapse
Affiliation(s)
- Edgar Francisco Carrizales-Sepúlveda
- Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
- Heart Failure Unit, Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
| | - Alejandro Ordaz-Farías
- Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
- Echocardiography Laboratory, Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
| | - José Arturo Vargas-Mendoza
- Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
- Echocardiography Laboratory, Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
| | - Raymundo Vera-Pineda
- Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
| | - Ramiro Flores-Ramírez
- Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
- Heart Failure Unit, Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
- Echocardiography Laboratory, Cardiology Service, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo LeónMonterrey, Nuevo León, Mexico
| |
Collapse
|
10
|
Meifang W, Ying W, Wen C, Kaizu X, Meiyan S, Liming L. Advance in the pharmacological and comorbidities management of heart failure with preserved ejection fraction: evidence from clinical trials. Heart Fail Rev 2024; 29:305-320. [PMID: 37561223 DOI: 10.1007/s10741-023-10338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
The prevalence of heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of the total heart failure population, and with the aging of the population and the increasing prevalence of hypertension, obesity, and type 2 diabetes (T2DM), the incidence of HFpEF continues to rise and has become the most common subtype of heart failure. Compared with heart failure with reduced ejection fraction, HFpEF has a more complex pathophysiology and is more often associated with hypertension, T2DM, obesity, atrial fibrillation, renal insufficiency, pulmonary hypertension, obstructive sleep apnea, and other comorbidities. HFpEF has generally been considered a syndrome with high phenotypic heterogeneity, and no effective treatments have been shown to reduce mortality to date. Diuretics and comorbidity management are traditional treatments for HFpEF; however, they are mostly empirical due to a lack of clinical evidence in the setting of HFpEF. With the EMPEROR-Preserved and DELIVER results, sodium-glucose cotransporter 2 inhibitors become the first evidence-based therapies to reduce rehospitalization for heart failure. Subgroup analyses of the PARAGON-HF, TOPCAT, and CHARM-Preserved trials suggest that angiotensin receptor-neprilysin inhibitors, spironolactone, and angiotensin II receptor blockers may be beneficial in patients at the lower end of the ejection fraction spectrum. Other potential pharmacotherapies represented by non-steroidal mineralocorticoid receptor antagonists finerenone and antifibrotic agent pirfenidone also hold promise for the treatment of HFpEF. This article intends to review the clinical evidence on current pharmacotherapies of HFpEF, as well as the comorbidities management of atrial fibrillation, hypertension, T2DM, obesity, pulmonary hypertension, renal insufficiency, obstructive sleep apnea, and iron deficiency, to optimize the clinical management of HFpEF.
Collapse
Affiliation(s)
- Wu Meifang
- Department of Cardiology, School of Clinical Medicine, Fujian Medical University, Affiliated Hospital of Putian University, Putian, 351100, Fujian, China
| | - Wu Ying
- Department of Cardiology, School of Clinical Medicine, Fujian Medical University, Affiliated Hospital of Putian University, Putian, 351100, Fujian, China
| | - Chen Wen
- Department of Cardiology, School of Clinical Medicine, Fujian Medical University, Affiliated Hospital of Putian University, Putian, 351100, Fujian, China
| | - Xu Kaizu
- Department of Cardiology, School of Clinical Medicine, Fujian Medical University, Affiliated Hospital of Putian University, Putian, 351100, Fujian, China
| | - Song Meiyan
- Department of Cardiology, School of Clinical Medicine, Fujian Medical University, Affiliated Hospital of Putian University, Putian, 351100, Fujian, China
| | - Lin Liming
- Department of Cardiology, School of Clinical Medicine, Fujian Medical University, Affiliated Hospital of Putian University, Putian, 351100, Fujian, China.
