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Hashemi D, Doeblin P, Blum M, Weiss KJ, Schneider M, Beyer R, Pieske B, Duengen HD, Edelmann F, Kelle S. Reduced functional capacity is associated with the proportion of impaired myocardial deformation assessed in heart failure patients by CMR. Front Cardiovasc Med 2023; 10:1038337. [PMID: 36844739 PMCID: PMC9947709 DOI: 10.3389/fcvm.2023.1038337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Aims Heart failure (HF) does not only reduce the life expectancy in patients, but their life is also often limited by HF symptoms leading to a reduced quality of life (QoL) and a diminished exercise capacity. Novel parameters in cardiac imaging, including both global and regional myocardial strain imaging, promise to contribute to better patient characterization and ultimately to better patient management. However, many of these methods are not part of clinical routine yet, their associations with clinical parameters have been poorly studied. An imaging parameters that also indicate the clinical symptom burden of HF patients would make cardiac imaging more robust toward incomplete clinical information and support the clinical decision process. Methods and results This prospective study conducted at two centers in Germany between 2017 and 2018 enrolled stable outpatient subjects with HF [n = 56, including HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] and a control cohort (n = 19). Parameters assessed included measures for external myocardial function, for example, cardiac index and myocardial deformation measurements by cardiovascular magnetic resonance imaging, left ventricular global longitudinal strain (GLS), the global circumferential strain (GCS), and the regional distribution of segment deformation within the LV myocardium, as well as basic phenotypical characteristics including the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 6-minute walk test (6MWT). If less than 80% of the LV segments are preserved in their deformation capacity the functional capacity by 6MWT (6 minutes walking distance: MyoHealth ≥ 80%: 579.8 ± 177.6 m; MyoHealth 60-<80%: 401.3 ± 121.7 m; MyoHealth 40-<60%: 456.4 ± 68.9 m; MyoHealth < 40%: 397.6 ± 125.9 m, overall p-value: 0.03) as well as the symptom burden are significantly impaired (NYHA class: MyoHealth ≥ 80%: 0.6 ± 1.1 m; MyoHealth 60-<80%: 1.7 ± 1.2 m; MyoHealth 40-<60%: 1.8 ± 0.7 m; MyoHealth < 40%: 2.4 ± 0.5 m; overall p-value < 0.01). Differences were also observed in the perceived exertion assessed by on the Borg scale (MyoHealth ≥ 80%: 8.2 ± 2.3 m; MyoHealth 60-<80%: 10.4 ± 3.2 m; MyoHealth 40-<60%: 9.8 ± 2.1 m; MyoHealth < 40%: 11.0 ± 2.9 m; overall p-value: 0.20) as well as quality of life measures (MLHFQ; MyoHealth ≥ 80%: 7.5 ± 12.4 m; MyoHealth 60-<80%: 23.4 ± 23.4 m; MyoHealth 40-<60%: 20.5 ± 21.2 m; MyoHealth < 40%: 27.4 ± 24.4 m; overall p-value: 0.15)-while these differences were not significant. Conclusion The share of LV segments with preserved myocardial contraction promises to discriminate between symptomatic and asymptomatic subjects based on the imaging findings, even when the LV ejection fraction is preserved. This finding is promising to make imaging studies more robust toward incomplete clinical information.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany,*Correspondence: Djawid Hashemi,
| | - Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Karl Jakob Weiss
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Rebecca Beyer
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Hans-Dirk Duengen
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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Cotter G, Davison B, Metra M, Sliwa K, Voors AA, Addad F, Celutkiene J, Chioncel O, Cohen Solal A, Diaz R, Damasceno A, Duengen HD, Filippatos G, Goncalvesova E, Merai I, Ponikowski P, Privalov D, Sani MU, Takagi K, Shogenov Z, Saidu H, Mebazaa A. Amended STRONG-HF study design. Eur J Heart Fail 2021; 23:1981-1982. [PMID: 34529313 DOI: 10.1002/ejhf.2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gad Cotter
- INSERM UMR-S 942, Paris, France.,Momentum Research Inc, Durham, NC, USA
| | - Beth Davison
- INSERM UMR-S 942, Paris, France.,Momentum Research Inc, Durham, NC, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Faouzi Addad
- Department of Cardiology, Abderrahmen Mami University hospital, Ariana, Tunisia
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine 'Carol Davila', Bucharest, Romania
| | - Alain Cohen Solal
