1
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Lala A, Hamo CE, Bozkurt B, Fiuzat M, Blumer V, Bukhoff D, Butler J, Costanzo MR, Felker GM, Filippatos G, Konstam MA, McMurray JJV, Mentz RJ, Metra M, Psotka MA, Solomon SD, Teerlink J, Abraham WT, O'Connor CM. Standardized Definitions for Evaluation of Acute Decompensated Heart Failure Therapies: HF-ARC Expert Panel Paper. JACC Heart Fail 2024; 12:1-15. [PMID: 38069997 DOI: 10.1016/j.jchf.2023.09.030] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 01/06/2024]
Abstract
Acute decompensated heart failure (ADHF) is one of the most common reasons for hospitalizations or urgent care and is associated with poor outcomes. Therapies shown to improve outcomes are limited, however, and innovation in pharmacologic and device-based therapeutics are therefore actively being sought. Standardizing definitions for ADHF and its trajectory is complex, limiting the generalizability and translation of clinical trials to effect clinical care and policy change. The Heart Failure Collaboratory is a multistakeholder organization comprising clinical investigators, clinicians, patients, government representatives (including U.S. Food and Drug Administration and National Institutes of Health participants), payors, and industry collaborators. The following expert consensus document is the product of the Heart Failure Collaboratory convening with the Academic Research Consortium, including members from academia, the U.S. Food and Drug Administration, and industry, for the purposes of proposing standardized definitions for ADHF and highlighting important endpoint considerations to inform the design and conduct of clinical trials for drugs and devices in this clinical arena.
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Affiliation(s)
- Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA.
| | - Carine E Hamo
- New York University School of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vanessa Blumer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Bukhoff
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Javed Butler
- Baylor Scott & White Research Institute, Dallas, Texas, USA; University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gerasimos Filippatos
- University of Cyprus Medical School, Shakolas Educational Center for Clinical Medicine, Nicosia, Cyprus
| | - Marvin A Konstam
- The CardioVascular Center of Tufts Medical Center, Boston, Massachusetts, USA
| | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marco Metra
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Christopher M O'Connor
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Inova Heart and Vascular Institute, Falls Church, Virginia, USA
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2
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Tsutsui H, Albert NM, Coats AJS, Anker SD, Bayes-Genis A, Butler J, Chioncel O, Defilippi CR, Drazner MH, Felker GM, Filippatos G, Fiuzat M, Ide T, Januzzi JL, Kinugawa K, Kuwahara K, Matsue Y, Mentz RJ, Metra M, Pandey A, Rosano G, Saito Y, Sakata Y, Sato N, Seferovic PM, Teerlink J, Yamamoto K, Yoshimura M. Natriuretic peptides: role in the diagnosis and management of heart failure: a scientific statement from the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society. Eur J Heart Fail 2023; 25:616-631. [PMID: 37098791 DOI: 10.1002/ejhf.2848] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/17/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/27/2023] Open
Abstract
Natriuretic peptides, brain (B-type) natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are globally and most often used for the diagnosis of heart failure (HF). In addition, they can have an important complementary role in the risk stratification of its prognosis. Since the development of angiotensin receptor-neprilysin inhibitors (ARNIs), the use of natriuretic peptides as therapeutic agents has grown in importance. The present document is the result of the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America and the Japanese Heart Failure Society. It represents an expert consensus that aims to provide a comprehensive, up-to-date perspective on natriuretic peptides in the diagnosis and management of HF, with a focus on the following main issues: (1) history and basic research: discovery, production and cardiovascular protection; (2) diagnostic and prognostic biomarkers: acute HF, chronic HF, inclusion/endpoint in clinical trials, and natriuretic peptide-guided therapy; (3) therapeutic use: nesiritide (BNP), carperitide (ANP) and ARNIs; and (4) gaps in knowledge and future directions.
