Journal: J Card Fail

Sorted by: date / impact
Abstract

Outcomes in LVAD Patients Undergoing Simultaneous Heart-Kidney Transplantation.

Atkins J, Hess NR, Fu S, Read JM, ... Kilic A, Tedford RJ
Background
Multiple studies have shown better outcomes for simultaneous heart kidney transplant (sHKT) compared with isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable LVAD have not been well studied.
Methods
Patients with durable LVADs and stage 3 or greater CKD (eGFR <60ml/min/1.73m2) undergoing iOHT or sHKT between 2008-2020 were identified from the United Network for Organ Sharing (UNOS) registry. Kaplan Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival. Multivariable modeling was used in order to identify risk adjusted predictors of one-year posttransplant mortality.
Results
4375 patients were identified, 366 underwent sHKT and 4009 iOHT. The frequency of sHKT increased over the study period. One-year post-transplant survival was worse in sHKT compared with iOHT (80.3% vs 88.3%, p<0.001), and persisted up to 5 years post-transplant (p=0.001). sHKT recipients were more likely to require dialysis after transplant and had longer hospital length of stay (p<0.001). Multivariable analysis showed sHKT remained an independent risk factor for mortality at 1 year (OR 1.58, p=0.002).
Conclusions
HKT is becoming more common in patients with durable LVADs. Compared with iOHT, sHKT have worse short and long-term survival are more likely to require posttransplant dialysis.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 18 May 2022; epub ahead of print
Atkins J, Hess NR, Fu S, Read JM, ... Kilic A, Tedford RJ
J Card Fail: 18 May 2022; epub ahead of print | PMID: 35597511
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic Interplay Between COVID-19 and Heart Failure with Reduced Ejection Fraction.

Greene SJ, Lautsch D, Yang L, Tan X, Brady JE
Background
COVID-19 may negatively impact the prognosis of patients with chronic HFrEF, and vice versa.
Methods
This study included two parallel analyses among US patients in the TriNetX health database who underwent PCR testing for SARS-CoV-2 as an inpatient or outpatient between January and September 2020. Analysis A included patients with a positive COVID-19 test, and compared patients with a history of worsening HFrEF (HF hospitalization or IV diuretic use in prior 12 months), HFrEF without worsening, and no prior HF. Analysis B included patients with history of HFrEF, and compared patients with positive vs. negative COVID-19 tests. Outcomes included mortality and worsening HF. In both analyses, pre-specified subgroup analyses stratified by inpatient vs. outpatient setting of COVID-19 test.
Results
In Analysis A of 99,052 patients with a positive COVID-19 test, 514 (0.5%) and 524 (0.5%) patients had histories of worsening HFrEF and HFrEF without worsening, respectively. After adjustment, compared with non-HF patients, worsening HFrEF (risk ratio [RR] 1.42, 95% CI 1.10-1.83; p<0.001) and HFrEF without worsening (RR 1.33, 95% CI 0.96-1.84; p=0.06) were associated with higher 30-day mortality. Excess mortality risk tended to be pronounced among patients initially diagnosed with COVID-19 as outpatients (p for interaction 0.12 and 0.006, respectively). In Analysis B of 14,838 patients with HFrEF tested for COVID-19, 1,038 (7.0%) had positive tests. After adjustment, testing positive was associated with excess 30-day mortality risk (RR 1.67, 95% CI 1.38-2.02; p<0.001) and worsening HF (RR 1.33, 95% CI 1.17-1.51; p<0.001). Mortality risk was nominally more pronounced among patients presenting as outpatients (p for interaction 0.07).
Conclusion
In this large cohort of patients tested for COVID-19, among patients testing positive, a history of HFrEF with or without worsening was associated with excess mortality, particularly among patients diagnosed with COVID-19 as outpatients. Among patients with established HFrEF, compared with testing negative, testing positive for COVID-19 was independently associated with higher risk of death and worsening HF.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 18 May 2022; epub ahead of print
Greene SJ, Lautsch D, Yang L, Tan X, Brady JE
J Card Fail: 18 May 2022; epub ahead of print | PMID: 35597512
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Epidemiology of worsening heart failure in a population-based cohort from Alberta, Canada: Evaluating eligibility for treatment with vericiguat.

Sepehrvand N, Islam S, Dover DC, Kaul P, ... Armstrong PW, Ezekowitz JA
Background
Patients with heart failure (HF) and a reduced ejection fraction (HFrEF) who experience worsening heart failure (WHF) events are at increased risk of adverse outcomes and experience significant morbidity and mortality. We herein describe the epidemiology of these patients and identify those potentially eligible for vericiguat therapy in this population-based study.
Methods
This retrospective cohort study included hospitalized or emergency department (ED) patients with a primary diagnosis of HF and left ventricular ejection fraction (LVEF) <45% diagnosed between April 1st, 2009 and March 31st, 2019 in Alberta, Canada, with follow-up to March 31st 2020. Inclusion criteria from the VICTORIA trial were applied to explore eligibility for vericiguat.
Results
Among 25,629 patients with HF and LVEF data, 9,948 (38.8%) had HFrEF, of which 5,259 (52.8%) experienced WHF at some point during a median 5.8 years of follow-up, and 38.3% of those met the vericiguat trial eligibility criteria. Compared to HFrEF patients without WHF, those with WHF were older, with more comorbidities, worse renal function, similar LVEF status, but more use of HF medications, at baseline. At the time of WHF, 27% of those with HFrEF and WHF were on triple therapy, 50.6% were on dual therapy, and 15.4% were on monotherapy. All-cause mortality and the composite outcome of all-cause mortality or cardiovascular hospitalization at 1-year of follow-up were higher in the HFrEF with WHF cohort compared to HFrEF without WHF (adjusted hazard ratios of 1.92 and 1.51, respectively, both p<.0001).
Conclusion
Approximately, one-half of patients with HFrEF experienced WHF over long-term follow-up. Most were not on triple therapy, highlighting the underutilization of the existing standard-of-care treatments and opportunities for application of newer therapies; more than one-third of patients with HFrEF may be eligible for vericiguat.
Lay summary
Among patients with heart failure (HF), those who experience worsening HF are at increased risk of adverse outcomes. A few new therapies, including vericiguat, have emerged recently for patients with HF and reduced ejection fraction. However, the epidemiology, treatment patterns, and outcomes of patients with worsening HF in large representative populations is unclear. In current study, roughly, half of the patients with HF and reduced ejection fraction experienced worsening HF and 38.3% were potentially eligible for vericiguat therapy. The guideline-recommended therapies were under-utilized among patients with worsening HF, which highlights the need for initiatives to address this care gap.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 16 May 2022; epub ahead of print
Sepehrvand N, Islam S, Dover DC, Kaul P, ... Armstrong PW, Ezekowitz JA
J Card Fail: 16 May 2022; epub ahead of print | PMID: 35589087
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Health Literacy in Patients Considering a Left Ventricular Assist Device: Findings from the DECIDE-LVAD Trial.