- INSERM UMR-S 942, Paris, France.,Department of Cardiology, Lariboisère University Hospital, Paris, France
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Hans-Dirk Duengen
- Department of Internal Medicine - Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Goncalvesova
- Department of Heart Failure and Transplantation, National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic
| | - Imad Merai
- Head of Cardiac Care Unit, Moscow City Hospital, Moscow, Russia
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Dmitry Privalov
- Critical Cardiac Unit, City Clinical Hospital, Moscow, Russia
| | - Mahmoud U Sani
- Department of Medicine, Bayero University Kano, Kano, Nigeria
| | | | | | - Hadiza Saidu
- Murtala Muhammed Specialist Hospital/Bayero University Kano, Kano, Nigeria
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care Medicine, St. Louis and Lariboisère University Hospitals, Paris, France
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Hashemi D, Motzkus L, Blum M, Kraft R, Tanacli R, Tahirovic E, Doeblin P, Zieschang V, Zamani SM, Kelm M, Kuehne T, Pieske B, Alogna A, Edelmann F, Duengen HD, Kelle S. Myocardial deformation assessed among heart failure entities by cardiovascular magnetic resonance imaging. ESC Heart Fail 2021; 8:890-897. [PMID: 33539681 PMCID: PMC8006725 DOI: 10.1002/ehf2.13193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Although heart failure (HF) is a leading cause for hospitalization and mortality, normalized and comparable non-invasive assessment of haemodynamics and myocardial action remains limited. Moreover, myocardial deformation has not been compared between the guideline-defined HF entities. The distribution of affected and impaired segments within the contracting left ventricular (LV) myocardium have also not been compared. Therefore, we assessed myocardial function impairment by strain in patients with HF and control subjects by magnetic resonance imaging after clinically phenotyping these patients. METHODS AND RESULTS This prospective study conducted at two centres in Germany between 2017 and 2018 enrolled stable outpatient subjects with HF [n = 56, including HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] and a control cohort (n = 12). Parameters assessed included measures for external myocardial function, for example, cardiac index and myocardial deformation measurements by cardiovascular magnetic resonance imaging, left ventricular global longitudinal strain (GLS), the global circumferential strain (GCS) and the regional distribution of segment deformation within the LV myocardium, as well as basic phenotypical characteristics. Comparison of the cardiac indices at rest showed no differences neither between the HF groups nor between the control group and HF patients (one-way ANOVA P = 0.70). The analysis of the strain data revealed differences between all groups in both LV GLS (One-way ANOVA: P < 0.01. Controls vs. HFpEF: -20.48 ± 1.62 vs. -19.27 ± 1.25. HFpEF vs. HFmrEF: -19.27 ± 1.25 vs. -15.72 ± 2.76. HFmrEF vs. HFrEF: -15.72 ± 2.76 vs. -11.51 ± 3.97.) and LV GCS (One-way ANOVA: P < 0.01. Controls vs. HFpEF: -19.74 ± 2.18 vs. -17.47 ± 2.10. HFpEF vs. HFmrEF: -17.47 ± 2.10 vs. -12.78 ± 3.47. HFrEF: -11.41 ± 3.27). Comparing the segment deformation distribution patterns highlighted the discriminating effect between the groups was much more prominent between the groups (one-way ANOVA P < 0.01) when compared by a score combining regional effects and a global view on the LV. Further analyses of the patterns among the segments affected showed that while the LVEF is preserved in HFpEF, the segments impaired in their contractility are located in the ventricular septum. The worse the LVEF is, the more segments are affected, but the septum remains an outstanding location with the most severe contractility impairment throughout the HF entities. CONCLUSIONS While cardiac index at rest did not differ significantly between controls and stable HF patients suffering from HFrEF, HFmrEF, or HFpEF, the groups did differ significantly in LV GLS and LV GCS values. Regional strain analysis revealed that the LV septum is the location affected most, with reduced values already visible in HFpEF and further reductions in HFmrEF and HFrEF.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Laura Motzkus
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Moritz Blum
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Robin Kraft
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Patrick Doeblin
