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Latest & greatest articles for heart failure
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on heart failure or other clinical topics then use Trip today.
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Trends in Kidney Function Outcomes Following RAAS Inhibition in Patients With HeartFailure With Reduced Ejection Fraction Angiotensin-converting enzyme (ACE) inhibitors are beneficial in heartfailure with reduced ejection fraction (HFrEF). We sought to describe longitudinal trends in estimated glomerular filtration rate (eGFR) in HFrEF and how ACE-inhibitor therapy influences these changes.Post hoc analysis of trial data.Symptomatic (Treatment Trial, n=2,423) and asymptomatic (Prevention
The OPTIMIZER smart system for managing heartfailure The OPTIMIZER smart system for managing The OPTIMIZER smart system for managing heartfailureheartfailure Medtech innovation briefing Published: 27 June 2019 www.nice.org.uk/guidance/mib186 pathways Summary Summary The technology technology described in this briefing is the OPTIMIZER smart system. It is a programmable cardiac stimulation device for people with chronic heartfailure. The system is for people who still have symptoms after (...) failure. The main points from the e main points from the evidence vidence summarised in this briefing are from 6 studies (1 randomised controlled trial, 1 case-control study, 3 observational studies and 1 retrospective analysis) including 633 adults. The studies show that the OPTIMIZER smart system could be more effective than drug therapy alone in patients with heartfailure. K Ke ey uncertainties y uncertainties around the evidence or technology are that there is only 1 comparative study, which
Hand-held ultrasound devices for cardiac assessment and diagnosis of heartfailure Hand-held ultrasound devices - Health Technology Wales > Hand-held ultrasound devices Hand-held ultrasound devices Topic Status Complete Hand-held ultrasound devices for cardiac assessment and diagnosis of heartfailure, in the community or primary care setting. Outcome of the appraisal Hand-held ultrasound devices (HUDs) show promise in the diagnosis of heartfailure in a primary care or community setting (...) , but the current evidence is insufficient to support routine adoption. HUDs have the potential to reduce secondary care referrals if heartfailure is excluded and to facilitate earlier treatment if confirmed, but convincing evidence is needed to substantiate any clinical and system benefits. HTW recommends further research to investigate the benefits of implementing HUDs in a primary care or community setting in Wales; see Guidance for more information. Why was this topic appraised? Heartfailure is a common
Analysis of How Emergency Physicians' Decisions to Hospitalize or Discharge Patients With Acute HeartFailure Match the Clinical Risk Categories of the MEESSI-AHF Scale The Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute HeartFailure (MEESSI-AHF) is a validated clinical decision tool that characterizes risk of mortality in emergency department (ED) acute heartfailure patients. The objective of this study is to compare the distribution of risk (...) categories between hospitalized and discharged ED patients with acute heart failure.We included consecutive acute heartfailure patients from 34 Spanish EDs. Patients were retrospectively classified according to MEESSI-AHF risk categories. We calculated the odds of hospitalization (versus direct discharge from the ED) across MEESSI-AHF risk categories. Next, we assessed the following 30-day postdischarge outcomes: ED revisit, hospitalization, death, and their combination. We used Cox hazards models
Usefulness of Right Ventricular to Pulmonary Circulation Coupling as an Indicator of Risk for Recurrent Admissions in HeartFailure With Preserved Ejection Fraction In recent years, the study of right ventricular (RV) to pulmonary circulation (PC) coupling in heartfailure with preserved ejection fraction (HFpEF) has been a matter of special interest. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has emerged as a reliable noninvasive index
Effect of Neladenoson Bialanate on Exercise Capacity Among Patients With HeartFailure With Preserved Ejection Fraction: A Randomized Clinical Trial. Heartfailure with preserved ejection fraction (HFpEF) lacks effective treatments. Based on preclinical studies, neladenoson bialanate, a first-in-class partial adenosine A1 receptor agonist, has the potential to improve several heartfailure-related cardiac and noncardiac abnormalities but has not been evaluated to treat HFpEF.To determine (...) whether neladenoson improves exercise capacity, physical activity, cardiac biomarkers, and quality of life in patients with HFpEF and to find the optimal dose.Phase 2b randomized clinical trial conducted at 76 centers in the United States, Europe, and Japan. Patients (N = 305) with New York Heart Association class II or III HFpEF with elevated natriuretic peptide levels were enrolled between May 10, 2017, and December 7, 2017 (date of final follow-up: June 20, 2018).Participants were randomized (1:2:2