Raymer DS, Allen LA, Chaussee EL, McIlvennan CK, ... Matlock DD, LaRue SJ
Objective
Assess the interaction of health literacy and a shared decision intervention on decision quality in patients considering destination therapy left ventricular assist device (DT LVAD) implantation.
Background
Evidence is limited for the use of decision aids by patients with low health literacy with a life-threatening illness.
Methods
We performed a secondary analysis of the DECIDE-LVAD Trial, a randomized, stepped-wedge trial conducted from 2015-2017 in the US. The intervention was the integration of a formal shared decision-making intervention. The main outcome was decision quality measured by LVAD knowledge and values-treatment concordance. Two components of health literacy were measured by the Rapid Estimate of Adult Literacy in Medicine and Subjective Numeracy Scale instruments.
Results
Of the 228 patients studied, 44% (N=101) received the formal shared decision-making intervention, half had low health literacy. LVAD knowledge improved for patients with low literacy in the intervention group compared to the control group: difference in increased knowledge score of 10.6%, p=0.04. Values-treatment concordance improved significantly for patients with low literacy in the intervention group compared to the control group: median improvement in values-treatment correlation coefficient 0.43, p=0.03. These benefits were not significant in those with adequate literacy (N=171). Patients with low numeracy (N=94) did not have a significant improvement in either measure of decision quality, and patients with adequate numeracy (N=134) had improvement in LVAD knowledge but not in values-treatment concordance.
Conclusions
Patients considering DT LVAD implantation with low literacy showed improvement in decision quality after the integration of a shared decision-making intervention.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 12 May 2022; epub ahead of print
Raymer DS, Allen LA, Chaussee EL, McIlvennan CK, ... Matlock DD, LaRue SJ
J Card Fail: 12 May 2022; epub ahead of print | PMID: 35569806
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association of Perceived Stress with Incident Heart Failure.

Balkan L, Ringel JB, Levitan EB, Khodneva YA, ... Safford M, Goyal P
Background
The relationship between psychological stress and HF has not been well studied. We sought to assess the relationship between perceived stress and incident heart failure (HF).
Methods
We utilized data from the national REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a large prospective biracial cohort study that enrolled community-dwellers aged ≥45 years between 2003-2007, with follow-up. We included participants free of suspected prevalent HF who completed the Cohen 4-item Perceived Stress Scale (PSS-4). Our outcome variables were incident HF event, HF with reduced ejection fraction (HFrEF) events, and HF with preserved ejection fraction (HFpEF) events. We estimated Cox proportional hazard models to determine if PSS-4 quartiles were independently associated with incident HF events, adjusting for socio-demographics, social support, unhealthy behaviors, comorbid conditions, and physiologic parameters. We also tested interactions by baseline statin use, given its anti-inflammatory properties.
Results
Among 25,785 participants with mean age 64 (9.3) years, 55% were female and 40% were Black. Over a median follow-up of 10.1 years, 1109 (4.3%) experienced an incident HF event. In fully-adjusted models, PSS-4 was not associated with HF or HFrEF. However, PSS-4 quartiles 2-4 (compared to the lowest quartile) were associated with incident HFpEF (Q2: HR=1.37, 95% CI 1.00-1.88; Q3: HR=1.42, 95% CI 1.03-1.95; Q4: HR=1.41, 95% CI 1.04-1.92). Notably, this association was attenuated among participants who took a statin at baseline (p-for-interaction=0.07).
Conclusions
Elevated perceived stress was associated with incident HFpEF but not HFrEF.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 11 May 2022; epub ahead of print
Balkan L, Ringel JB, Levitan EB, Khodneva YA, ... Safford M, Goyal P
J Card Fail: 11 May 2022; epub ahead of print | PMID: 35568129
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

HFSA Position Statement The Impact of Healthcare Disparities on Patients with Heart Failure.