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Victoria Zieschang
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - S Mahsa Zamani
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Marcus Kelm
- Charité-Universitätsmedizin Berlin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Titus Kuehne
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Hans-Dirk Duengen
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
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4
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Duengen HD, Kim RJ, Zahger D, Orvin K, Kornowski R, Admon D, Kettner J, Shimony A, Otto C, Becka M, Kanefendt F, Romo AI, Hasin T, Ostadal P, Rojas GC, Senni M. Effects of the chymase inhibitor fulacimstat on adverse cardiac remodeling after acute myocardial infarction-Results of the Chymase Inhibitor in Adverse Remodeling after Myocardial Infarction (CHIARA MIA) 2 trial. Am Heart J 2020; 224:129-137. [PMID: 32375104 DOI: 10.1016/j.ahj.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adverse cardiac remodeling is a major risk factor for the development of post myocardial infarction (MI) heart failure (HF). This study investigates the effects of the chymase inhibitor fulacimstat on adverse cardiac remodeling after acute ST-segment-elevation myocardial infarction (STEMI). METHODS In this double-blind, randomized, placebo-controlled trial patients with first STEMI were eligible. To preferentially enrich patients at high risk of adverse remodeling, main inclusion criteria were a left-ventricular ejection fraction (LVEF) ≤45% and an infarct size >10% on day 5 to 9 post MI as measured by cardiac MRI. Patients were then randomized to 6 months treatment with either 25 mg fulacimstat (n = 54) or placebo (n = 53) twice daily on top of standard of care starting day 6 to 12 post MI. The changes in LVEF, LV end-diastolic volume index (LVEDVI), and LV end-systolic volume index (LVESVI) from baseline to 6 months were analyzed by a central blinded cardiac MRI core laboratory. RESULTS Fulacimstat was safe and well tolerated and achieved mean total trough concentrations that were approximately tenfold higher than those predicted to be required for minimal therapeutic activity. Comparable changes in LVEF (fulacimstat: 3.5% ± 5.4%, placebo: 4.0% ± 5.0%, P = .69), LVEDVI (fulacimstat: 7.3 ± 13.3 mL/m2, placebo: 5.1 ± 18.9 mL/m2, P = .54), and LVESVI (fulacimstat: 2.3 ± 11.2 mL/m2, placebo: 0.6 ± 14.8 mL/m2, P = .56) were observed in both treatment arms. CONCLUSION Fulacimstat was safe and well tolerated in patients with left-ventricular dysfunction (LVD) after first STEMI but had no effect on cardiac remodeling.
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Affiliation(s)
- Hans-Dirk Duengen
- Department of Internal Medicine, Cardiology, Charité-Universitaetsmedizin, Berlin, Germany
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, United States
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Katia Orvin
- Rabin Medical Center - Beilinson Campus, Cardiology Division, Petah Tikva, Israel
| | - Ran Kornowski
- Rabin Medical Center - Beilinson Campus, Cardiology Division, Petah Tikva, Israel
| | - Dan Admon
- Hadassah Hebrew University Hospital Ein Kerem, Heart Institute, Jerusalem, Israel
| | - Jiri Kettner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Avraham Shimony
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Christiane Otto
- Experimental Medicine Cardiovascular, Bayer AG, Wuppertal, Germany.
| | - Michael Becka
- Research and Clinical Sciences Statistics, Bayer AG, Wuppertal, Germany
| | | | | | - Tal Hasin
- Shaare Zedek Medical Center, Department of Cardiology, Jerusalem, Israel
| | | | | | - Michele Senni
- Division of Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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5
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Duengen HD, Kim RJ, Zahger D, Orvin K, Admon D, Kettner J, Shimony A, Otto C, Becka M, Kanefendt F, Iniguez Romo A, Hasin T, Ostadal P, Calvo Rojas G, Senni M. 87Effects of the chymase inhibitor fulacimstat on adverse cardiac remodelling after acute myocardial infarction - Results of the CHIARA MIA 2 trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Adverse cardiac remodelling represents the most important risk factor for the development of heart failure (HF) after myocardial infarction (MI). Chymase is a protease that generates locally pro-fibrotic factors such as angiotensin II, TGFβ, and matrixmetallproteases that contribute to tissue remodelling.