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Affiliation(s)
- Hiroyuki Tsutsui
- From the Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nancy M Albert
- Research and Innovation-Nursing Institute, Kaufman Center for Heart Failure-Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew J S Coats
- University of Warwick, Warwick, UK, and Monash University, Clayton, Australia
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin, Germany; Charite Universit atsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Spain
- Universitat Autonoma Barcelona, Spain
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi, Jackson, MS, USA
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | | | - Mark H Drazner
- Clinical Chief of Cardiology, University of Texas Southwestern Medical Center, Department of Internal Medicine/Division of Cardiology, Dallas, TX, USA
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Gerasimos Filippatos
- School of Medicine of National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Tomomi Ide
- From the Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, MA, USA
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
- Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Petar M Seferovic
- University of Belgrade Faculty of Medicine, Serbian Academy of Sciences and Arts, and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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3
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Tsutsui H, Albert NM, Coats AJS, Anker SD, Bayes-Genis A, Butler J, Chioncel O, Defilippi CR, Drazner MH, Felker GM, Filippatos G, Fiuzat M, Ide T, Januzzi JL, Kinugawa K, Kuwahara K, Matsue Y, Mentz RJ, Metra M, Pandey A, Rosano G, Saito Y, Sakata Y, Sato N, Seferovic PM, Teerlink J, Yamamoto K, Yoshimura M. Natriuretic Peptides: Role in the Diagnosis and Management of Heart Failure: A Scientific Statement From the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society. J Card Fail 2023; 29:787-804. [PMID: 37117140 DOI: 10.1016/j.cardfail.2023.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 10/17/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/30/2023]
Abstract
Natriuretic peptides, brain (B-type) natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are globally and most often used for the diagnosis of heart failure (HF). In addition, they can have an important complementary role in the risk stratification of its prognosis. Since the development of angiotensin receptor neprilysin inhibitors (ARNIs), the use of natriuretic peptides as therapeutic agents has grown in importance. The present document is the result of the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America and the Japanese Heart Failure Society. It represents an expert consensus that aims to provide a comprehensive, up-to-date perspective on natriuretic peptides in the diagnosis and management of HF, with a focus on the following main issues: (1) history and basic research: discovery, production and cardiovascular protection; (2) diagnostic and prognostic biomarkers: acute HF, chronic HF, inclusion/endpoint in clinical trials, and natriuretic peptides-guided therapy; (3) therapeutic use: nesiritide (BNP), carperitide (ANP) and ARNIs; and (4) gaps in knowledge and future directions.
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Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Nancy M Albert
- Research and Innovation-Nursing Institute, Kaufman Center for Heart Failure-Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew J S Coats
- University of Warwick, Warwick, UK, and Monash University, Clayton, Australia
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin, Germany; Charité Universitätsmedizin Berlin, Germany; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Spain; Universitat Autonoma Barcelona, Spain
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | | | - Mark H Drazner
- Clinical Chief of Cardiology, University of Texas Southwestern Medical Center, Department of Internal Medicine/Division of Cardiology, Dallas, Texas, USA
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gerasimos Filippatos
- School of Medicine of National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, Nortth Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan; Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Petar M Seferovic
- University of Belgrade Faculty of Medicine, Serbian Academy of Sciences and Arts, and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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4
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Bayes-Genis A, Aimo A, Jhund P, Richards M, de Boer RA, Arfsten H, Fabiani I, Lupón J, Anker SD, González A, Castiglione V, Metra M, Mueller C, Núñez J, Rossignol P, Barison A, Butler J, Teerlink J, Filippatos G, Ponikowski P, Vergaro G, Zannad F, Seferovic P, Rosano G, Coats AJS, Emdin M, Januzzi JL. Biomarkers in heart failure clinical trials. A review from the Biomarkers Working Group of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2022; 24:1767-1777. [PMID: 36073112 DOI: 10.1002/ejhf.2675] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 06/06/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/09/2022] Open
Abstract
The approval of new heart failure (HF) therapies has slowed over the past two decades in part due to the high costs of conducting large randomized clinical trials that are needed to adequately power major clinical endpoint studies. Several biomarkers have been identified reflecting different elements of HF pathophysiology, with possible applications in diagnosis, risk stratification, treatment monitoring, and even in the design of clinical trials. Biomarkers could potentially be used to refine study inclusion criteria to enable enrolment of patients who are more likely to respond to a therapeutic intervention, despite being at sufficient risk to meet pre-determined study endpoint rates. When there is a close relationship between biomarker levels and clinical endpoints, changes in biomarker levels after a given treatment can act as a surrogate endpoint, potentially reducing the duration and cost of a clinical trial. Natriuretic peptides have been widely used in clinical trials with a variable amount of added value, which such variation being probably due to the absence of a close pathophysiological connection to the study drug. Notable exceptions to this include sacubitril/valsartan and vericiguat. Future studies should seek to adopt unbiased approaches for discovery of true companion diagnostics; with -omics-based tools, biomarkers might be more precisely selected for use in clinical trials to identify responses that closely reflect the biological effects of the drug under investigation. Finally, biomarkers associated with cardiac damage and remodelling, such as cardiac troponin, could be employed as safety endpoints provided that standardization between different assays is achieved.