| |
Collapse
|
11
|
Norouzi S, Hajizadeh E, Jafarabadi MA, Mazloomzadeh S. Analysis of the survival time of patients with heart failure with reduced ejection fraction: a Bayesian approach via a competing risk parametric model. BMC Cardiovasc Disord 2024; 24:45. [PMID: 38218798 PMCID: PMC10787971 DOI: 10.1186/s12872-023-03685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE Heart failure (HF) is a widespread ailment and is a primary contributor to hospital admissions. The focus of this study was to identify factors affecting the extended-term survival of patients with HF, anticipate patient outcomes through cause-of-death analysis, and identify risk elements for preventive measures. METHODS A total of 435 HF patients were enrolled from the medical records of the Rajaie Cardiovascular Medical and Research Center, covering data collected between March and August 2018. After a five-year follow-up (July 2023), patient outcomes were assessed based on the cause of death. The survival analysis was performed with the AFT method with the Bayesian approach in the presence of competing risks. RESULTS Based on the results of the best model for HF-related mortality, age [time ratio = 0.98, confidence interval 95%: 0.96-0.99] and ADHF [TR = 0.11, 95% (CI): 0.01-0.44] were associated with a lower survival time. Chest pain in HF-related mortality [TR = 0.41, 95% (CI): 0.10-0.96] and in non-HF-related mortality [TR = 0.38, 95% (CI): 0.12-0.86] was associated with a lower survival time. The next significant variable in HF-related mortality was hyperlipidemia (yes): [TR = 0.34, 95% (CI): 0.13-0.64], and in non-HF-related mortality hyperlipidemia (yes): [TR = 0.60, 95% (CI): 0.37-0.90]. CAD [TR = 0.65, 95% (CI): 0.38-0.98], CKD [TR = 0.52, 95% (CI): 0.28-0.87], and AF [TR = 0.53, 95% (CI): 0.32-0.81] were other variables that were directly related to the reduction in survival time of patients with non-HF-related mortality. CONCLUSION The study identified distinct predictive factors for overall survival among patients with HF-related mortality or non-HF-related mortality. This differentiated approach based on the cause of death contributes to the estimation of patient survival time and provides valuable insights for clinical decision-making.
Collapse
Affiliation(s)
- Solmaz Norouzi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia.
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia.
| | - Saeideh Mazloomzadeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Rutledge CA. Molecular mechanisms underlying sarcopenia in heart failure. THE JOURNAL OF CARDIOVASCULAR AGING 2024; 4:7. [PMID: 38455513 PMCID: PMC10919908 DOI: 10.20517/jca.2023.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The loss of skeletal muscle, also known as sarcopenia, is an aging-associated muscle disorder that is disproportionately present in heart failure (HF) patients. HF patients with sarcopenia have poor outcomes compared to the overall HF patient population. The prevalence of sarcopenia in HF is only expected to grow as the global population ages, and novel treatment strategies are needed to improve outcomes in this cohort. Multiple mechanistic pathways have emerged that may explain the increased prevalence of sarcopenia in the HF population, and a better understanding of these pathways may lead to the development of therapies to prevent muscle loss. This review article aims to explore the molecular mechanisms linking sarcopenia and HF, and to discuss treatment strategies aimed at addressing such molecular signals.
Collapse
Affiliation(s)
- Cody A. Rutledge
- Acute Medicine Section, Division of Medicine, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, OH 44106, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| |
Collapse
|
13
|
Lund LH, Crespo-Leiro MG, Laroche C, Garcia-Pinilla JM, Bennis A, Vataman EB, Polovina M, Radovanovic S, Apostolovic SR, Ašanin M, Gackowski A, Kaplon-Cieslicka A, Cabac-Pogorevici I, Anker SD, Chioncel O, Coats AJS, Filippatos G, Lainscak M, Mcdonagh T, Mebazaa A, Metra M, Piepoli M, Rosano GM, Ruschitzka F, Savarese G, Seferović PM, Iung B, Popescu BA, Maggioni AP. Rationale and design of the ESC Heart Failure III Registry - Implementation and discovery. Eur J Heart Fail 2023; 25:2316-2330. [PMID: 37990135 DOI: 10.1002/ejhf.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology Heart Failure III Registry (ESC HF III Registry) aims to characterize HF clinical features and outcomes and to assess implementation of guideline-recommended therapy in Europe and other ESC affiliated countries. METHODS Between 1 November 2018 and 31 December 2020, 10 162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enrolled from 220 centres in 41 European or ESC affiliated countries. The ESC HF III Registry collected data on baseline characteristics (hospital or clinic presentation), hospital course, diagnostic and therapeutic decisions in hospital and at the clinic visit; and on outcomes at 12-month follow-up. These data include demographics, medical history, physical examination, biomarkers and imaging, quality of life, treatments, and interventions - including drug doses and reasons for non-use, and cause-specific outcomes. CONCLUSION The ESC HF III Registry will provide comprehensive and unique insight into contemporary HF characteristics, treatment implementation, and outcomes, and may impact implementation strategies, clinical discovery, trial design, and public policy.