Purpose
This phase IIa study examined the effects of the chymase inhibitor fulacimstat on functional parameters of adverse cardiac remodelling after acute MI.
Methods
A double-blind, multinational, randomized, placebo-controlled study was performed in patients after first STEMI who were treated with primary percutaneous coronary intervention within 24h of symptom onset. To enrich for patients at risk of adverse remodelling, main inclusion criteria were a left-ventricular ejection fraction (LVEF)≤45% and an infarct size>10% on day 5 to 9 post MI as measured by cardiac MRI. On day 6 to 12 post MI, patients were randomized to treatment with either 25 mg fulacimstat (n=54) or placebo (n=53) twice daily on top of standard of care. The changes in LVEF, LVEDVI, and LVESVI from baseline to 6 months of treatment were analyzed by a central blinded cardiac MRI core laboratory.
Results
Fulacimstat was safe and well tolerated, 64.8% of patients treated with fulacimstat and 75.5% of patients treated with placebo reported treatment emergent adverse events. Fulacimstat achieved exposures that were approximately 10-fold higher than those predicted to be required for minimal therapeutic activity. After six months of treatment, there were no effects of fulacimstat compared to placebo on the changes in LVEF, LVEDVI, and LVESVI (see Table).
Analysis of primary efficacy parameters Parameter Placebo Fulacimstat p-value LVEF (%) baseline 37.2±6.1 39.1±5.5 0.15 6 months 41.2±8.4 42.6±8.4 0.45 delta 4.0±5.0 3.5±5.4 0.69 LVEDVI (mL/m2) baseline 80.0±17.1 77.4±18.2 0.51 6 months 85.1±19.1 84.7±23.4 0.94 delta 5.1±18.9 7.3±13.3 0.54 LVESVI (mL/m2) baseline 50.5±13.0 47.3±12.3 0.26 6 months 51.1±16.9 49.6±18.1 0.71 delta 0.6±14.8 2.3±11.2 0.56 Data are given as mean ± standard deviation.
Conclusion
Fulacimstat was safe and well tolerated in patients with left-ventricular dysfunction (LVD) after first STEMI but had no effect on adverse cardiac remodelling in the experimental setting of this study.
Acknowledgement/Funding
The study was funded by its sponsor BAYER AG
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Affiliation(s)
- H D Duengen
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine, Cardiology, Berlin, Germany
| | - R J Kim
- Duke University Medical Center, Duke Cardiovascular Magnetic Resonance Center, Durham, United States of America
| | - D Zahger
- Soroka University Medical Center, Beer Sheva, Israel
| | - K Orvin
- Rabin Medical Center - Beilinson Campus, Cardiology Division, Petah Tikva, Israel
| | - D Admon
- Hadassah Hebrew University Hospital Ein Kerem, Heart Institute, Jerusalem, Israel
| | - J Kettner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - A Shimony
- Soroka University Medical Center, Beer Sheva, Israel
| | - C Otto
- BAYER AG, Experimental Medicine Hematology and Cardiology, Wuppertal, Germany
| | - M Becka
- BAYER AG, Research and Clinical Sciences Statistics, Wuppertal, Germany
| | - F Kanefendt
- BAYER AG, Clinical Pharmacokinetics, Wuppertal, Germany
| | - A Iniguez Romo
- Hospital Alvaro Cunqueiro, Servicio de la Cardiologia, Babio-Beade, Spain
| | - T Hasin
- Shaare Zedek Medical Center, Department of Cardiology, Jerusalem, Israel
| | - P Ostadal
- Nemocnice na Homolce, Prague, Czechia
| | | | - M Senni
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
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6
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Kimmoun A, Cotter G, Davison B, Takagi K, Addad F, Celutkiene J, Chioncel O, Solal AC, Diaz R, Damasceno A, Duengen HD, Filippatos G, Goncalvesova E, Merai I, Metra M, Ponikowski P, Privalov D, Sliwa K, Sani MU, Voors AA, Shogenov Z, Mebazaa A. Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP and GDF-15, of Heart Failure therapies (STRONG-HF): rationale and design for a multicentre, randomized, parallel-group study. Eur J Heart Fail 2019; 21:1459-1467. [PMID: 31423712 DOI: 10.1002/ejhf.1575] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Patients admitted for acute heart failure (HF) are at high risk of readmission and death, especially in the 90 days following discharge. We aimed to assess the safety and efficacy of early optimization of oral HF therapy with beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNi), and mineralocorticoid receptor antagonists (MRA) on 90-day clinical outcomes in patients admitted