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Mohamed K, Sengodan PM, Mohammad A, Carabello BA. Clinical Implications of Variability in Left Ventricular Ejection Fraction Determined by Echocardiography and Cardiac Magnetic Resonance. J Am Soc Echocardiogr 2024:S0894-7317(24)00168-8. [PMID: 38593887 DOI: 10.1016/j.echo.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
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Xia J, Brownell NK, Fonarow GC, Ziaeian B. New models for heart failure care delivery. Prog Cardiovasc Dis 2024; 82:70-89. [PMID: 38311306 DOI: 10.1016/j.pcad.2024.01.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 02/10/2024]
Abstract
Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT. Only a minority of HF patients are prescribed on all four classes of GDMT. To bridge the gap between the vulnerable population of HF patients and lifesaving GDMT, HF implementation is of increasing importance. HF implementation involves strategies and techniques to improve GDMT optimization along with other modalities to improve HF management. HF implementation meets patients where they are, including at the time of acute decompensation in the inpatient setting, at the vulnerable discharge stage, and at the chronic management stage in the outpatient setting. Inpatient HF implementation strategies include protocolized rapid titration of GDMT, site-level audit-and-feedback, virtual GDMT optimization teams, and electronic health record notifications and alerts. Discharge HF implementation strategies include education at patient and provider levels, discharge summaries, and HF transitional programs. Outpatient HF implementation strategies include digital innovations such as electronic health record utilization and mobile applications, population level strategies such as registries and clinical dashboards), changes in HF team structure and member roles, remote monitoring with implanted devices and telemonitoring, and hospital at home care model. With a growing population of HF patients, there is an increasing need for novel and creative HF implementation and monitoring methods.
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Affiliation(s)
- Jeffrey Xia
- Department of Medicine David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Nicholas K Brownell
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
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Badger S, McVeigh J, Indraratna P. Summary and Comparison of the 2022 ACC/AHA/HFSA and 2021 ESC Heart Failure Guidelines. Cardiol Ther 2023; 12:571-588. [PMID: 37653361 DOI: 10.1007/s40119-023-00328-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
The guidelines released by the American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) in 2022 and those released in 2021 by the European Society of Cardiology (ESC) play a crucial role in offering evidence-based recommendations for the diagnosis and management of heart failure (HF). This comprehensive review aims to provide an overview of these guidelines, incorporating insights from relevant clinical trials. While there is considerable alignment between the two sets of guidelines, certain notable differences arise due to variations in publication timelines, which we will outline. By presenting this summary, our objective is to empower clinicians to make informed decisions regarding HF management in their own practice, and facilitate the development of more harmonized guidelines in the future.
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Affiliation(s)
- Sarah Badger
- Department of Cardiology, Prince of Wales Hospital, Randwick, Australia
| | - James McVeigh
- Department of Cardiology, Prince of Wales Hospital, Randwick, Australia
| | - Praveen Indraratna
- Department of Cardiology, Prince of Wales Hospital, Randwick, Australia.
- School of Clinical Medicine, UNSW, Sydney, Australia.
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Ahmed A, Ahmed W, Arshad MS, Suri A, Amin E, Shahid I, Memon MM. Meta-Analysis Evaluating Risk of Hyperkalemia Stratified by Baseline MRA Usage in Patients with Heart Failure Receiving SGLT2 Inhibitors. Cardiovasc Drugs Ther 2023. [PMID: 36920647 DOI: 10.1007/s10557-023-07446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Both mineralocorticoid receptor antagonists (MRAs) and sodium-glucose co-transporter type 2 inhibitors (SGLT2is) have demonstrated beneficial reductions in cardiovascular outcomes. However, the risk of precipitating hyperkalemia with their concomitant usage remains unclear. METHODS MEDLINE and Cochrane were searched from inception through March 2022. Randomized controlled trials on patients with heart failure (HF) evaluating the effect of SGLT2is on clinical outcomes between MRA users and non-users were considered for inclusion. Outcomes of interest were mild and moderate/severe hyperkalemia, for which hazard ratios (HR) were pooled using a random effects model. RESULTS From the 972 articles retrieved from the initial search, three RCTs (n = 14,462 patients) were included in our meta-analysis. Pooled analysis demonstrated no significant difference in the incidence of mild hyperkalemia between MRA users (HR 0.82 [0.70-0.97]) and non-users (HR 0.95 [0.77-1.17]) (P-interaction = 0.28). The risk of severe hyperkalemia was significantly decreased in MRA users (HR 0.59 [0.44-0.78]; p = 0.0002; I2 = 0%) but not in non-users (HR 0.76 [0.56-1.02]; p = 0.07; I2 = 0%) (P-interaction = 0.22). Sensitivity analysis including patients with HF with reduced ejection fraction (HFrEF) revealed similar results across all subgroups, but no significant reduction in the incidence of mild hyperkalemia (HR 0.89 [0.76-1.04] was noted in MRA users with HFrEF. CONCLUSION MRAs reduced the risk of mild or moderate/severe hyperkalemia, when added to SGLT2is. Future clinical trials should target scrupulous assessment of the risk of mild and moderate/severe hyperkalemia when used concomitantly with MRAs.