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Affiliation(s)
- Antoni Bayes-Genis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Pardeep Jhund
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henrike Arfsten
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapy (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Arantxa González
- CIBERCV, Carlos III Institute of Health, Madrid, Spain.,Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Marco Metra
- Cardiology Department, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Julio Núñez
- CIBERCV, Carlos III Institute of Health, Madrid, Spain.,Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain
| | | | - Andrea Barison
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John Teerlink
- Heart Failure and of the Echocardiography Laboratory, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | | | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Faiez Zannad
- Université de Lorraine, Centre d'Investigations Cliniques-Plurithématique 1433, and Inserm U1116 CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Petar Seferovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | | | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
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5
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Levy WC, Hauptman P, Gilbert E, Carson P, Teerlink J, Chung E, Bourge R, Brett ME, Henderson J, Ginn G, Miller A. Is The Benefit Of CardioMEMS Lessened In Elderly Patients With Heart Failure? J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.230] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Teerlink J, Voors A, Collins S, Kosiborod M, Biegus J, Ferreira J, Nassif M, Psotka M, Tromp J, Blatchford J, Salsali A, Kraus B, Ponikowski P, Angermann C. Empagliflozin in Patients Hospitalised for De Novo Versus Decompensated Chronic Heart Failure: Insights From the EMPULSE Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.087] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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7
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Rosano GMC, Allen LA, Abdin A, Lindenfeld J, O'Meara E, Lam CSP, Lancellotti P, Savarese G, Gottlieb SS, Teerlink J, Wintrich J, Böhm M. Drug Layering in Heart Failure: Phenotype-Guided Initiation. JACC Heart Fail 2021; 9:775-783. [PMID: 34627725 DOI: 10.1016/j.jchf.2021.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Medications with proven benefit in patients with heart failure with reduced ejection fraction are recommended, according to prospective large clinical trials, in the stable patient after careful up-titration in a strict sequential order. Although the relevance of careful clinical up-titration is unproven, there is evidence that after recompensation and shortly after hospital discharge, the rate of cardiovascular death and hospitalization is high. Clinical studies provided evidence that the onset of treatment effects is rapid, occurring within 28 days with most of these drugs used, and in some trials, early treatment after discharge or already started in the hospital has provided benefits. Therefore, early treatment without deferring it to the stable outpatient may be useful to reduce cardiac-related events further. This expert opinion proposes treatment layering according to individual patient phenotypes involving heart rate, blood pressure, impaired renal function, and electrolyte disturbances, as well as dedicated subgroups of patients with specific requirements for treatment initiation. This complements other approaches that suggest starting sequential treatment according to the size of treatment effects of drugs, specific cardiac diseases, and patient wishes. Patient phenotyping may guide personalized drug layering in heart failure with reduced ejection fraction that provides the best outcomes, whereas pragmatic clinical trials are warranted to scrutinize the effectiveness of these approaches.
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Affiliation(s)
- Giuseppe M C Rosano
- Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Rome, Italy
| | - Larry A Allen
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Amr Abdin
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Joann Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Carolyn S P Lam
- Duke-National University of Singapore and National Heart Centre Singapore, Singapore
| | | | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Stephen S Gottlieb
- University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jan Wintrich
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany.