Morris A, Shah KS, Enciso JS, Hsich E, ... Page R, Yancy C
Heart Failure (HF) remains a condition associated with high morbidity, mortality, and associated costs. Although the number of medical and device-based therapies available to treat HF are expanding at a remarkable rate, disparities in the risk for incident HF and treatments delivered to patients are also of growing concern. These disparities span across racial and ethnic groups, socioeconomic status, and apply across the spectrum of HF from Stage A to Stage D. The complexity of HF risk and treatment is further impacted by the number of patients who experience the downstream impact of social determinants of health. The purpose of this document is to highlight the known healthcare disparities that exist in the care of patients with HF, and to provide a context for how clinicians and researchers should assess both biologic and social determinants of HF risk in vulnerable populations. Furthermore, this document will provide a framework for future steps that can be utilized to help diminish inequalities in access and clinical outcomes over time, and offer solutions to help reduce disparities within HF care.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 10 May 2022; epub ahead of print
Morris A, Shah KS, Enciso JS, Hsich E, ... Page R, Yancy C
J Card Fail: 10 May 2022; epub ahead of print | PMID: 35595161
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Digging Deeper: Understanding Trajectories and Experiences of Shared Decision-Making for Primary Prevention ICD Implantation.

Rao BR, Merchant FM, Abernethy ER, Bethencourt C, Matlock D, Dickert NW
Background
Shared decision-making using a decision aid is required for patients undergoing implantation of primary prevention implantable cardioverter-defibrillators (ICD). It is unknown how much this process has impacted patients\' experiences or choices. Effective shared decision-making requires an understanding of how patients make ICD decisions. A qualitative key-informant study was chosen to capture the breadth of patients\' experiences making ICD decisions in the context of required shared decision-making.
Methods
We conducted in-depth interviews with 20 patients referred to electrophysiology clinics for consideration of primary prevention ICD implantation. Purposeful sampling from a prior survey study evaluating mandated shared decision-making was based on patient characteristics and responses to the initial survey questions. Qualitative descriptive analysis of the interviews was performed utilizing a multilevel coding strategy.
Results
Patients\' paths to an ICD decision often involved multiple visits with multiple clinicians. However, the decision aid was almost exclusively provided to the patient during electrophysiology clinic visits. Some patients used the numeric data in the decision aid to make an ICD decision based on the risk-benefit profile; others made decisions based on other data or based on trust in clinicians\' recommendations. Patients highlighted information related to living with the device as particularly important in helping them make their ICD decisions. Some patients struggled with emotional aspects of making an ICD decision.
Conclusion
Patients\' ICD decision-making paths poses a challenge to episodic shared decision-making and may make tools such as decision aids perfunctory if used solely during the electrophysiology visit. Understanding patients\' ICD decision-making paths, especially in the context of encounters with primary cardiologists, can inform the implementation strategies of shared decision-making help to enhance its impact. Components of decision aids focusing on the experience of living with an ICD rather than probabilistic data may also be more impactful, though the nature of their impact will differ.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 09 May 2022; epub ahead of print
Rao BR, Merchant FM, Abernethy ER, Bethencourt C, Matlock D, Dickert NW
J Card Fail: 09 May 2022; epub ahead of print | PMID: 35550427
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Eligibility for dapagliflozin and empagliflozin in a real-world heart failure population.

Thorvaldsen T, Ferrannini G, Mellbin L, Benson L, ... Lund LH, Savarese G
Background
We investigated eligibility for dapagliflozin and empagliflozin in a real-world heart failure (HF) cohort based on selection criteria of DAPA-HF, DELIVER, and EMPEROR trials.
Methods and results
Selection criteria were applied to the Swedish HF registry out-patient population according to three scenarios: (i) a \"trial scenario\" applying all selection criteria; (ii) a \"pragmatic scenario\" applying the most clinically relevant criteria; (iii) a \"label scenario\" following the regulatory agencies labels. Of 49,317 patients, 55% had ejection fraction (EF)<40% and were assessed for eligibility based on DAPA-HF and EMPEROR-Reduced, 45% had EF≥40% and were assessed based on EMPEROR-Preserved and DELIVER. Eligibility using trial, pragmatic and label scenarios was: 35%, 61% and 80% for DAPA-HF; 31%, 55% and 81% for EMPEROR-Reduced; 30%, 61% and 74% for DELIVER; 32%, 59% and 75% for EMPEROR-Preserved. Main selection criteria limiting eligibility were HF duration and NT-proBNP. Eligible patients had more severe HF, more comorbidities, higher use of HF treatments and higher mortality/morbidity.
Conclusions
In a real-world HF setting, eligibility for SGLT2i was similar whether selection criteria from DAPA-HF or EMPEROR-Reduced were applied in HFrEF, or EMPEROR-Preserved or DELIVER in HFpEF. These data might help stakeholders assessing the consequences of future trial eligibility.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 09 May 2022; epub ahead of print
Thorvaldsen T, Ferrannini G, Mellbin L, Benson L, ... Lund LH, Savarese G
J Card Fail: 09 May 2022; epub ahead of print | PMID: 35550428
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Center Variability in Patient Outcomes following HeartMate 3 Implantation: An Analysis of the MOMENTUM 3 Trial.