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Krittanawong C, Rodriguez M, Lui M, Misra A, Tang WHW, Bozkurt B, Yancy CW. Misconceptions and Facts about Heart Failure with Reduced Ejection Fraction. Am J Med 2023; 136:422-431. [PMID: 36740210 DOI: 10.1016/j.amjmed.2023.01.024] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Heart failure with reduced ejection fraction is a significant driver of morbidity and mortality. There are common misconceptions regarding the disease processes underlying heart failure and best practices for therapy. The terms heart failure with reduced ejection fraction and left ventricular systolic dysfunction are not interchangeable terms. Key therapies for heart failure with reduced ejection fraction target the underlying disease processes, not the left ventricular ejection fraction alone. The absence of congestion does not rule out heart failure. Patients with cardiac amyloidosis can also present with heart failure with reduced ejection fraction. A rise in serum creatinine in acute heart failure exacerbation is not associated with tubular injury. Guideline directed medical therapy should be continued during acute exacerbations of heart failure with reduced ejection fraction and should be started in the same hospitalization in new diagnoses. Marginal blood pressure is not a relative contraindication to optimal guideline directed medical therapy. Guideline directed medical therapy should be continued even if ejection fraction improves. There are other therapies that provide significant benefit besides the four key medications in guideline directed medical therapy.
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Affiliation(s)
| | - Mario Rodriguez
- John T Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine, Mo
| | - Matthew Lui
- John T Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine, Mo
| | - Arunima Misra
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio
| | - Biykem Bozkurt
- Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, DeBakey VA Medical Center, Houston, Texas
| | - Clyde W Yancy
- Chief, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
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Biegus J, Moayedi Y, Saldarriaga C, Ponikowski P. Getting ahead of the game: in-hospital initiation of HFrEF therapies. Eur Heart J Suppl 2022; 24:L38-L44. [PMID: 36545227 PMCID: PMC9762886 DOI: 10.1093/eurheartjsupp/suac120] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hospitalizations for heart failure (HF) have become a global problem worldwide. Each episode of HF decompensation may lead to deleterious short- and long- term consequences, but on the other hand is an unique opportunity to adjust the heart failure pharmacotherapy. Thus, in-hospital and an early post-discharge period comprise an optimal timing for initiation and optimization of the comprehensive management of HF. This timeframe affords clinicians an opportunity to up titrate and adjust guideline-directed medical therapies (GDMT) to potentially mitigate poor outcomes associated post-discharge and longer-term. This review will cover this timely concept, present the data of utilization of GDMT in HF populations, discuss recent evidence for in-hospital initiation and up-titration of GDMT with a need for post-discharge follow-up and implementation this into clinical practice in patients with heart failure and reduced ejection fraction.