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8
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Fiuzat M, Lowy N, Stockbridge N, Sbolli M, Latta F, Lindenfeld J, Lewis EF, Abraham WT, Teerlink J, Walsh M, Heidenreich P, Bozkurt B, Starling RC, Solomon S, Felker GM, Butler J, Yancy C, Stevenson LW, O'Connor C, Unger E, Temple R, McMurray J. Endpoints in Heart Failure Drug Development: History and Future. JACC Heart Fail 2020; 8:429-440. [PMID: 32278679 DOI: 10.1016/j.jchf.2019.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 10/24/2022]
Abstract
Heart failure (HF) patients experience a high burden of symptoms and functional limitations, and morbidity and mortality remain high despite successful therapies. The majority of HF drugs in the United States are approved for reducing hospitalization and mortality, while only a few have indications for improving quality of life, physical function, or symptoms. Patient-reported outcomes that directly measure patient's perception of health status (symptoms, physical function, or quality of life) are potentially approvable endpoints in drug development. This paper summarizes the history of endpoints used for HF drug approvals in the United States and reviews endpoints that measure symptoms, physical function, or quality of life in HF patients.
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Affiliation(s)
- Mona Fiuzat
- Duke University and Duke Clinical Research Institute, Durham, North Carolina; U.S. Food and Drug Administration, Silver Spring, Maryland.
| | - Naomi Lowy
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Marco Sbolli
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Federica Latta
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - JoAnn Lindenfeld
- Heart Failure and Transplantation Section, Vanderbilt University, Nashville, Tennessee
| | - Eldrin F Lewis
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - William T Abraham
- Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
| | - John Teerlink
- Division of Cardiology, San Francisco VA Medical Center, and University of California San Francisco, San Francisco, California
| | - Mary Walsh
- St. Vincent Heart Center, Indianapolis, Indiana
| | | | - Biykem Bozkurt
- Winters Center for Heart Failure, DeBakey VA Medical Center, Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas
| | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Scott Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - G Michael Felker
- Duke University and Duke Clinical Research Institute, Durham, North Carolina
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi
| | - Clyde Yancy
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Lynne W Stevenson
- Heart Failure and Transplantation Section, Vanderbilt University, Nashville, Tennessee
| | | | - Ellis Unger
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Robert Temple
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - John McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
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Janwanishstaporn S, Feng S, Teerlink J, Metra M, Cotter G, Davison BA, Felker GM, Filippatos G, Pang P, Ponikowski P, Severin T, Gimpelewicz C, Holbro T, Chen CW, Sama I, Voors AA, Greenberg BH. Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial. Eur J Heart Fail 2020; 22:726-738. [DOI: 10.1002/ejhf.1772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/04/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Satit Janwanishstaporn
- Division of Cardiology University of California San Diego CA USA
- Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok Thailand
| | - Siting Feng
- Division of Cardiology University of California San Diego CA USA
- Beijing Anzhen Hospital Capital Medical University Beijing China
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine University of California San Francisco CA USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health University of Brescia Brescia Italy
| | | | | | - G. Michael Felker
- Division of Cardiology Duke University School of Medicine Durham NC USA
| | | | - Peter Pang
- Department of Emergency Medicine Indiana University School of Medicine, and the Regenstrief Institute Indianapolis IN USA
| | - Piotr Ponikowski
- Department of Heart Diseases Medical University, Military Hospital Wrocław Poland
| | | | | | | | | | - Iziah Sama
- Department of Cardiology University of Groningen Groningen The Netherlands
| | - Adriaan A. Voors
- Department of Cardiology University of Groningen Groningen The Netherlands
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Alhakak AS, Sengeløv M, Jørgensen P, Bruun NE, Abildgaard U, Iversen A, Hansen TF, Teerlink J, Malik F, Solomon SD, Gislason G, Biering-Sorensen T. LEFT VENTRICULAR SYSTOLIC EJECTION TIME IS AN INDEPENDENT PREDICTOR OF ALL-CAUSE MORTALITY IN HEART FAILURE WITH REDUCED EJECTION FRACTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32403-7] [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] [Indexed: 11/28/2022]
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11
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Anand I, Konstam M, Udelson J, Butler J, Klein H, Parker J, Teerlink J, Libbus I, Amurthur B, Kenknight B, Ardell J, Gregory D, Massaro J, Dicarlo L. P3522Vagus nerve stimulation for chronic heart failure: differences in therapy delivery and clinical efficacy in ANTHEM-HF, INOVATE-HF, and NECTAR-HF. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0386] [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: 11/15/2022] Open
Abstract
Abstract
Background
Vagus Nerve Stimulation (VNS) is meant to deliver Autonomic Regulation Therapy (ART) to neurological targets with sufficient neuromodulation (NM) to ameliorate chronic heart failure (CHF). VNS delivery consists of its intensity (a combination of pulse amplitude, pulse frequency, and pulse duration), polarity, duty cycle (DC; stimulation “on” time and “off” time), and mode (continuous, or intermittent and periodic). In the ANTHEM-HF Pilot Study patients with CHF and reduced ejection fraction (HFrEF), VNS intensity was up-titrated until a change in heart rate (HR) dynamics was objectively confirmed. This did not require any change in GDMT and was associated with significant improvements in LVEF, 6-minute walk distance (6MWD), Minnesota Living with HF (MLWHF) score, and HR variability.