Collapse
Affiliation(s)
- Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Generosa Crespo-Leiro
- Department of Cardiology, Hospital Universitario A Coruña (CHUAC), A Coruña, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña (UDC), A Coruña, Spain
- Instituto Investigación Biomedica A Coruña (INIBIC), A Coruña, Spain
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Jose M Garcia-Pinilla
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga Biomedical Research Institute (IBIMA), Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Ahmed Bennis
- Department of Cardiology, Ibn Rochd University Center, Casablanca, Morocco
| | - Eleonora B Vataman
- Heart Failure Department, Institute of Cardiology, Chișinău, Moldova
- Cardiac Rehabilitation Department, Institute of Cardiology, Chișinău, Moldova
| | - Marija Polovina
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Slavica Radovanovic
- Department of Cardiology, Heart Failure Center, University Hospital Center 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Svetlana R Apostolovic
- Department of Cardiology, University Clinical Centre of Serbia, Nis, Serbia
- Medical School, University Clinical Centre of Serbia, Nis, Serbia
| | - Milika Ašanin
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Jagiellonian University, Medical College, John Paul II Hospital, Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | | | - Irina Cabac-Pogorevici
- Department of Cardiology, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chișinău, Moldova
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- 1st Cardiology Department, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Andrew J S Coats
- Office of the CEO, Heart Research Institute, Sydney, NSW, Australia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian, University of Athens, Athens, Greece
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Theresa Mcdonagh
- Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Alexandre Mebazaa
- Anaethesia and Critical Care, APHP, Hôpital Lariboisière, Paris, France
- Burn and the multi-organ retrieval, APHP, Hôpital Saint Louis, Paris, France
- Cardiovascular MArkers in Stressed COndiTions, UMRS INSERM 942, Université Paris-Cité, Paris, France
| | - Marco Metra
- Department of Cardiology, Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Cardiology, ASST Spedali Civili, Brescia, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe M Rosano
- Department of Medical Sciences, IRCCS Ospedale San Raffaele, Rome, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Bernard Iung
- Department of Cardiology, APHP, Hôpital Bichat Claude-Bernard, Paris, France
- LVTS INSERM 1148, Université Paris-Cité, Paris, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| |
Collapse
|
14
|
Gao Y, Wang N, Zhang L, Liu N. Effectiveness of home-based cardiac telerehabilitation in patients with heart failure: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:7661-7676. [PMID: 37062028 DOI: 10.1111/jocn.16726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/13/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of home-based cardiac telerehabilitation in patients with heart failure. DESIGN This systematic review and meta-analysis of randomised controlled trials were designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias within the included studies. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test. DATA SOURCES A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify studies in English or Chinese on randomised controlled trials up to 15 August 2022. RESULTS A total of 2291 studies were screened. The meta-analysis included data from 16 studies representing 4557 participants. The results indicated that home-based cardiac telerehabilitation could improve heart rate, VO2 peak, 6-minute walk distance, quality of life and reduce readmission rates. No significant differences were observed in the left ventricular ejection fraction percentages between the home-based cardiac telerehabilitation and usual care groups. Compared with centre-based cardiac rehabilitation, home-based cardiac telerehabilitation showed no significant improvement in outcome indicators. CONCLUSION Patients with heart failure benefit from home-based cardiac telerehabilitation intervention. With the rapid development of information and communication technology, home-based cardiac telerehabilitation has great potential and may be used as an adjunct or substitute for centre-based cardiac rehabilitation. IMPACT This systematic review and meta-analysis found that patients with heart failure would benefit from home-based cardiac telerehabilitation intervention in terms of cardiac function, functional capacity, quality-of-life management and readmission rate. Future clinical interventions should consider home-based cardiac telerehabilitation as an alternative to conventional cardiac rehabilitation in patients with heart failure to improve their quality of life. NO PATIENT OR PUBLIC CONTRIBUTION Our paper is a systematic review and meta-analysis, and such details do not apply to our work.