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Affiliation(s)
- Jan Biegus
- Institute of Heart Diseases, Cardiology Department, Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Yasbanoo Moayedi
- University Health Network, Department of Medicine, Division of Cardiology, Ted Rogers Centre for Heart Function Research, Toronto, ON, M5G 2C2, Canada
| | - Clara Saldarriaga
- University of Antioquia, CardioVID Clinic, Cardiology Department, 050021 Medellín, Colombia
| | - Piotr Ponikowski
- Institute of Heart Diseases, Cardiology Department, Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Dunlay SM, Killian JM, Roger VL, Schulte PJ, Blecker SB, Savitz ST, Redfield MM. Guideline-Directed Medical Therapy in Newly Diagnosed Heart Failure With Reduced Ejection Fraction in the Community. J Card Fail 2022; 28:1500-1508. [PMID: 35902033 PMCID: PMC9588715 DOI: 10.1016/j.cardfail.2022.07.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/03/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Guideline-directed medical therapy (GDMT) dramatically improves outcomes in heart failure with reduced ejection fraction (HFrEF). Our goal was to examine GDMT use in community patients with newly diagnosed HFrEF. METHODS AND RESULTS We performed a population-based, retrospective cohort study of all Olmsted County, Minnesota, residents with newly diagnosed HFrEF (EF ≤ 40%) 2007-2017. We excluded patients with contraindications to medication initiation. We examined the use of beta-blockers, HF beta-blockers (metoprolol succinate, carvedilol, bisoprolol), angiotensin converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIS), and mineralocorticoid receptor antagonists (MRAs) in the first year after HFrEF diagnosis. We used Cox models to evaluate the association of being seen in an HF clinic with the initiation of GDMT. From 2007 to 2017, 1160 patients were diagnosed with HFrEF (mean age 69.7 years, 65.6% men). Most eligible patients received beta-blockers (92.6%) and ACEis/ARBs/ARNIs (87.0%) in the first year. However, only 63.8% of patients were treated with an HF beta-blocker, and few received MRAs (17.6%). In models accounting for the role of an HF clinic in initiation of these medications, being seen in an HF clinic was independently associated with initiation of new GDMT across all medication classes, with a hazard ratio (95% CI) of 1.54 (1.15-2.06) for any beta-blocker, 2.49 (1.95-3.20) for HF beta-blockers, 1.97 (1.46-2.65) for ACEis/ARBs/ARNIs, and 2.14 (1.49-3.08) for MRAs. CONCLUSIONS In this population-based study, most patients with newly diagnosed HFrEF received beta-blockers and ACEis/ARBs/ARNIs. GDMT use was higher in patients seen in an HF clinic, suggesting the potential benefit of referral to an HF clinic for patients with newly diagnosed HFrEF.
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Affiliation(s)
- Shannon M Dunlay
- Department of Cardiovascular Medicine, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.
| | - Jill M Killian
- Department of Quantitative Health Sciences, Rochester, Minnesota
| | - Veronique L Roger
- National Heart Lung Blood Institute in the National Institutes of Health, Bethesda, Maryland
| | | | - Saul B Blecker
- Department of Population Health and Medicine, New York University Langone, New York, New York
| | - Samuel T Savitz
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
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Mwabutwa ES, Kateta S, Kinley L, Ulemu T, Goodson P, Muula AS, Kumwenda J. An audit of Heart failure management among ambulatory adult patients at Queen Elizabeth Central Hospital (QECH), Malawi. Malawi Med J 2022; 34:170-175. [PMID: 36406095 PMCID: PMC9641614 DOI: 10.4314/mmj.v34i3.5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background There are limited data on the clinical characteristics and use of guideline directed medical therapy among patients with heart failure in Malawi. We conducted a study to assess patient characteristics and clinical management given to heart failure patients at Queen Elizabeth Central hospital in Malawi. Methods In a cross sectional study, patients with a diagnosis of heart failure who were followed up in the adult chest clinic at QECH were recruited to ascertain their characteristics and the therapy they were receiving. Echocardiograms and electrocardiograms were performed to identify abnormalities. Results A total of 79 patients were recruited and 62% (49 out of 79) were female. The median age was 60 years (IQR 40.5-70.5). Most patients were hypertensive with NYHA (New York Heart Association) class I and II symptoms. Left ventricular(LV) systolic dysfunction was found in 55% (36 out of 65), with 68% (39 out of 65) having features of left ventricular remodeling. Most patients were on at least a single neurohormonal drug with 77% (61 out of 79) on ACEI (angiotensin converting enzyme inhibitor), 52% (42 out of 79) on a beta blocker and 34%(27 out of 79) on aldosterone antagonists. The recommended doses of medications were achieved in 14% (9 out 61), 24% (10 out 42), 22% (6 out of 27) on ACEI, beta blockers and aldosterone antagonists respectively. Conclusions Hypertension is the commonest comorbidity in patients with heart failure, who are mostly females with NYHA class I or II symptoms. Most had LV remodeling changes and are on at least one neurohormonal antagonist but most remain sub optimally treated.