Methods
Qualitative and quantitative analyses used data from peer-reviewed publications and other sources in the public domain to compare VNS delivery in ANTHEM-HF, INOVATE-HF, and NECTAR-HF.
Results (Table): Up-titration of VNS intensity was attempted in all 3 studies. In contrast to ANTHEM-HF, INOVATE-HF aimed only at peripheral neural targets. VNS intensity was delivered at a lower pulse frequency, and had a variable DC as a consequence of R-wave synchronization and only intermittent, periodic stimulation. In NECTAR-HF VNS intensity was delivered at a higher pulse frequency, and this was associated with intolerable adverse off-target effects which restricted VNS up-titration. Significant improvements in EF, 6MWD, MLWHF, and SDNN occurred in ANTHEM-HF relative to the other studies.
ANTHEM-HF (n=60) INOVATE-HF (n=436) NECTAR-HF (n=63) Neural Target Central/Peripheral Peripheral Central/Peripheral Delivery Site Left or right CVN Right CVN Right CVN Delivery Intensity: Amplitude (milliamperes) 2.0±0.6 3.9±1.0 1.4±0.8 Frequency (Hertz) 10 1–2 20 Duration (microseconds) 250 500 300 Electrode Polarity (Cathode) Caudal Cephalad Caudal Duty Cycle 23% 25% 17% On Time/Off Time (seconds) 18/62 Variable 10/50 Mode of Delivery Cyclic/Continuous Intermittent/Periodic Cyclic/Continuous Clinical Efficacy at 6 Months: EF 32.4±7.2 to 37.2±10.4 Not available 30.5±6.0 to 32.7±6.4 6MWD 287±66 to 346±78 317±109 to 347±123 Not available MLWHFS 40±14 to 21±10 Not available 44.2±22.2 to 35.8±20.8 SDNN 94±26 to 111±50 Not available 146±48 to 130±52 Values reported as mean ± standard deviation; CVN = Cervical vagus nerve. *p<0.05 versus NECTAR-HF; **p<0.05 versus INOVATE-HF; ***p<0.025 versus NECTAR-HF; ****p<0.001 versus NECTAR-HF (Analysis using two-sample t-test of the means).
Conclusion
VNS differed in ANTHEM-HF when compared to INOVATE-HF and NECTAR-HF. The neural targets, pulse frequencies for titration, and the DC for NM were different. VNS in ANTHEM-HF was clinically efficacious. The ongoing ANTHEM-HFrEF Pivotal Study uses a similar paradigm.