Collapse
Affiliation(s)
- Yan Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Naiquan Liu
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
15
|
Morita K, Miyamoto Y, Mizuno A, Shirane S, Ohbe H, Hashimoto Y, Kaneko H, Matsui H, Fushimi K, Yasunaga H. Impact of a financial incentive scheme for team-based palliative care in patients with heart failure in Japan: A nationwide database study. Int J Cardiol 2023; 387:131145. [PMID: 37364713 DOI: 10.1016/j.ijcard.2023.131145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/05/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Palliative care provided to patients with heart failure (HF) are reported to be inadequate. Herein, we examined the impact of the recently introduced financial incentive scheme for team-based palliative care for patients with HF in acute care hospitals in Japan. METHODS Using a nationwide inpatient database, we identified patients aged ≥65 years with HF who had died between April 2015 and March 2021. Interrupted time-series analyses were used to compare practice patterns in end-of-life care (symptom management and invasive medical procedures within one week before death) before and after the financial incentive scheme issuance in April 2018. RESULTS Overall, 53,857 patients in 835 hospitals were eligible. The adoption of the financial incentive was 1.10 to 1.22% after the introduction. There were upward pre-trends in opioid use (+0.11% per month; 95% confidence interval [CI], 0.06 to 0.15) and antidepressant use (+0.06% per month; 95% CI, 0.04 to 0.09). Opioid use showed a downward slope change during the post-period (-0.07% change in trend; 95% CI, -0.13 to -0.01). Intensive care unit stay showed a downward pre-trend (-0.09% per month; 95% CI, -0.14 to -0.04) and upward slope changes during the post-period (+0.12% change in trend; 95% CI, 0.04 to 0.19). Invasive mechanical ventilation showed downward slope changes during the post-period (-0.11% change in trend; 95% CI, -0.18 to -0.04). CONCLUSIONS The financial incentive scheme for team-based palliative care was rarely adopted and not associated with changes in end-of-life care. Further multifaceted strategies to promote palliative care for HF are warranted.
Collapse
Affiliation(s)
- Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, QI center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Sachie Shirane
- Department of Palliative Therapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan; Department of Palliative Care, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Ophthalmology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Advanced Cardiology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| |
Collapse
|
16
|
Zhao H, Liu Y, Liu M, Xu Y, Ling Q, Lin W, Zhang J, Yan Z, Ma J, Li W, Zhao Y, Yu P, Liu X, Wang J. Clinical Outcomes with GLP-1 Receptor Agonists in Patients with Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Drugs 2023; 83:1293-1307. [PMID: 37639180 DOI: 10.1007/s40265-023-01932-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). However, there remains uncertainty about the efficiency of GLP-1 RAs in patients with heart failure (HF). METHODS Randomized placebo-controlled trials (RCTs) that reported the effect of GLP-1 RAs on prognosis in patients with HF were identified by searching databases. The primary outcome was defined as MACE. Trail Sequential Analysis (TSA) was used to evaluate the reality and authenticity. RESULTS Nine RCTs involving 8920 patients with HF were included. GLP-1 RAs significantly reduced the risk of MACE compared with placebo (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77-0.98) in HF coexisting with T2DM. The benefit was not observed in all-cause death (HR 0.99, 95% CI 0.84-1.15), hospitalization for heart failure (HR 1.04, 95% CI 0.89-1.22), cardiovascular death (HR 0.95, 95% CI 0.79-1.16), myocardial infarction (HR 0.88, 95% CI 0.71-1.08), stroke (HR 1.03, 95% CI 0.75-1.43) and death or hospitalization for HF (HR 1.07, 95% CI 0.78-1.46). GLP-1 RAs did not improve the change in LVEF (mean difference [MD]): - 0.86, p = 0.12, left-ventricular end-diastolic volume (LVEDV) (MD: 3.54, p = 0.11), left-ventricular end-systolic volume (LVESV) (MD: 2.78, p = 0.07) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (MD: - 140.36, p = 0.08). However, GLP-1 RAs significantly increased the change in the 6-min walk test (MWT) distance (MD: 19.74, p = 0.002). In the subgroup analyses, human GLP-1 RAs, but not nonhuman GLP-1 RAs, reduced the risk of MACE in patients with HF (p interaction = 0.11). Grading of Recommendations Assessment, Development and Evaluation (GRADE) showed moderate certainty for MACE, all-cause death and hospitalization for HF. Trail Sequential Analysis revealed that there may be a high possibility of false positive results for MACE. CONCLUSION Compared with placebo, GLP-1 RAs may reduce the risk of MACE in patients with HF coexisting with T2DM, with a more significant efficiency of human GLP-1 RAs. More RCTs are needed to assess the cardiovascular benefits of GLP-1 RAs in HF, regardless of T2DM. REGISTRATION The protocol for this meta-analysis is registered on PROSPERO [CRD42022357886].