Effect of Dapagliflozin on HeartFailure and Mortality in Type 2 Diabetes Mellitus In DECLARE-TIMI 58 (Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the composite end point of cardiovascular death/hospitalization for heartfailure (HHF) in a broad population of patients with type 2 diabetes mellitus. However, the impact of baseline left ventricular ejection fraction (EF) on the clinical (...) benefit of sodium-glucose cotransporter 2 inhibition is unknown.In the DECLARE-TIMI 58 trial, baseline heartfailure (HF) status was collected from all patients, and EF was collected when available. HF with reduced EF (HFrEF) was defined as EF <45%. Outcomes of interest were the composite of cardiovascular death/HHF, its components, and all-cause mortality.Of 17 160 patients, 671 (3.9%) had HFrEF, 1316 (7.7%) had HF without known reduced EF, and 15 173 (88.4%) had no history of HF at baseline
Iron Supplementation Improves Cardiovascular Outcomes in Patients with HeartFailure Iron deficiency is prevalent in patients with heartfailure. This meta-analysis was performed to evaluate the therapeutic effects of iron in patients with systolic heartfailure and iron deficiency.We searched PubMed, Embase, and Cochrane databases through March 2018 and included 10 randomized controlled trials involving 1404 heartfailure patients who underwent iron or placebo treatment. Odds ratio (...) (OR) and weighted mean differences (WMD) were calculated using fixed- or random-effects models.Our results showed that iron supplementation significantly reduced hospitalization for worsening heartfailure (OR 0.39; 95% confidence interval [CI], 0.19-0.80) and the combined endpoint of death and heartfailure hospitalization (OR 0.47; 95% CI, 0.32-0.69). In addition, iron treatment was found to improve New York Heart Association class, 6-minute walk distance, left ventricular ejection fraction, and peak oxygen
Association between mortality and implantable cardioverter-defibrillators by aetiology of heartfailure: a propensity-matched analysis of the WARCEF trial. There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced (...) proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heartfailure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641
Anticoagulation therapy in heartfailure and sinus rhythm: a systematic review and meta-analysis Heartfailure is a prothrombotic state, and it has been hypothesised that thrombosis and embolism cause non-fatal and fatal events in heartfailure and reduced ejection fraction (HFrEF). We sought to determine the effect of anticoagulant therapy on clinical outcomes in patients with HFrEF who are in sinus rhythm.We conducted an updated systematic review and meta-analysis to examine the effect (...) of anticoagulation therapy in patients with HFrEF in sinus rhythm. Our analysis compared patients randomised to anticoagulant therapy with those randomised to antiplatelet therapy, placebo or control, and examined the endpoints of all-cause mortality, (re)hospitalisation for worsening heartfailure, non-fatal myocardial infarction, non-fatal stroke of any aetiology and major haemorrhage.Five trials were identified that met the prespecified search criteria. Compared with control therapy, anticoagulant treatment
Health Status After Transcatheter Mitral-Valve Repair in HeartFailure and Secondary Mitral Regurgitation: COAPT Trial In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for HeartFailure Patients with Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) led to reduced heartfailure (HF) hospitalizations and improved survival in patients with symptomatic HF and 3+ to 4+ secondary mitral regurgitation (MR) on maximally-tolerated (...) timepoint (24-month mean difference in SF-36 summary scores: physical 3.6 points; 95% CI: 1.4 to 5.8 points; mental 3.6 points; 95% CI: 0.8 to 6.4 points).Among patients with symptomatic HF and 3+ to 4+ secondary MR receiving maximally-tolerated medical therapy, edge-to-edge TMVr resulted in substantial early and sustained health status improvement compared with medical therapy alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for HeartFailure Patients With Functional
Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated HeartFailure: A Systematic Review and Meta-analysis Standard tools used to diagnose pulmonary edema in acute decompensated heartfailure (ADHF), including chest radiography (CXR), lack adequate sensitivity, which may delay appropriate diagnosis and treatment. Point-of-care lung ultrasonography (LUS) may be more accurate than CXR, but no meta-analysis
Intramyocardial Injection of Mesenchymal Precursor Cells and Successful Temporary Weaning From Left Ventricular Assist Device Support in Patients With Advanced HeartFailure: A Randomized Clinical Trial. Left ventricular assist device (LVAD) therapy improves myocardial function, but few patients recover sufficiently for explant, which has focused attention on stem cells to augment cardiac recovery.To assess efficacy and adverse effects of intramyocardial injections of mesenchymal precursor (...) cells (MPCs) during LVAD implant.A randomized phase 2 clinical trial involving patients with advanced heartfailure, undergoing LVAD implant, at 19 North American centers (July 2015-August 2017). The 1-year follow-up ended August 2018.Intramyocardial injections of 150 million allogeneic MPCs or cryoprotective medium as a sham treatment in a 2:1 ratio (n = 106 vs n = 53).The primary efficacy end point was the proportion of successful temporary weans (of 3 planned assessments) from LVAD support within
Heartfailure drug treatment. Heartfailure is the most common cardiovascular reason for hospital admission for people older than 60 years of age. Few areas in medicine have progressed as remarkably as heartfailure treatment over the past three decades. However, progress has been consistent only for chronic heartfailure with reduced ejection fraction. In acutely decompensated heartfailure and heartfailure with preserved ejection fraction, none of the treatments tested to date have been (...) definitively proven to improve survival. Delaying or preventing heartfailure has become increasingly important in patients who are prone to heartfailure. The prevention of worsening chronic heartfailure and hospitalisations for acute decompensation is also of great importance. The objective of this Series paper is to provide a concise and practical summary of the available drug treatments for heartfailure. We support the implementation of the international guidelines. We offer views on the basis of our
Beyond pharmacological treatment: an insight into therapies that target specific aspects of heartfailure pathophysiology. Heartfailure is a common syndrome associated with substantial morbidity and mortality. The management of symptoms and the strategies for improving prognosis have largely been based on pharmacological treatments. The pathophysiology of heartfailure is complex because of the multiple causes responsible for this syndrome. This Series paper presents some examples of advances (...) in heartfailure management, in which the treatment specifically targets the underlying pathophysiological mechanisms responsible for the symptoms. These treatments include treatment of electromechanical dyssynchrony and dysrhythmia by cardiac resynchronisation and implantable cardioverter-defibrillators; neurohumoral modification by baroreflex and vagal stimulation; prevention of adverse cardiac remodelling by interatrial shunts; and finally targeting the myocardium directly by cell therapy
Multimodality imaging in ischaemic heartfailure. In heartfailure, extensive evaluation with modern non-invasive imaging modalities is needed to assess causes, pathophysiology, and haemodynamics, to determine prognosis and consider therapeutic options. This systematic evaluation includes a stepwise assessment of left ventricular size and function, the presence and severity of coronary artery disease, mitral regurgitation, pulmonary hypertension, right ventricular dilation and dysfunction
Association of genetically predicted testosterone with thromboembolism, heartfailure, and myocardial infarction: mendelian randomisation study in UK Biobank. To determine whether endogenous testosterone has a causal role in thromboembolism, heartfailure, and myocardial infarction.Two sample mendelian randomisation study using genetic variants as instrumental variables, randomly allocated at conception, to infer causality as additional randomised evidence.Reduction by Dutasteride of Prostate (...) Cancer Events (REDUCE) randomised controlled trial, UK Biobank, and CARDIoGRAMplusC4D 1000 Genomes based genome wide association study.3225 men of European ancestry aged 50-75 in REDUCE; 392 038 white British men and women aged 40-69 from the UK Biobank; and 171 875 participants of about 77% European descent, from CARDIoGRAMplusC4D 1000 Genomes based study for validation.Thromboembolism, heartfailure, and myocardial infarction based on self reports, hospital episodes, and death.Of the UK Biobank