Kanwar MK, Pagani FD, Mehra MR, Estep JD, ... Chuang J, Cowger JA
Background
As left ventricular assist device (LVAD) survival continues to improve, evaluating site-specific variability in outcome can facilitate identifying targets for quality improvement initiative opportunities in the field.
Methods
De-identified center-specific outcomes were analyzed for HeartMate 3 (HM3) patients enrolled into the MOMENTUM 3 pivotal and continued access protocol trials. Centers <25th percentile for HM3 volumes were excluded. Variability in risk-adjusted center mortality was assessed at 90 days and 2 years (conditional upon 90-day survival). Adverse event (AE) rates were compared across centers.
Results
Among 48 included centers (1958 patients), study implant volumes ranged between 17-106 HM3s. Despite similar trial inclusion criteria, patient demographics varied across sites, including age (Q1-Q3:57-62 years), sex (73-85% male), destination therapy intent (60-84%), and INTERMACS profile 1-2 (16-48%). Center mortality was highly variable, nadiring at ≤3.6% (≤25th percentile) and peaking at ≥10.4% (≥75th percentile) at 90 days and ≤10.2% and ≥18.7%, respectively, at 2-years. Centers with low mortality tended to have lower 2-year AE rates but no center was a top performer for all AEs studied.
Conclusions
Mortality and AEs were highly variable across MOMENTUM 3 centers. Studies are needed to improve our understanding of the drivers of outcome variability, and to ascertain best practices associated with high performing centers across the continuum of intra-operative to chronic stages of LVAD support.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

J Card Fail: 29 Apr 2022; epub ahead of print
Kanwar MK, Pagani FD, Mehra MR, Estep JD, ... Chuang J, Cowger JA
J Card Fail: 29 Apr 2022; epub ahead of print | PMID: 35504508
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Quantitative Blood Volume Analysis and Hemodynamic Measures of Vascular Compliance in Patients with Worsening Heart Failure: BVA and Hemodynamic Profiles in Worsening HF.

Rao VN, Andrews J, Applefeld WN, Gray JM, ... Hernandez AF, Fudim M
Background
The role of blood volume (BV) expansion versus a change in vascular compliance in worsening heart failure (HF) remains under debate. We aimed to assess the relationship between BV and resting and stress hemodynamics in worsening HF, and to further elucidate the significance of BV in cardiac decompensation.
Methods and results
Patients with worsening HF underwent radiolabeled indicator-dilution BV analysis and cardiac catheterization. Intravascular volumes and resting/stress hemodynamics were recorded. Provocative stress maneuvers included change in systolic blood pressure (ΔSBP) from lying to standing and Valsalva, and intracardiac pressure changes with leg raise. Correlation between BV and invasive hemodynamics were assessed by linear regression. Of 27 patients with worsening HF, patient characteristics included mean age 61±12 years, 70% male, 19% Black, and mean ejection fraction 29±15%. Thirteen (48%) had hypervolemia measured by total BV (TBV). TBV weakly correlated with ΔSBP by position (R2=0.009) and Valsalva (R2=0.003), and with right atrial (R2=0.049) and pulmonary capillary wedge (R2=0.047) pressure changes during leg raise.
Conclusions
In patients with worsening HF, BV mildly correlated with intracardiac pressures at rest. Provocative maneuvers intended to test vascular compliance did not correlate with BV, indicating that compliance may serve as a standalone metric in HF.

Copyright © 2022 Elsevier Ltd. All rights reserved.

J Card Fail: 25 Apr 2022; epub ahead of print
Rao VN, Andrews J, Applefeld WN, Gray JM, ... Hernandez AF, Fudim M
J Card Fail: 25 Apr 2022; epub ahead of print | PMID: 35483537
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Risk of hospitalization for heart failure in patients with hyperkalemia treated with sodium zirconium cyclosilicate versus patiromer.

Zhuo M, Kim SC, Patorno E, Paik JM
Background
Sodium zirconium cyclosilicate (SZC) and patiromer were recently approved to treat hyperkalemia. Whether the initiation of SZC is associated with an increased risk of hospitalization for heart failure (HHF) compared to patiromer in routine practice remains unknown.
Methods and results
We conducted a new-user cohort study of non-dialysis adults who initiated SZC or patiromer using Optum\'s de-identified Clinformatics® Data Mart Database from May 2018 to September 2020. We performed propensity score (PS) matching in a variable ratio to match each SZC initiator with up to three patiromer initiators. The primary outcome was HHF. Cox proportional hazards regression models generated hazard ratios (HRs) with 95% confidence intervals (CIs) in the PS-matched groups. The cohort included 1,126 SZC initiators and 2,839 PS-matched patiromer initiators. The mean age was 72 years old, about 30% had a history of heart failure, and 85% had chronic kidney disease stages 3-5. The SZC group had 88 cases of HHF (incidence rate [IR] 35.8 per 100 person-years [PY]), and the patiromer group had 245 cases of HHF (IR 25.1 per 100 PY). The rate of HHF was numerically higher in the SZC initiators than patiromer initiators (HR 1.22, 95%CI 0.95, 1.56), but did not reach statistical significance. Results were consistent across sensitivity and subgroup analyses.
Conclusions
Initiation of SZC might be associated with an increased risk of hospitalization for heart failure compared to patiromer in routine practice. Larger comparative studies are needed to evaluate the safety of SZC in routine practice more precisely.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 22 Apr 2022; epub ahead of print
Zhuo M, Kim SC, Patorno E, Paik JM
J Card Fail: 22 Apr 2022; epub ahead of print | PMID: 35470055
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Increased Opportunities for Transplantation for Women in the New Heart Allocation System.