Acknowledgement/Funding
LivaNova PLC
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Affiliation(s)
- I Anand
- University of Minnesota, Minneapolis, United States of America
| | - M Konstam
- Tufts Medical Center, CardioVascular Center, Boston, United States of America
| | - J Udelson
- Tufts Medical Center, CardioVascular Center, Boston, United States of America
| | - J Butler
- The University of Mississippi Medical Center, Department of Medicine, Jackson, United States of America
| | - H Klein
- University of Rochester, Department of Medicine, Rochester, United States of America
| | - J Parker
- University of Toronto, University Health Network, Toronto, Canada
| | - J Teerlink
- University of California San Francisco, San Francisco, United States of America
| | - I Libbus
- LivaNova USA, Inc., Houston, United States of America
| | - B Amurthur
- LivaNova USA, Inc., Houston, United States of America
| | - B Kenknight
- LivaNova USA, Inc., Houston, United States of America
| | - J Ardell
- University of California Los Angeles, Neurocardiology Center, Los Angeles, United States of America
| | - D Gregory
- Clinical Cardiovascular Science Foundation, Boston, United States of America
| | - J Massaro
- Boston University, Boston, United States of America
| | - L Dicarlo
- LivaNova USA, Inc., Houston, United States of America
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Cerbin L, Ambrosy A, Armstrong P, Butler J, Coles A, Ezekowitz J, Greene S, Hernandez A, Metra M, O'Connor C, Starling R, Tang WH, Teerlink J, Voors A, Wu A, Mentz R. TIME OF PRESENTATION AMONG PATIENTS HOSPITALIZED FOR ACUTE HEART FAILURE (CLINICAL CHARACTERISTICS, INITIAL THERAPIES AND OUTCOMES): INSIGHTS FROM ASCEND-HF. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34158-x] [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] [Indexed: 10/20/2022]
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13
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Biering-Sorensen T, Teerlink J, Felker GM, McMurray J, Malik F, Honarpour N, Monsalvo ML, Johnston J, Solomon SD. THE CARDIAC MYOSIN ACTIVATOR, OMECAMTIV MECARBIL, IMPROVES LEFT VENTRICULAR MYOCARDIAL DEFORMATION IN CHRONIC HEART FAILURE (COSMIC-HF). J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34247-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Ye S, Qian M, Zhao B, Lip G, Buchsbaum R, Sacco R, Levin B, Di Tullio M, Mann D, Pullicino P, Freudenberger R, Teerlink J, Mohr J, Graham S, Labovitz A, Estol C, Lok D, Ponikowski P, Anker S, Thompson J, Homma S. CHA2DS2-VASC SCORE AND ADVERSE EVENTS IN PATIENTS WITH HEART FAILURE AND SINUS RHYTHM. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31336-5] [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] [Indexed: 10/22/2022]
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15
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Ambrosy AP, Armstrong PW, Butler J, Cerbin L, Coles A, DeVore A, Ezekowitz JA, Fudim M, Greene S, Hernandez A, O’Connor C, Schulte P, Starling R, Teerlink J, Voors AA, Mentz R. THE RELATIONSHIP BETWEEN BODY WEIGHT CHANGE DURING HOSPITALIZATION FOR ACUTE HEART FAILURE AND PATIENT CHARACTERISTICS, MARKERS OF CONGESTION, AND OUTCOMES: FINDINGS FROM ASCEND-HF. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31407-3] [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] [Indexed: 11/16/2022]
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16
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Demissei B, Postmus D, Liu L, Cleland J, O’Connor CM, Metra M, Ponikowski P, Teerlink J, Cotter G, Davison B, Givertz M, Bloomfield D, Dittrich H, Voors A, Hillege H. HETEROGENEITY IN EFFICACY OF ROLOFYLLINE USING A RISK-BASED EVALUATION IN PATIENTS HOSPITALIZED WITH ACUTE HEART FAILURE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31441-3] [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] [Indexed: 11/25/2022]
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17
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Rajaei S, Groeneveld P, Teerlink J, Whooley M, Turakhia M, Richman I, Sahay A, Kini V, Heidenreich P. Abstract 315: Use of Echocardiography and Nuclear Scintigraphy for Patients with Heart Failure in the Veterans Administration and Medicare Systems. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.315] [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: 11/16/2022]
Abstract
Background:
The high use of cardiac imaging in the United States is increasingly scrutinized. We sought to determine differences in cardiac imaging between the Veterans Healthcare Administration (VA) and Medicare for veterans with heart failure (HF).
Methods:
We analyzed VA and Medicare data from 2002 to 2009 to identify 2,536,556 unique veterans age 65 and older with a known diagnosis of HF for at least one year (those with care in both systems are excluded). The fraction of patients with an echocardiogram (ECHO) or nuclear scintigraphy (NUC) test was determined. Logistic regression was used to adjust for patient characteristics.
Results:
More veterans received care in Medicare (82%) than in the VA (18%) The mean age was 79 years, 93% were male and comorbidities were common: diabetes mellitus (44%), ischemic heart disease (67%), and chronic kidney disease (25%). Imaging per year was higher in Medicare compared to the VA for ECHO (51% vs. 21%) and NUC (18% vs. 8%, both p<0.0001). Use plateaued or decreased for all procedures after 2006 except for VA ECHO (Figure). After adjustment for patient characteristics the use odds ratio in Medicare (compared to VA) was 3.61 for ECHO (95% CI 3.58-3.64) and 2.82 for NUC (2.79-2.86). Adjusted 1 year mortality was lower in the VA, OR 0.80 (0.81-0.79).