for acute HF. METHODS In a multicentre, randomized, open-label, parallel-group study, a total of 900 patients will be randomized in a 1:1 ratio to either 'usual care' or 'high-intensity care'. Patients enrolled in the usual care arm will be discharged and managed according to usual clinical practice at the site. In the high-intensity care arm, doses of oral HF medications - including a BB, ACEi or ARB, and MRA - will be up-titrated to 50% of recommended doses before discharge and to 100% of recommended doses within 2 weeks of discharge. Up-titration will be delayed if the patients develop worsening symptoms and signs of congestion, hyperkalaemia, hypotension, bradycardia, worsening of renal function or significant increase in N-terminal pro-B-type natriuretic peptide between visits. The primary endpoint is 90-day all-cause mortality or HF readmission. CONCLUSIONS STRONG-HF is the first study to assess whether rapid up-titration of evidence-based guideline-recommended therapies with close follow-up in a large cohort of patients discharged from an acute HF admission is safe and can affect adverse outcomes during the first 90 days after discharge. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03412201.
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Affiliation(s)
- Antoine Kimmoun
- INSERM UMR-S 942, St. Louis and Lariboisère University Hospitals, Paris University, Paris, France
| | | | | | - Koji Takagi
- INSERM UMR-S 942, St. Louis and Lariboisère University Hospitals, Paris University, Paris, France
| | - Faouzi Addad
- Department of Cardiology, Abderrahmen Mami University hospital, Ariana, Tunisia
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine 'Carol Davila', Bucharest, Romania
| | - Alain Cohen Solal
- INSERM UMR-S 942, St. Louis and Lariboisère University Hospitals, Paris University, Paris, France.,Department of Cardiology, Lariboisère University Hospital, Paris, France
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Hans-Dirk Duengen
- Department of Internal Medicine - Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Greece; School of Medicine, University of Cyprus, Nicosia, Cyprus
| | - Eva Goncalvesova
- Department of Heart Failure and Transplantation, National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic
| | - Imad Merai
- Cardiac Care Unit, Moscow City Hospital, Moscow, Russia
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Dmitry Privalov
- Critical Cardiac Unit, City Clinical Hospital, Moscow, Russia
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | | | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Alexandre Mebazaa
- INSERM UMR-S 942, St. Louis and Lariboisère University Hospitals, Paris University, Paris, France.,Department of Anesthesiology and Critical Care Medicine, St. Louis and Lariboisère University Hospitals, Paris, France
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Solomon SD, Rizkala AR, Lefkowitz MP, Shi VC, Gong J, Anavekar N, Anker SD, Arango JL, Arenas JL, Atar D, Ben-Gal T, Boytsov SA, Chen CH, Chopra VK, Cleland J, Comin-Colet J, Duengen HD, Echeverría Correa LE, Filippatos G, Flammer AJ, Galinier M, Godoy A, Goncalvesova E, Janssens S, Katova T, Køber L, Lelonek M, Linssen G, Lund LH, O’Meara E, Merkely B, Milicic D, Oh BH, Perrone SV, Ranjith N, Saito Y, Saraiva JF, Shah S, Seferovic PM, Senni M, Sibulo AS, Sim D, Sweitzer NK, Taurio J, Vinereanu D, Vrtovec B, Widimský J, Yilmaz MB, Zhou J, Zweiker R, Anand IS, Ge J, Lam CS, Maggioni AP, Martinez F, Packer M, Pfeffer MA, Pieske B, Redfield MM, Rouleau JL, Van Veldhuisen DJ, Zannad F, Zile MR, McMurray JJ. Baseline Characteristics of Patients With Heart Failure and Preserved Ejection Fraction in the PARAGON-HF Trial. Circ Heart Fail 2018; 11:e004962. [DOI: 10.1161/circheartfailure.118.004962] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., M.A.P.)
| | - Adel R. Rizkala
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (V.C.S., A.R.R., J.J.G., M.P.L.)
| | - Martin P. Lefkowitz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (V.C.S., A.R.R., J.J.G., M.P.L.)
| | - Victor C. Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (V.C.S., A.R.R., J.J.G., M.P.L.)
| | - JianJian Gong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (V.C.S., A.R.R., J.J.G., M.P.L.)
| | - Nagesh Anavekar
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia (N.A.)