DeFilippis EM, Truby LK, Clerkin KJ, Donald E, ... Topkara VK, Farr M
Background
Historically, women have had less access to advanced heart failure therapies, including temporary and permanent mechanical circulatory support (MCS) and heart transplantation (HT), with worse waitlist and post-transplant survival compared to men. This study evaluated for improvement in sex differences across all phases of HT in the 2018 allocation system.
Methods
The UNOS registry was queried to identify adult patients (≥18 years) listed for HT from 10/18/2016-10/17/2018 (old allocation) and 10/18/2018-10/18/2020 (new allocation). Outcomes of interest included waitlist survival, pre-transplant use of temporary and durable MCS, rates of HT and post-transplant survival.
Results
15629 patients listed for HT were included; 7745 (2039 women, 26.3%) in new and 7875 patients (2074 women, 26.3%) in old allocation. When compared with men in the new allocation system, women were more likely to have lower priority UNOS status at time of transplant, and less likely to be supported by IABP (27.1% vs. 32.2%), p <0.001), with no difference in the use of VA-ECMO (5.5% vs. 6.3%, p=0.28). Despite these findings, when transplant was viewed in the context of risk for death or delisting, the cumulative incidence of transplant within 6 months of listing was higher in women than men in the new allocation system (62.4% v. 54.9%, p<0.001) with no differences in post-transplant survival. When comparing women in the old vs. new allocation, distance traveled for organ procurement was 187.5±207 vs. 272.84 ± 233.7 miles; p<0.001.
Conclusions
While use of temporary MCS in women remains lower than men in new allocation, more women are being transplanted with comparable waitlist and post-transplant outcomes to men. Broader sharing may be making its greatest impact on improving transplant opportunities for women.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 22 Apr 2022; epub ahead of print
DeFilippis EM, Truby LK, Clerkin KJ, Donald E, ... Topkara VK, Farr M
J Card Fail: 22 Apr 2022; epub ahead of print | PMID: 35470056
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Baseline Quality of Life of Caregivers of Patients with Heart Failure Prior to Advanced Therapies: Findings from the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) study.

Mg P, T W, Ac A, A B, ... Jk K, Kl G
Background
We compared HRQOL, depressive symptoms, anxiety and burden among caregivers of older HF patients based on intended patient therapy goal: awaiting heart transplantation (HT) with or without mechanical circulatory support (MCS); and prior to long-term MCS; and identified factors associated with HRQOL.
Methods
Caregivers (n=281) recruited from 13 U.S. HT and MCS programs, completed measures of HRQOL (EQ-5D-3L), depressive symptoms (PHQ-8), anxiety (STAI-state), and burden (Oberst Caregiving Burden Scale). Analyses included ANOVA, Kruskal-Wallis tests, chi-square tests, and linear regression.
Results
The majority of caregivers were female, white, spouses with ≤2 co-morbidities, median[Q1,Q3] age=62[57.8,67.0] years. Caregivers (HT with MCS=87, HT without MCS=98, long-term MCS=96) reported similarly high baseline HRQOL (EQ-5D-3L visual analog scale median score=90, p=0.67, for all groups) and low levels of depressive symptoms. STAI-state median scores were higher in the long-term MCS group versus the HT groups with and without MCS, (38 versus 32 versus 31, p<0.001), respectively. Burden (task: time spent/difficulty) differed significantly among groups. Caregiver factors (number of comorbidities, diabetes, and higher anxiety levels) were significantly associated with worse caregiver HRQOL, R2=26%.
Conclusions
Recognizing caregiver-specific factors, including comorbidities and anxiety, associated with HRQOL of caregivers of these older advanced HF patients may guide support strategies.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 22 Apr 2022; epub ahead of print
Mg P, T W, Ac A, A B, ... Jk K, Kl G
J Card Fail: 22 Apr 2022; epub ahead of print | PMID: 35470057
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Outcomes in Patients with Chronic Kidney Disease and End Stage Renal Disease and Durable Left Ventricular Assist Device: Insights from United States Renal Data System Database.

Dalia T, Chan WC, Sauer AJ, Ranka S, ... Fang JC, Shah Z
Background
There is paucity of data regarding durable LVAD outcomes in patients with chronic kidney disease (CKD) stage 3-5 and CKD stage 5 on dialysis (ESRD: end stage renal disease).
Methods
We conducted a retrospective study of Medicare beneficiaries with ESRD and 5% sample of CKD with LVAD (2006 to 2018) to determine one-year outcomes utilizing the United States Renal Data System (USRDS) database. The LVAD implantation, comorbidities and outcomes were identified using appropriate ICD-9 and ICD-10 codes.
Results
We identified 496 CKD and 95 ESRD patients who underwent LVAD implantation. The ESRD patients were younger (59 vs 66 years; p <0.001), had more Blacks (40% vs 24.6%; p=0.009), compared to the CKD group. One-year mortality (49.5% vs 30.9%; p <0.001) and index mortality (27.4% vs 16.7%; p=0.014) was higher in ESRD. Subgroup analysis showed significantly higher mortality in ESRD vs CKD 3 (49.5% vs 30.2%, adjusted p=0.009), but no significant difference in mortality between stage 3 vs 4/5 (30.2% vs 30.8%; adjusted p=0.941). There was no significant difference in secondary outcomes (bleeding, stroke, and sepsis/infection) during follow-up between two groups.
Conclusions
Patients with ESRD undergoing LVAD implantation had significantly higher index and 1-year mortality compared to CKD patients.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 22 Apr 2022; epub ahead of print
Dalia T, Chan WC, Sauer AJ, Ranka S, ... Fang JC, Shah Z
J Card Fail: 22 Apr 2022; epub ahead of print | PMID: 35470059
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Preferred Role in Healthcare Decision-Making Over Time among Patients with Heart Failure: My Decision, Or My Doctor\'s Decision?