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Affiliation(s)
- Emmanuel S Mwabutwa
- Department of Medicine, School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Steve Kateta
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Louis Kinley
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Tadala Ulemu
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Patrick Goodson
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Adamson S Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Johnstone Kumwenda
- Department of Medicine, School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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Huang H, Huang J, Lin P, Lee Y, Hsu C, Chung F, Liao C, Chiou W, Lin W, Liang H, Chang H. Clinical impacts of sacubitril/valsartan on patients eligible for cardiac resynchronization therapy. ESC Heart Fail 2022; 9:3825-3835. [PMID: 35945811 PMCID: PMC9773776 DOI: 10.1002/ehf2.14107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/09/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Sacubitril/valsartan (SAC/VAL) has been used in patients with heart failure and reduced ejection fraction (HFrEF), and cardiac resynchronization therapy (CRT) could benefit the HFrEF patients with wide QRS durations. This study aimed to evaluate the clinical impacts of SAC/VAL on reverse cardiac remodelling in CRT-eligible and CRT-ineligible HFrEF patients with different QRS durations. METHODS AND RESULTS The TAROT-HF study was a multicentre, observational study enrolling patients who initiated SAC/VAL from 10 hospitals since 2017. Patients with baseline left ventricular ejection fraction (LVEF) ≤ 35% were classified into two groups: (i) Group 1: CRT-eligible group, patients with left bundle branch block (LBBB) morphology plus QRS duration ≥130 ms or non-LBBB morphology plus QRS duration ≥150 ms; and (ii) Group 2: CRT-ineligible group. Propensity score matching was performed to adjust for confounders, and 1168 patients were analysed. Baseline characteristics were comparable between the two groups. The improvements in LVEF and left ventricular end-systolic volume index (LVESVi) were more significant in Group 2 than in Group 1 after 1 year SAC/VAL treatment (LVEF: 8.4% ± 11.3% vs. 4.5% ± 8.1%, P < 0.001; change percentages in LVESVi: -14.4% ± 25.9% vs. -9.6% ± 23.1%, P = 0.004). LVEF improving to ≥50% in Groups 1 and 2 constituted 5.2% and 20.2% after 1 year SAC/VAL treatment (P < 0.001). Multivariate analyses showed that wide QRS durations were negatively associated with the reverse cardiac remodelling in these HFrEF patients with SAC/VAL treatment. CONCLUSION Despite SAC/VAL treatment, wide QRS durations are associated with lower degrees of left ventricular improvement than narrow ones in the HFrEF patients. Optimal intervention timing for the CRT-eligible patients requires further investigation.
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Affiliation(s)
- Hsin‐Ti Huang
- Division of Nephrology, Department of Internal Medicine and Medical EducationTaichung Veterans General HospitalTaichungTaiwan,Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jin‐Long Huang
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Post‐Baccalaureate Medicine, College of MedicineNational Chung Hsing UniversityTaichungTaiwan,Department of Medical EducationTaichung Veterans General HospitalTaichungTaiwan
| | - Po‐Lin Lin
- Department of MedicineMacKay Medical CollegeNew TaipeiTaiwan,Division of Cardiology, Department of Internal MedicineHsinchu MacKay Memorial HospitalHsinchuTaiwan
| | - Ying‐Hsiang Lee
- Department of MedicineMacKay Medical CollegeNew TaipeiTaiwan,Cardiovascular CenterMacKay Memorial HospitalTaipeiTaiwan,Department of Artificial Intelligence and Medical ApplicationMacKay Junior College of Medicine, Nursing, and ManagementTaipeiTaiwan
| | - Chien‐Yi Hsu
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Division of Cardiology and Cardiovascular Research Center, Department of Internal MedicineTaipei Medical University HospitalTaipeiTaiwan,Taipei Heart Institute, Division of Cardiology, Department of Internal Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Fa‐Po Chung
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Chia‐Te Liao