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Berlin, Charité Universitätsmedizin Berlin, Germany (S.D.A.)
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Germany (S.D.A.)
| | | | - Jose L. Arenas
- Centro de Atención e Investigación Cardiovascular del Potosi SC and Hospital Ángeles San Luis, México (J.L. Arenas)
| | - Dan Atar
- Department of Cardiology B, Oslo University Hospital, University of Oslo, Norway (D.A.)
| | - Turia Ben-Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (T.B.-G.)
| | - Sergey A. Boytsov
- National Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia (S.A.B.)
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China (C.-H.C.)
| | - Vijay K. Chopra
- Heart Failure Unit, Medanta Medicity, Gurugram, Haryana, India (V.K.C.)
| | - John Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.C.)
- University of Glasgow, United Kingdom. National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom (J.C.)
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, Spain (J.C.-C.)
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, Spain (J.C.-C.)
| | - Hans-Dirk Duengen
- National Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia (S.A.B.)
| | | | - Gerasimos Filippatos
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.F.)
- School of Medicine, University of Cyprus, Greece (G.F.)
| | - Andreas J. Flammer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (A.J.F.)
| | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France (M.G.)
| | - Armando Godoy
- Universidad Nacional Mayor de San Marcos, Lima, Perú (A.G.)
- Instituto Nacional Cardiovascular INCOR, Lima, Perú (A.G.)
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú (A.G.)
| | - Eva Goncalvesova
- Department of Heart Failure/Transplantation, National Cardiovascular Institute, Bratislava, Slovakia (E.G.)
| | - Stefan Janssens
- Department of Cardiology, University Hospitals Leuven, Belgium (S.J.)
| | - Tzvetana Katova
- Clinic of Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.)
| | - Lars Køber
- Department of Cardiology, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (L.K.)
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Poland (M.L.)
| | - Gerard Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands (G.L.)
| | - Lars H. Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Eileen O’Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Québec, Canada (E.O.M., J.L.R.)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Croatia (D.M.)
| | - Byung-Hee Oh
- Seoul National University Hospital, Seoul National University College of Medicine, Korea (B.-H.O.)
| | | | - Naresh Ranjith
- Department of Cardiology, City Hospital, Durban, South Africa (N.R.)
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.)
| | - Jose F. Saraiva
- Disciplina de Cardiologia Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Sao Paulo, Brazil (J.F.K.S.)
| | - Sanjiv Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.)
| | - Petar M. Seferovic
- Department of Cardiology, University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia (P.M.S.)
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.)
| | - Antonio S. Sibulo
- St Luke’s Heart Institute, St. Luke’s Medical Center, Taguig, Philippines (A.S.S.)
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore (D.S.)
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.)
| | - Jyrki Taurio
- Department of Cardiology, Tampere University Hospital, Finland (J.T.)
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital of Bucharest, Romania (D.V.)
| | - Bojan Vrtovec
- University Medical Centre, Ljubljana, Slovenia (B.V.)
| | - Jiří Widimský
- First Faculty of Medicine, Charles University Prague, Czech Republic (J.W.)
| | - Mehmet B. Yilmaz
- Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey (M.B.Y.)
| | - Jingmin Zhou
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (J.Z.)
| | - Robert Zweiker
- Department of Cardiology, Medical University Graz, Austria (R.Z.)
| | - Inder S. Anand
- Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis (I.S.A.)
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China (J.G.)
| | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | - Aldo P. Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.)
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.)
| | - Marc A. Pfeffer
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., M.A.P.)
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology Charité, Universitaetsmedizin Berlin, Campus Virchow Klinikum Berlin, Germany (B.P., H.-D.D.)
| | | | - Jean L. Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Québec, Canada (E.O.M., J.L.R.)
| | - Dirk J. Van Veldhuisen
- University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.)
| | - Faiez Zannad
- Inserm CIC 1433 and Université de Lorraine, Centre Hospitalier Ré gional Universitaire, Nancy, France (F.Z.)
| | - Michael R. Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.R.Z.)