Deng LR, Matlock DD, Bekelman DB
Background
Understanding patients\' preferred role in decision-making can improve patient-centered care. This study aimed to determine change and the predictors of change in preferred decision-making roles over time in patients with heart failure.
Methods and results
During the CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) trial, patients\' preferred roles in decision-making were measured using the Control Preferences Scale (range 1-5, higher=less active; N=312) at four timepoints over one year. The effect of the CASA intervention on preferred decision-making roles was tested using generalized linear mixed models. Whether preferences changed over time in the whole population was determined using linear regression. Demographic and health-related factors were examined as predictors of change using multiple linear regression. At baseline, most participants preferred active (score 1-2, 37.2%) or collaborative (score 3, 44.9%) roles. The CASA intervention did not influence preferred decision-making roles (p>0.1). Preferences significantly changed over one year (p<0.01), becoming more active (82.1%, 84.2%, 89.0%, 90.1% active/collaborative at each timepoint). Among all models and covariates, there were no significant predictors of change (p>0.1).
Conclusions
Patients\' preferred roles in decision-making change over time, but changes are not well predicted. Clinicians should frequently and directly communicate with patients about their preferred decision-making role.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 22 Apr 2022; epub ahead of print
Deng LR, Matlock DD, Bekelman DB
J Card Fail: 22 Apr 2022; epub ahead of print | PMID: 35470060
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Health System-Level Performance in Prescribing Guideline-Directed Medical Therapy for Patients with HFrEF: Results from the CONNECT-HF Trial.

Granger BB, Kaltenbach LA, Fonarow GC, Allen LA, ... Hernandez AF, DeVore AD
Background
Health system-level interventions to improve use of guideline-directed medical therapy (GDMT) often fail in the acute care setting. We sought to identify factors associated with high performance in adoption of GDMT among health systems in CONNECT-HF.
Methods and results
Site-level composite quality scores were calculated at discharge and last follow-up. Site performance was defined as the average change in score from baseline to last follow-up and analyzed by performance tertile using a mixed-effects model with baseline performance as a fixed effect and site as a random effect. Among 150 randomized sites, mean 12-month improvement in GDMT was 1.8% (-26.4% to 60.0%). Achievement of ≥50% target dose for angiotensin-converting enzymes/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors and beta blockers at 12 months was modest, even at the highest performing sites (median 29.6% [23%, 41%] and 41.2% [29%, 50%]). Sites achieving higher GDMT scores had care teams that included social workers and pharmacists and patients able to afford medications and access medication lists in the electronic health record.
Conclusions
Substantial gaps in site-level use of GDMT were found even among highest performing sites. Failure of hospital-level interventions to improve quality metrics suggests that a team-based approach to care and improved patient access to medications are needed for post-discharge success.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 21 Apr 2022; epub ahead of print
Granger BB, Kaltenbach LA, Fonarow GC, Allen LA, ... Hernandez AF, DeVore AD
J Card Fail: 21 Apr 2022; epub ahead of print | PMID: 35462033
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) - Phase I Evaluation of the Integration and Safety of the HeartLogic Multisensor Algorithm in Patients With Heart Failure.

Hernandez AF, Albert NM, Allen LA, Ahmed R, ... Stein K, MANAGE-HF Study
Background
Patients with heart failure and reduced ejection fraction (HFrEF) suffer from a relapsing and remitting disease, where early treatment changes may improve outcomes. We assessed the clinical integration and safety of the HeartLogic multi-sensor index and alerts in heart failure care.
Methods
The Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) study enrolled 200 patients with HFrEF (< 35%), NYHA class II-III symptoms, implanted with a CRT-D or ICD, who had either a hospitalization for HF within 12 months or unscheduled visit for HF exacerbation within 90 days or an elevated natriuretic peptide concentration (BNP≥150 pg/mL or NT-proBNP≥600 pg/mL). This phase included development of an alert management guide and evaluated changes in medical treatment, natriuretic peptide levels, and safety.
Results
Mean age of participants was 67 years, 68% were men, 81% were white, and 61% had a HF hospitalization in prior 12 months. During follow-up there were 585 alert cases with an average of 1.76 alert cases/pt-yr. HF medications were augmented during 74% of the alert cases. HF treatment augmentation within 2 weeks from an initial alert was associated with more rapid recovery of the HeartLogic Index. Five SAEs (0.015 per pt-year) occurred in relation to alert-prompted medication change. NTproBNP levels decreased from median of 1316 pg/mL at baseline to 743 pg/mL at 12 months (p<0.001).
Conclusions
HeartLogic alert management was safely implemented in HF care and may optimize HF management. This phase supports further evaluation in larger studies.
Trial registration
ClinicalTrials.gov (NCT03237858).

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 20 Apr 2022; epub ahead of print
Hernandez AF, Albert NM, Allen LA, Ahmed R, ... Stein K, MANAGE-HF Study
J Card Fail: 20 Apr 2022; epub ahead of print | PMID: 35460884
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Beta-blockers and Ambulatory Inotropic Therapy.

Zaghlol R, Ghazzal A, Radwan S, Zaghlol L, ... Sheikh FH, Najjar SS
Background
Continuous infusion of ambulatory inotropic therapy (AIT) is increasingly used in patients with end stage heart failure (HF). There is a paucity of data on the concomitant use of beta blockers (BB) in these patients.
Methods
We retrospectively reviewed all patients discharged from our institution on AIT. The cohort was stratified into two groups based on BB use. The 2 groups were compared for differences in HF hospitalizations, ventricular arrhythmias, and ICD therapies (shock or anti-tachycardia pacing).
Results
Between 2010 and 2017, 349 patients were discharged on AIT (95% on Milrinone), 74% were males with a mean age of 61 ±14 years. BB were used in 195 (56%) patients, whereas 154 (44%) did not receive these medications. Patients in the BB-group had longer duration of AIT support compared to those in the non-BB group (141 [1-2114] vs. 68 [1-690] days). After adjusting for differences in baseline characteristics and indication for AIT, patients in the BB-group had significantly lower rates of HF-hospitalizations (hazard ratio (HR) 0.61 [0.43-0.86], p= 0.005), ventricular arrhythmias (HR 0.34 [0.15-0.74], p=0.007)and ICD therapies (HR 0.24 [0.07-0.79], p=0.02).
Conclusion
In patients with end-stage heart failure on AIT, the use of BB with inotropes was associated with lower HF hospitalizations and ventricular arrhythmias.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 18 Apr 2022; epub ahead of print
Zaghlol R, Ghazzal A, Radwan S, Zaghlol L, ... Sheikh FH, Najjar SS
J Card Fail: 18 Apr 2022; epub ahead of print | PMID: 35447337
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Donation After Circulatory Death in Heart Transplantation: History, Outcomes, Clinical Challenges, and Opportunities to Expand the Donor Pool.