- Division of CardiologyChi‐Mei Medical CenterTainanTaiwan
| | - Wei‐Ru Chiou
- Department of MedicineMacKay Medical CollegeNew TaipeiTaiwan,Division of CardiologyTaitung MacKay Memorial HospitalTaitungTaiwan
| | - Wen‐Yu Lin
- Division of Cardiology, Department of Medicine, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Huai‐Wen Liang
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital; I‐Shou UniversityKaohsiungTaiwan
| | - Hung‐Yu Chang
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Heart CenterCheng Hsin General HospitalTaipeiTaiwan
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Pahuja M, Leifer ES, Clarke JD, Ahmad T, Daubert MA, Mark DJ, Cooper L, Desvigne-Nickens P, Fiuzat M, Adams K, Ezekowitz J, Whellan DJ, Januzzi JL, O'Connor CM, Felker GM, Piña IL. Assessing race and ethnicity differences in outcomes based on GDMT and target NT-proBNP in patients with heart failure with reduced ejection fraction: An analysis of the GUIDE-IT study. Prog Cardiovasc Dis 2022:S0033-0620(22)00039-1. [PMID: 35490873 DOI: 10.1016/j.pcad.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The GUIDE-IT trial was, a multicenter, randomized, parallel group, unblinded study that randomized patients to having heart failure therapy titrated to achieve an NT-proBNP <1000 pg/mL or to usual clinical care. METHODS AND RESULTS We performed pre-specified subgroup analysis to look for the race and ethnicity-based differences in clinical outcomes of patients who were able to achieve GDMT or target NT-proBNP concentration of ≤1000 pg/mL at 90 days of follow-up. There were 894 patients enrolled in GUIDE-IT study. Of these, 733 participants had available data on 90-day guideline directed triple therapy and 616 on NT-proBNP. 35% of the patients were Black and 6% were Hispanic. Black patients were younger, had more comorbidities, lower EF, and higher NYHA class compared with non-Black. Adjusting for 90-day NT-proBNP and important baseline covariates, Black patients were at a higher risk than non-Black patients for HF hospitalization [HR, 2.19; 95% CI, 1.51-3.17; p < 0.0001], but at a similar risk for mortality [HR, 0.85.; 95% CI, 0.44-1.66; p = 0.64]. Similar results were seen adjusting for 90-day GDMT [HF hospitalization: Black vs non-Black, HR: 1.97; 1.41-2.77, P < 0.0001; mortality: HR: 0.70; 0.39-1.26, p = 0.23]. There were no significant differences between Hispanic and non-Hispanic patients with respect to heart failure hospitalization, cardiovascular or all-cause mortality. Over the study period, Black and Hispanic patients experienced smaller changes in physical function and quality of life as measured by the Kansas City Cardiomyopathy Questionnaire overall score. CONCLUSION Compared to non-Black patients, Black patients in GUIDE-IT study had a higher risk of heart failure hospitalization, but a comparable risk of mortality, despite improved use of GDMT and achievement of similar biomarker targets.
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Ilonze OJ, Guglin M. Vericiguat, organic nitrates, and heart failure in African Americans. Int J Cardiol 2021; 338:136-7. [PMID: 34157357 DOI: 10.1016/j.ijcard.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
African Americans (AA) have a higher prevalence of heart failure (HF) when compared with White Americans (3% vs 2%), respectively and HF comes on at an earlier age and is more severe in AA. The A-HEFT trial with the combination of hydralazine and isosorbide dinitrate (ISDNHYD) for self-described AA with NYHA class III-IV heart failure with reduced ejection fraction (HFrEF) showed reduction in mortality and HF hospitalizations with a class I level of evidence A recommendation in the ACC/AHA guidelines. Vericiguat is an oral soluble guanylate cyclase stimulator that enhances the cyclic guanosine monophosphate (GMP) pathway. A randomized, double-blind, placebo-controlled trial in patients with higher risk HFrEF in which AA were underrepresented found that vericiguat reduced the composite primary outcome of cardiovascular death or first HF hospitalization. In the new era of guideline directed medical therapies of quadruple therapy - hydralazine and isosorbide dinitrate should be preferred over vericiguat in AA with HFrEF.