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8
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Trippel TD, Holzendorf V, Halle M, Gelbrich G, Nolte K, Duvinage A, Schwarz S, Rutscher T, Wiora J, Wachter R, Herrmann-Lingen C, Duengen HD, Hasenfuß G, Pieske B, Edelmann F. Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex-DHF pilot study. ESC Heart Fail 2016; 4:56-65. [PMID: 28217313 PMCID: PMC5292632 DOI: 10.1002/ehf2.12109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Over 50% of patients with symptomatic heart failure (HF) experience HF with preserved ejection fraction (HFpEF). Exercise training (ET) is effective in improving cardiorespiratory fitness and dimensions of quality of life in patients with HFpEF. A systemic pro-inflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations has been proposed in HFpEF. ET modifies myocardial structure and has been related to inflammatory state. We investigated Ghrelin, related adipokines, markers of inflammation, and neuro-hormonal activation in patients undergoing a structured ET vs. usual care are with HFpEF. METHODS AND RESULTS Ex-DHF-P was a prospective, controlled, randomized multi-centre trial on structured and supervised ET in patients with HFpEF. We performed a post hoc analysis in 62 patients from Ex-DHF-P. Ghrelin, adiponectin, leptin, IL-1ß, IL-6, IL-10, tumour necrosis factor-alpha, MR-proANP, MR-proADM, CT-proET1, and CT-proAVP were assessed to seize the impact of ET on these markers in patients with HFpEF. Thirty-six (58%) patients were female, mean age was 64 years, and median ghrelin was 928 pg/mL (interquartile range 755-1156). When stratified for high versus low ghrelin, groups significantly differed at baseline in presence obesity, waist circumference, and adiponectin levels (P < 0.05, respectively). Overall, ghrelin levels rose significantly to 1013 pg/mL (interquartile range 813-1182) (P < 0.001). Analysis of covariance modelling for change in ghrelin identified ET (P = 0.013) and higher baseline adiponectin levels (P = 0.035) as influencing factors. CONCLUSIONS Exercise training tended to increase ghrelin levels in Ex-DHF-P. This increase was especially pronounced in patients with higher baseline adiponectin levels. Future trials are needed to investigate the effect of ET on endogenous ghrelin levels in regard to interactions with cardiac structure and clinically meaningful surrogate parameters.
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Affiliation(s)
- Tobias Daniel Trippel
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Volker Holzendorf
- ZKS Leipzig (Clinical Trial Centre Leipzig) University of Leipzig Leipzig Germany
| | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and BiometryUniversity of WürzburgWürzburgGermany; Clinical Trial CentreUniversity Hospital WürzburgWürzburgGermany
| | - Kathleen Nolte
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Andre Duvinage
- DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany; Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Silja Schwarz
- DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany
| | - Tinka Rutscher
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Julian Wiora
- Department of Internal Medicine - Cardiology Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum Berlin Germany
| | - Rolf Wachter
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Christoph Herrmann-Lingen
- DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany; Department for Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Hans-Dirk Duengen
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Gerd Hasenfuß
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Burkert Pieske
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Frank Edelmann
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany; Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany
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9
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Jaarsma T, Strömberg A, Ben Gal T, Cameron J, Driscoll A, Duengen HD, Inkrot S, Huang TY, Huyen NN, Kato N, Köberich S, Lupón J, Moser DK, Pulignano G, Rabelo ER, Suwanno J, Thompson DR, Vellone E, Alvaro R, Yu D, Riegel B. Comparison of self-care behaviors of heart failure patients in 15 countries worldwide. Patient Educ Couns 2013; 92:114-120. [PMID: 23579040 DOI: 10.1016/j.pec.2013.02.017] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/09/2013] [Accepted: 02/24/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. METHODS Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. RESULTS In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. CONCLUSION Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. PRACTICE IMPLICATIONS Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.
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Affiliation(s)
- Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
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Lainscak M, Duengen HD, Anker SD. Beta-Blockers in Elderly Patients With Heart Failure. J Am Coll Cardiol 2009; 54:2202. [DOI: 10.1016/j.jacc.2009.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 02/16/2009] [Indexed: 10/20/2022]
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