Conclusion:
There is much greater use of imaging procedures among veterans in Medicare than in the VA not explained by patient characteristics and not associated with improved survival.
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Rajaei S, Groeneveld P, Teerlink J, Whooley M, Turakhia M, Richman I, Sahay A, Kini V, Heidenreich PA. Abstract 217: Racial Disparities in Echocardiography Use Within The Veterans Administration and Medicare Systems. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.217] [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: 11/16/2022]
Abstract
Background:
There is increasing interest in understanding the factors that influence the use of diagnostic imaging in heart failure in US health systems. However, there is limited data examining overall use and the impact of racial disparities in the VA and Medicare.
Methods:
We analyzed Veterans Healthcare Administration (VA) and Medicare data from 2002 to 2009 to identify veteran patients above the age of sixty-five with a diagnosis of heart failure for at least 1 year. Patients receiving care in both systems were excluded. We examined patients undergoing echocardiography and scintigraphy each year by race and system of care. Multivariate logistic regression analyses were performed adjusting for age, gender and comorbidities.
Results:
A total of 2,917,307 veteran patients were included (263,778 in VA and 1,698,497 in Medicare). Overall use of echocardiography each year was 45.6% for Whites, 51.9% for Asians, 43.2% for Blacks, 39.7% for Hispanics, 42.0% for Pacific Islanders, 40.9% for Native-American and 48.1% for Other. The adjusted odds ratio of undergoing echocardiography was higher for Asians in both systems compared to Whites (Figure). In Medicare, use was lower for Native Americans, Blacks and Hispanics compared to Whites. In the VA, use among Blacks and Hispanics was higher than Whites.
Conclusion:
There are significant differences in echocardiography use between the VA and Medicare systems by race for veterans with heart failure. Whites were more likely to receive echocardiography compared to most races in Medicare but not in the VA.
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Rajaei S, Teerlink J, Whooley M, Sahay A, Heidenreich P. READMISSIONS IN HEART FAILURE AND MYOCARDIAL INFARCTIONS: A PARADOXICAL IMPROVEMENT IN QUALITY OF CARE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61055-5] [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] [Indexed: 10/23/2022]
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Liu L, Valente MA, Postmus D, O’Connor C, Metra M, Ponikowski P, Teerlink J, Cotter G, Davison B, Cleland J, Givertz M, Bloomfield D, van Veldhuisen D, Hillege H, van der Meer P, Voors A. TAILORING THERAPY IN ACUTE HEART FAILURE: CAN BIOMARKERS DISTINGUISH RESPONDERS FROM NON-RESPONDERS? J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61013-0] [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] [Indexed: 10/23/2022]
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Ye S, Graham S, Qian M, Sanford LR, Di Tullio M, Sacco R, Mann D, Levin B, Pullicino P, Freudenberger R, Teerlink J, Mohr J, Labovitz A, Lip G, Estol CJ, Lok DJ, Ponikowski P, nker S, Thompson JL, Homma S. COGNITIVE FUNCTION IN AMBULATORY PATIENTS WITH SYSTOLIC HEART FAILURE: INSIGHTS FROM THE WARFARIN VERSUS ASPIRIN IN REDUCED CARDIAC EJECTION FRACTION (WARCEF) TRIAL. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60946-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Metra M, Chiswell K, Fiuzat M, Lazzarini V, Horton J, Davison B, Cleland J, Ponikowski P, Teerlink J, Voors A, Givertz M, Mansoor G, Massie B, Cotter G, O'Connor C. Age, Clinical Characteristics and Outcomes of Patients With Acute Decompensated Heart Failure: Insights from the PROTECT Trial. J Card Fail 2012. [DOI: 10.1016/j.cardfail.2012.06.484] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cleland J, Chiswell K, Filippatos G, Givertz M, Massie B, Cotter G, Davison B, Fiuzat M, Voors A, Mansoor G, Ponikowski P, Teerlink J, O'Connor C. QUALITY OF LIFE 60 DAYS AFTER AN ACUTE HEART FAILURE EVENT: INSIGHTS FROM THE PROTECT TRIAL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61033-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Miller AB, Teerlink J, Carson P, Levy W, Chung E, Gilbert E, Jeffries B, Yadav J, Neville S, Cowart P, Adamson P, Abraham W. IMPACT OF REMOTE, WIRELESS PULMONARY ARTERY HEMODYNAMIC MONITORING IN PATIENTS WITH ATRIAL FIBRILLATION AND CHRONIC HEART FAILURE: INSIGHTS FROM THE CHAMPION TRIAL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60869-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Beohar N, Erdogan AK, Lee DC, Sabbah HN, Kern MJ, Teerlink J, Bonow RO, Gheorghiade M. Acute heart failure syndromes and coronary perfusion. J Am Coll Cardiol 2008; 52:13-6. [PMID: 18582629 DOI: 10.1016/j.jacc.2008.03.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [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] [Received: 01/28/2008] [Revised: 03/18/2008] [Accepted: 03/24/2008] [Indexed: 11/28/2022]