Collapse
Affiliation(s)
- Huilei Zhao
- Department of Anesthesiology, The Third Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Yang Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Menglu Liu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, China
| | - Yi Xu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qin Ling
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weichun Lin
- Department of Gastroenterology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhiwei Yan
- Department of Sports Rehabilitation, Shenyang Sport University, Shenyang, Liaoning, China
- Provincial University Key Laboratory of Sport and Health Science, School of Physical Education and Sport Sciences, Fujian Normal University, Fuzhou, China
| | - Jianyong Ma
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weiguang Li
- Department of Rehabilitation, Liaoning Province Jinqiu Hospital, Shenyang, Liaoning, China
| | - Yujie Zhao
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, China
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
- Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-Sen University, Guangzhou, Guangdong, China.
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou, Guangdong, China.
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou, Guangdong, China
| |
Collapse
|
17
|
Vetrovsky T, Siranec M, Frybova T, Gant I, Semerad M, Miklikova M, Bunc V, Vesely J, Stastny J, Griva M, Precek J, Pelouch R, Parenica J, Jarkovsky J, Belohlavek J. Statistical analysis plan for a randomized controlled trial examining pedometer-based walking intervention in patients with heart failure with reduced ejection fraction: the WATCHFUL trial. Trials 2023; 24:539. [PMID: 37587489 PMCID: PMC10433657 DOI: 10.1186/s13063-023-07516-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Physical activity is an effective management strategy for heart failure with reduced ejection fraction, but patients' compliance is challenging. Walking is a suitable form of physical activity due to its convenience and sustainability, and it can potentially improve functional capacity in heart failure patients. OBJECTIVES The WATCHFUL trial aims to determine whether a pedometer-based walking intervention combined with face-to-face sessions and regular telephone contact improves functional capacity in heart failure patients. METHODS The WATCHFUL trial is a 6-month multicenter, parallel-group, randomized, controlled, superiority trial with a 6-month follow-up. A total of 202 patients were recruited for the trial. The primary analysis will evaluate the change in distance walked during the 6-min walk test from baseline to 6 months based on the intention-to-treat population; the analysis will be performed using a linear mixed-effect model adjusted for baseline values. Missing data will be imputed using multiple imputations, and the impact of missing data will be assessed using a sensitivity analysis. Adverse events are monitored and recorded throughout the trial period. DISCUSSION The trial has been designed as a pragmatic trial with a scalable intervention that could be easily translated into routine clinical care. The trial has been affected by the COVID-19 pandemic, which slowed patients' recruitment and impacted their physical activity patterns. CONCLUSIONS The present publication provides details of the planned statistical analyses for the WATCHFUL trial to reduce the risks of reporting bias and erroneous data-driven results. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03041610, registered: 3/2/2017).
Collapse
Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.