Truby LK, Casalinova S, Patel CB, Agarwal R, ... Schroder JN, DeVore AD
Heart transplantation remains the gold standard therapy for end stage heart failure, with an expected median survival of 12 to 13 years1. Over 30,000 heart transplants have been performed globally in the last decade alone. With advances in medical and surgical therapies for heart failure, including durable left ventricular assist devices (LVAD), an increasing number of patients are living with end-stage disease. Last year alone, over 2500 patients were added to the heart transplant waitlist in the US2. Despite recent efforts to expand the donor pool including an increase in transplantation of hepatitis C positive and extended criteria donors, supply continues to fall short of demand. Donation after circulatory death (DCD), defined by irreversible cardiopulmonary arrest rather than donor brain death (DBD), is widely used in other solid organ transplants including kidney and liver but has not been widely adopted in heart transplantation. However, resurging interest in DCD donation and the introduction of ex vivo perfusion technology has catalyzed recent clinical trials and the development of DCD heart transplant programs. Herein, we review the history of, describe the currently utilized procurement protocols for, and examine clinical challenges and outcomes of DCD heart transplantation.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 18 Apr 2022; epub ahead of print
Truby LK, Casalinova S, Patel CB, Agarwal R, ... Schroder JN, DeVore AD
J Card Fail: 18 Apr 2022; epub ahead of print | PMID: 35447338
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Sacubitril/Valsartan Off-Label Uses for Heart Failure.

Kido K, Colvin BM, Szymanski TW, Guglin M
Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor, Food and Drug Administration (FDA) indicated to reduce the risk of cardiovascular death and hospitalization in patients with left ventricular ejection fraction below normal, with no specified ejection fraction cut-off. However, clinically significant patient groups were excluded or minimally represented in sacubitril/valsartan\'s pivotal clinical trials. Clinicians often encounter scenarios when a sacubitril/valsartan off-label use may be beneficial, but limited resources are available to evaluate the efficacy and safety in these patients. This state-of-the-art review describes contemporary literature for sacubitril/valsartan FDA off-label indications to help clinicians assess its appropriateness in these selected clinically important patient groups: acute decompensated heart failure, acute coronary syndrome, peripartum cardiomyopathy, chemotherapy-induced cardiomyopathy, adult congenital heart disease, cardiomyopathy in dialysis patients, right ventricular failure, and durable left ventricular assist device.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 08 Apr 2022; epub ahead of print
Kido K, Colvin BM, Szymanski TW, Guglin M
J Card Fail: 08 Apr 2022; epub ahead of print | PMID: 35405341
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Outcomes and Predictors of Mortality Among Cardiac Intensive Care Unit Patients With Heart Failure.

Jentzer JC, Reddy YN, Rosenbaum AN, Dunlay SM, Borlaug BA, Hollenberg SM
Background
Little is known regarding the causes of critical illness and determinants of prognosis of patients with heart failure (HF) admitted to the modern cardiac intensive care unit (CICU). We sought to describe the epidemiology and outcomes of patients with HF admitted to the contemporary CICU.
Methods and results
Retrospective cohort analysis of Mayo Clinic CICU patients admitted with HF from 2007 to 2018 who had left ventricular ejection fraction (LVEF) data. HF with reduced LVEF (HFrEF) was defined as a LVEF of less than 50%, and HF with preserved LVEF (HFpEF) as a LVEF of 50% or greater. In-hospital mortality was analyzed using multivariable logistic regression. Survival to 1 year was analyzed using a Kaplan-Meier analysis. We included 4012 patients, including 67.8% with HFrEF and 32.2% with HFpEF. Patients with HFrEF and HFpEF were comparable and had equivalent severity of illness. Critical care therapies were used in 59.4%, with a slight preponderance in patients with HFrEF. In-hospital mortality occurred in 12.5% of patients and was similar in HFrEF vs HFpEF. Shock and cardiac arrest were the strongest predictors of adjusted in-hospital mortality, followed by Braden skin score and serum chloride level; patients with HFrEF and HFpEF had similar adjusted mortality rates. The 1-year survival after hospital discharge was 74.5% and was slightly lower for patients with HFpEF. All-cause rehospitalization occurred in 36.6%, and 52.8% of hospital survivors died or were readmitted within 1 year.
Conclusions
CICU patients with HF have a substantial burden of critical illness, high use of critical care therapies, and poor outcomes regardless of LVEF. This finding emphasizes the potential unmet care needs in this cohort.
Lay summary
Patients with heart failure who require admission to the cardiac intensive care unit have high severity of illness and are at significant risk of death during and after hospitalization. These patients often require specialized critical care therapies to treat manifestations of critical illness. Patients who are admitted with cardiac arrest or shock, including those who require mechanical ventilation or vasopressors, are at particularly high risk of death. Patients\' left ventricular ejection fraction is not strongly associated with the risk of death when accounting for other major predictors including frailty and laboratory abnormalities.