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Naing P, Zhang M, Khine AMT, Aung HS, Chean LN, Liaw J, Bazley M, Vaidya S, Musameh MD, Khan A. Mackay Heart Failure Study: Examining the Root Causes, Compliance With Guideline-Based Therapy and Prognosis. Heart Lung Circ 2021; 30:1302-1308. [PMID: 33875377 DOI: 10.1016/j.hlc.2021.03.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Heart failure patients have poor outcomes comparable to some malignancies; however, the modern guideline directed medical therapy (GDMT) has improved its outcomes. The clinical characteristics and prescribers' compliance with GDMT for heart failure patients have not been studied in the Mackay region. METHODS A retrospective cohort study of 115 consecutive adult heart failure patients was conducted at our institution. RESULTS The study cohort consisted of 80% (n=92) males. Ischaemia was the leading cause accounting for 54% (n=62) of the cohort, followed by idiopathic cardiomyopathy at 32% (n=37). Drug-induced and Takotsubo cardiomyopathies were responsible for 11% and 1% respectively. Two (2) patients (2%) had valvular heart disease. Hypertension was present in 57% while diabetes and atrial fibrillation were present in 32% and 43% of patients. Fifty-nine per cent (59%) had a smoking history. All, except four patients, had reduced left ventricular ejection fraction (LVEF <50%) at diagnosis. Among patients with coronary ischaemia, 37% and 31% were revascularised with percutaneous coronary interventions and bypass graft surgeries, respectively. Renin-angiotensin-aldosterone system inhibitors and beta blockers were prescribed in 94% and 95% of the patients, respectively. Mineralocorticoid inhibitors were used in 25% while ivabradine was given to 8% of patients. Nine per cent (9%) of patients received cardiac resynchronisation therapy. Most patients had improvement in functional class and LVEF during follow-up. There were very few mortalities at 3% (n=3) at the median follow-up of 403 (IQR 239-896) days. CONCLUSION Our study has shed light on heart failure epidemiology in the Mackay region. We found excellent compliance with GDMT and good prognosis for most patients in terms of both symptom and survival.
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Affiliation(s)
- Pyi Naing
- Mackay Base Hospital, Mackay, Qld, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia; University of Notre Dame, Fremantle, WA, Australia.
| | - Michael Zhang
- Mackay Base Hospital, Mackay, Qld, Australia; James Cook University, Townsville, Qld, Australia
| | | | | | | | | | | | | | | | - Ahmed Khan
- Mackay Base Hospital, Mackay, Qld, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
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Stigi J, Jabir A, Sanjay G, Panniyammakal J, Anwar CV, Harikrishnan S. Kerala acute heart failure registry-Rationale, design and methods. Indian Heart J 2018; 70 Suppl 1:S118-S120. [PMID: 30122241 PMCID: PMC6097170 DOI: 10.1016/j.ihj.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/09/2018] [Indexed: 11/30/2022] Open
Abstract
Heart failure (HF) is recognized as a major public health problem in both the low and high- income countries. However, data are scarce on the burden, prevailing practice patterns and long-term health outcomes of HF patients in India. The Kerala heart failure registry (KHFR) is a multi-centric, prospective, and hospital based registry in Kerala, India. Consecutive patients admitted with the diagnosis of acute heart failure satisfying the European Society of Cardiology (ESC) criteria will be enrolled in the registry. Data on demographic, clinical, laboratory, imaging, other diagnostics and therapeutic approaches employed and the usage of guideline based medical therapy will be collected as part of the registry. Additionally, all registered patients will be followed-up regularly at 1-month, and thereafter at every 3-months. Both mortality and hospital admission data will be collected during the follow-up visits. We will be recruiting 7500 HF patients in the KHFR. Once completed, KFHR is going to be the largest HF registry in India. We will validate a HF mortality risk score developed based on a previously conducted Trivandrum Heart Failure Registry in the KHFR patients.
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Affiliation(s)
- Joseph Stigi
- Little Flower Hospital & Research Centre, Angamaly, India.
| | - A Jabir
- Lisie Hospital, Ernakulam, India
| | - G Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Jeemon Panniyammakal
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Gajanana D, Shah M, Junpapart P, Romero-Corral A, Figueredo VM, Bozorgnia B. Mortality in systolic heart failure revisited: Ischemic versus non-ischemic cardiomyopathy. Int J Cardiol 2016; 224:15-7. [PMID: 27599385 DOI: 10.1016/j.ijcard.2016.08.316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/17/2016] [Accepted: 08/20/2016] [Indexed: 01/11/2023]
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