| | - Michal Siranec
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tereza Frybova
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Iulian Gant
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Miroslav Semerad
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Marie Miklikova
- Cardiology Department, University Hospital Brno and Medical Faculty of the Masaryk University, Brno, Czech Republic
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jiri Vesely
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Edumed S.R.O, Broumov, Czech Republic
| | - Jiri Stastny
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Martin Griva
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
- Innere Medizin I - Abteilung Für Kardiologie Und Internistische Intensivmedizin, Landesklinikum Mistelbach, Mistelbach, Austria
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Jiri Parenica
- Cardiology Department, University Hospital Brno and Medical Faculty of the Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| |
Collapse
|
18
|
Yang T, Hu X, Wang J, Rao S, Cai YS, Li G, Huang J, Rahimi K. Long-Term Exposure to Road Traffic Noise and Incident Heart Failure: Evidence From UK Biobank. JACC. HEART FAILURE 2023; 11:986-996. [PMID: 37227391 DOI: 10.1016/j.jchf.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Evidence on road traffic noise and heart failure (HF) is limited, and little is known on the potential mediation roles of acute myocardial infarction (AMI), hypertension, or diabetes. OBJECTIVES The purpose of this study was to evaluate the impacts of long-term road traffic noise exposure on the risk of incident HF considering air pollution, and explore the mediations of the previously mentioned diseases. METHODS This prospective study included 424,767 participants without HF at baseline in UK Biobank. The residential-level noise and air pollution exposure was estimated, and the incident HF was identified through linkages with medical records. Cox proportional hazard models were used to estimate HRs. Furthermore, time-dependent mediation was performed. RESULTS During a median 12.5 years of follow-up, 12,817 incident HF were ascertained. The HRs were 1.08 (95% CI: 1.00-1.16) per 10 dB[A] increase in weighted average 24-hour road traffic noise level (Lden), and 1.15 (95% CI: 1.02-1.31) for exposure to Lden >65 dB[A] compared with the reference category (Lden ≤55 dB[A]), respectively. Furthermore, the strongest combined effects were found in those with both high exposures to road traffic noise and air pollution including fine particles and nitrogen dioxide. Prior AMI before HF within 2 years' time interval mediated 12.5% of the association of road traffic noise with HF. CONCLUSIONS More attention should be paid and a preventive strategy should be considered to alleviate the disease burden of HF related to road traffic noise exposure, especially in participants who survived AMI and developed HF within 2 years.
Collapse
Affiliation(s)
- Teng Yang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Xin Hu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Jiawei Wang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Shishir Rao
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Yutong Samuel Cai
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, United Kingdom; National Institute for Health Research Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, Leicester, United Kingdom
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China; Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom.
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China; Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.
| | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
19
|
Jain A, Meyur S, Wadhwa L, Singh K, Sharma R, Panchal I, Varrassi G. Effects of Angiotensin Receptor-Neprilysin Inhibitors Versus Enalapril or Valsartan on Patients With Heart Failure: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e41566. [PMID: 37554618 PMCID: PMC10405977 DOI: 10.7759/cureus.41566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
Recent studies have focused on treating heart failure, primarily mitigating symptoms and reducing the risk of mortality and other cardiovascular complications. A promising new treatment approach involves using LCZ696, an angiotensin receptor-neprilysin inhibitor (ARNI) comprising sacubitril and valsartan. This treatment is superior to the conventional drugs enalapril or valsartan in patients diagnosed with heart failure. A systematic search was conducted on PubMed, the Cochrane Library, and Elsevier's ScienceDirect databases to identify studies comparing sacubitril/valsartan with other drugs in heart failure patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The analyses were conducted using the random-effects model. The study's primary outcomes included all-cause mortality, death from cardiovascular causes, first hospitalization for heart failure, congestive heart failure, and changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical score. The pooled analysis showed that treatment with the sacubitril/valsartan combination was associated with a significantly decreased rate of first hospitalization for heart failure (RR: 0.86; 95% CI: 0.79, 0.98, p: 0.03; I2: 57%) and significantly increased KCCQ clinical score (WMD: 2.20; 95% CI: 0.33, 4.06, p: 0.02; I2: 100%). However, the two groups had no significant difference in all-cause mortality (RR: 0.90; 95% CI: 0.80, 1.01, p: 0.08; I2: 20%), death from cardiovascular causes (RR: 0.96; 95% CI: 0.87, 1.05, p: 0.34; I2: 0%), or congestive heart failure (RR: 0.97; 95% CI: 0.75, 1.25, p: 0.19; I2: 38%). The research findings suggest that sacubitril/valsartan (LCZ696) reduces hospitalizations due to heart failure and improves KCCQ clinical scores. This treatment also reduces the decline in renal function and side effects associated with enalapril or valsartan. Nonetheless, further high-quality randomized controlled trials with large sample sizes are needed to assess other impacts of this therapy on heart failure patients. Overall, the use of LCZ696 represents a promising new approach to the treatment of heart failure.