Abstract
Acute heart failure syndromes (AHFS), with a high post-discharge mortality and rehospitalization rate, represent a significant public health burden. The treatment of patients hospitalized with AHFS often includes the use of vasoactive medications such as inotropes and vasodilators. Although such agents are frequently used, their safety and efficacy remain controversial. A significant number of patients with heart failure have underlying coronary artery disease and may be at greater risk from hemodynamic alterations that can diminish coronary perfusion. In AHFS, the relationship among vasoactive medications, coronary perfusion, and potential myocardial injury needs further investigation. Newer techniques now available to evaluate coronary perfusion should provide guidance for the evaluation of existing and future vasoactive therapies for AHFS.
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Affiliation(s)
- Nirat Beohar
- Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA.
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Thakkar R, Teerlink J, Colucci W, Young J, Massie B. The ADHERE classification and regression tree model overestimates mortality rates in clinical trials: results from REVIVE I & II. Crit Care 2007. [PMCID: PMC4095277 DOI: 10.1186/cc5383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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O'Connor CM, Gattis WA, Adams KF, Hasselblad V, Chandler B, Frey A, Kobrin I, Rainisio M, Shah MR, Teerlink J, Gheorghiade M. Tezosentan in patients with acute heart failure and acute coronary syndromes: results of the Randomized Intravenous TeZosentan Study (RITZ-4). J Am Coll Cardiol 2003; 41:1452-7. [PMID: 12742280 DOI: 10.1016/s0735-1097(03)00194-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We sought to determine the effect of tezosentan in patients with acute decompensated heart failure (HF) associated with acute coronary syndrome (ACS). BACKGROUND Tezosentan is a dual endothelin receptor antagonist that has been shown to improve cardiac output, decrease pulmonary capillary wedge pressure, and reduce pulmonary and systemic vascular resistance in initial clinical studies in acute decompensated HF. METHODS The Randomized Intravenous TeZosentan (RITZ)-4 study was a multicenter, randomized, double-blinded, placebo-controlled study of tezosentan in patients with acute decompensated HF associated with ACS. A total of 193 patients were randomized to receive tezosentan (25 mg/h for 1 h, then 50 mg/h for 23 to 47 h) or placebo. Patients with evidence of acute decompensated HF and ACS were eligible to participate. The primary end point was the composite of death, worsening HF, recurrent ischemia, and recurrent or new myocardial infarction within 72 h. RESULTS No significant differences were observed between placebo and 50 mg/h tezosentan in the composite primary end point: 24.2% (95% confidence interval [CI] 16.0% to 34.1%) and 28.9% (95% CI 20.1% to 39.0%), respectively (p = 0.5152). Symptomatic hypotension was more frequent in the treatment group. CONCLUSIONS At the doses studied, tezosentan did not result in a significant improvement in the composite primary clinical end point in the RITZ-4 trial. Tezosentan did not demonstrate pro-ischemic effects in this population. Symptomatic hypotension may have resulted in an increased number of adverse events in the treatment group. Further studies with lower tezosentan doses are warranted.
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Affiliation(s)
- Christopher M O'Connor
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina 27705, USA
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Teerlink J. Increased Expression of Human Cu-Zn Superoxide Dismutase in a Transgenic Mouse Model of Ischemia/reperfusion. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)85421-6] [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] [Indexed: 10/17/2022]
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