Collapse
Affiliation(s)
- Arpit Jain
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Shourya Meyur
- Medicine, AMA School of Medicine, Makati, PHL
- Internal Medicine, Sambhunath Pandit Hospital, Kolkata, IND
| | | | - Kamaldeep Singh
- Cardiology, Government Medical College & Hospital, Chandigarh, IND
- Internal Medicine, Jawaharlal Nehru Medical College, Chandigarh, IND
| | - Rishi Sharma
- Medicine, D. Y. Patil Medical College, D. Y. Patil Education Society Deemed University, Kolhapur, IND
| | - Ishita Panchal
- Internal Medicine, Jawaharlal Nehru Medical College, Belagavi, IND
| | | |
Collapse
|
20
|
Zhang D, Chen W, Cheng C, Huang H, Li X, Qin P, Chen C, Luo X, Zhang M, Li J, Sun X, Liu Y, Hu D. Air pollution exposure and heart failure: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 872:162191. [PMID: 36781139 DOI: 10.1016/j.scitotenv.2023.162191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
While the literature strongly supports a positive association between particulate matter with diameter ≤ 2.5 μm (PM2.5) exposure and heart failure (HF), there is uncertainty regarding the other pollutants and the dose and duration of exposure that triggers an adverse response. To comprehensively assess and quantify the association of air pollution exposure with HF incidence and mortality, we performed separate meta-analyses according to pollutant types [PM2.5, PM10, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3)], and exposure duration (short- and long-term). We systematically searched PubMed, EMBASE, and Web of Science for relevant articles with publication dates up to July 12, 2022, identifying 35 eligible studies. Random-effects models were used to summarize the pooled odds ratios (ORs) and 95 % confidence intervals (95 % CIs). For long-term exposure, the growing risk of HF was significantly associated with each 10 μg/m3 increase in PM2.5 (OR = 1.196, 95 % CI: 1.079-1.326; I2 = 76.8 %), PM10 (1.190, 1.045-1.356; I2 = 76.2 %), and NO2 (1.072, 1.028-1.118; I2 = 78.3 %). For short-term exposure, PM2.5, PM10, NO2, and O3 (per 10 μg/m3 increment) increased the risk of HF, with estimated ORs of 1.019 (1.008-1.030; I2 = 39.9 %), 1.012 (1.007-1.017; I2 = 28.3 %), 1.016 (1.005-1.026; I2 = 53.7 %), and 1.006 (1.002-1.010; I2 = 0.0 %), respectively. No significant effects of SO2 and CO exposure on the risk of HF were observed. In summary, our study powerfully highlights the deleterious impact of PM2.5, PM10, and NO2 exposure (either short- or long-term) on HF risk. Serious efforts should be made to improve air quality through legislation and interdisciplinary cooperation.
Collapse
Affiliation(s)
- Dongdong Zhang
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, Guangdong, People's Republic of China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Weiling Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Cheng Cheng
- Department of Biostatistics and Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hao Huang
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, Guangdong, People's Republic of China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Xi Li
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Pei Qin
- Department of Medical Record Management, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Chuanqi Chen
- Department of Endocrinology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xinping Luo
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Jing Li
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xizhuo Sun
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Yu Liu
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Dongsheng Hu
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, Guangdong, People's Republic of China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China.
| |
Collapse
|
21
|
Tsigkou V, Oikonomou E, Anastasiou A, Lampsas S, Zakynthinos GE, Kalogeras K, Katsioupa M, Kapsali M, Kourampi I, Pesiridis T, Marinos G, Vavuranakis MA, Tousoulis D, Vavuranakis M, Siasos G. Molecular Mechanisms and Therapeutic Implications of Endothelial Dysfunction in Patients with Heart Failure. Int J Mol Sci 2023; 24:ijms24054321. [PMID: 36901752 PMCID: PMC10001590 DOI: 10.3390/ijms24054321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Heart failure is a complex medical syndrome that is attributed to a number of risk factors; nevertheless, its clinical presentation is quite similar among the different etiologies. Heart failure displays a rapidly increasing prevalence due to the aging of the population and the success of medical treatment and devices. The pathophysiology of heart failure comprises several mechanisms, such as activation of neurohormonal systems, oxidative stress, dysfunctional calcium handling, impaired energy utilization, mitochondrial dysfunction, and inflammation, which are also implicated in the development of endothelial dysfunction. Heart failure with reduced ejection fraction is usually the result of myocardial loss, which progressively ends in myocardial remodeling. On the other hand, heart failure with preserved ejection fraction is common in patients with comorbidities such as diabetes mellitus, obesity, and hypertension, which trigger the creation of a micro-environment of chronic, ongoing inflammation. Interestingly, endothelial dysfunction of both peripheral vessels and coronary epicardial vessels and microcirculation is a common characteristic of both categories of heart failure and has been associated with worse cardiovascular outcomes. Indeed, exercise training and several heart failure drug categories display favorable effects against endothelial dysfunction apart from their established direct myocardial benefit.
Collapse
Affiliation(s)
- Vasiliki Tsigkou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-69-4770-1299
| | - Artemis Anastasiou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - George E. Zakynthinos
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Maria Katsioupa
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Maria Kapsali
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Islam Kourampi
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Georgios Marinos
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
22
|
Mebazaa A, Solal AC, Colombo PC. Assessing and treating congestion in acute decompensated heart failure: are we seeing the light at the end of the tunnel? Eur Heart J 2023; 44:51-53. [PMID: 36426405 DOI: 10.1093/eurheartj/ehac680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Alexandre Mebazaa
- Université Paris Cité, Inserm MASCOT, AP-HP Department of Anesthesia and Critical Care, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Alain Cohen Solal
- Université Paris Cité, Inserm MASCOT, AP-HP Department of Cardiology, Hôpital Lariboisière, Paris, France
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
23
|
Wang L, Wang S, Zhang Q, He C, Fu C, Wei Q. The role of the gut microbiota in health and cardiovascular diseases. MOLECULAR BIOMEDICINE 2022; 3:30. [PMID: 36219347 PMCID: PMC9554112 DOI: 10.1186/s43556-022-00091-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022] Open
Abstract
The gut microbiota is critical to human health, such as digesting nutrients, forming the intestinal epithelial barrier, regulating immune function, producing vitamins and hormones, and producing metabolites to interact with the host. Meanwhile, increasing evidence indicates that the gut microbiota has a strong correlation with the occurrence, progression and treatment of cardiovascular diseases (CVDs). In patients with CVDs and corresponding risk factors, the composition and ratio of gut microbiota have significant differences compared with their healthy counterparts. Therefore, gut microbiota dysbiosis, gut microbiota-generated metabolites, and the related signaling pathway may serve as explanations for some of the mechanisms about the occurrence and development of CVDs. Several studies have also demonstrated that many traditional and latest therapeutic treatments of CVDs are associated with the gut microbiota and its generated metabolites and related signaling pathways. Given that information, we summarized the latest advances in the current research regarding the effect of gut microbiota on health, the main cardiovascular risk factors, and CVDs, highlighted the roles and mechanisms of several metabolites, and introduced corresponding promising treatments for CVDs regarding the gut microbiota. Therefore, this review mainly focuses on exploring the role of gut microbiota related metabolites and their therapeutic potential in CVDs, which may eventually provide better solutions in the development of therapeutic treatment as well as the prevention of CVDs.
Collapse
Affiliation(s)
- Lu Wang
- grid.412901.f0000 0004 1770 1022Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China ,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People’s Republic of China
| | - Shiqi Wang
- grid.412901.f0000 0004 1770 1022Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China ,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People’s Republic of China
| | - Qing Zhang
- grid.412901.f0000 0004 1770 1022Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China ,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People’s Republic of China
| | - Chengqi He
- grid.412901.f0000 0004 1770 1022Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China ,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People’s Republic of China
| | - Chenying Fu
- grid.412901.f0000 0004 1770 1022National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, People’s Republic of China ,grid.412901.f0000 0004 1770 1022Aging and Geriatric Mechanism Laboratory, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Quan Wei
- grid.412901.f0000 0004 1770 1022Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China ,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People’s Republic of China
| |
Collapse
|