Copyright © 2022 Elsevier Inc. All rights reserved.

J Card Fail: 02 Apr 2022; epub ahead of print
Jentzer JC, Reddy YN, Rosenbaum AN, Dunlay SM, Borlaug BA, Hollenberg SM
J Card Fail: 02 Apr 2022; epub ahead of print | PMID: 35381356
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Lead With the Why: Research Recruitment of Older Adults With HF During COVID-19.

Degroot L
Recruitment of older adults with advanced heart failure is notoriously challenging, particularly for doctoral students conducting dissertation research studies with limited financial and personnel resources. Successful recruitment of participants requires a multifaceted recruitment strategy that is mindful of context and sensitive to the clinical partners who provide care in the recruitment setting. This article reflects on these challenges and proposes a practical framework to guide recruitment strategies in future research.

Copyright © 2022 Elsevier Inc. All rights reserved.

J Card Fail: 31 Mar 2022; 28:684-687
Degroot L
J Card Fail: 31 Mar 2022; 28:684-687 | PMID: 35121149
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Outpatient Management of Guideline-Directed Medical Therapy for Heart Failure Using Telehealth: A Comparison of In-Office, Video, and Telephone Visits.

Sammour Y, Main ML, Austin BA, Magalski A, Sperry BW
Background
There are limited data regarding the management of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) with virtual visits in comparison with in-office visits. We sought to compare the changes in GDMT (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium glucose cotransporter-2 inhibitors) and loop diuretics across visit types.
Methods and results
This study included 13,481 outpatient visits performed for 5439 unique patients with HFrEF between March 16, 2020, and March 15, 2021. The rates of initiation and discontinuation of GDMT were documented, and multivariable logistic regression was performed to test associations with outcomes between modes of visit. The rates of medication initiation were higher in office (11.7%) compared with video (9.6%) or telephone (7.2%) visits. In multivariable adjusted analysis, the initiation of at least 1 GDMT class was similar between in-office visits and video visits (adjusted odds ratio [OR] 0.97, 95% confidence interval [CI] 0.82-1.14, P = .703). Telephone visits were associated with less frequent initiation of at least 1 class of GDMT in comparison with in-office visits (adjusted OR 0.64, 95% CI 0.55-0.75; P < .001) and video visits (adjusted OR 0.67, 95% CI 0.55-0.81, P < .001). Despite similar rates of baseline loop diuretic use, patients seen with both video visits (adjusted OR 0.70, 95% CI 0.52-0.94, P = .018) and telephone visits (adjusted OR 0.64, 95% CI 0.49-0.83, P < .001) were less likely to have a loop diuretic initiated when compared with in-office visits.
Conclusions
The initiation of GDMT for HFrEF was similar between in-office and video visits and lower with telephone visits, whereas the initiation of a loop diuretic was less frequent in both types of virtual visits. These data suggest that video streaming capabilities should be encouraged for virtual visits.

Copyright © 2022 Elsevier Inc. All rights reserved.

J Card Fail: 19 Mar 2022; epub ahead of print
Sammour Y, Main ML, Austin BA, Magalski A, Sperry BW
J Card Fail: 19 Mar 2022; epub ahead of print | PMID: 35318127
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

Heidenreich PA, BozkurtChair B, Aguilar D, Allen LA, ... Yancy CW, Writing Committee Members
Aim
The \"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure\" replaces the \"2013 ACCF/AHA Guideline for the Management of Heart Failure\" and the \"2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.\" The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.
Methods
A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021.
Structure
Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients\' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 17 Mar 2022; epub ahead of print
Heidenreich PA, BozkurtChair B, Aguilar D, Allen LA, ... Yancy CW, Writing Committee Members
J Card Fail: 17 Mar 2022; epub ahead of print | PMID: 35378259
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.

Writing Committee Members, ACC/AHA Joint Committee Members
Aim
The \"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure\" replaces the \"2013 ACCF/AHA Guideline for the Management of Heart Failure\" and the \"2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.\" The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.
Methods
A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021.
Structure
Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients\' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Mar 2022; epub ahead of print
Writing Committee Members, ACC/AHA Joint Committee Members
J Card Fail: 14 Mar 2022; epub ahead of print | PMID: 35378257
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Medical Therapy During Hospitalization for Heart Failure with Reduced Ejection Fraction: The VICTORIA Registry: Medical Therapy During Hospitalization for HFrEF.

Greene SJ, Ezekowitz JA, Anstrom KJ, Demyanenko V, ... Armstrong PW, Mentz RJ
Background
For patients hospitalized for heart failure with reduced ejection fraction (HFrEF), guidelines recommend optimization of medical therapy prior to discharge. The degree to which changes in medical therapy occur during hospitalizations for HFrEF in North American clinical practice is unclear.
Methods
The VICTORIA registry enrolled patients hospitalized for worsening chronic HFrEF across 51 sites in the US and Canada from February 2018-January 2019. Among patients with complete medication data and not receiving dialysis, use and dose of angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA), and sodium glucose cotransporter-2 inhibitors (SGLT2i) were assessed at admission and discharge.
Results
Among 1,695 patients, median (IQR) age was 69 (59-79) years and 33% were women. Among eligible patients, 33%, 25%, and 55% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA at discharge, respectively; 99% were not prescribed SGLT2i. For each medication, >50% of patients remained on stable sub-target doses or no medication during hospitalization. In-hospital rates of initiation/dose increase were 20% for ACEI/ARB, 4% for ARNI, 20% for beta-blocker, 22% for MRA, and <1% for SGLT2i; corresponding rates of dose decrease/discontinuation were 11%, 2%, 9%, 5%, and <1%, respectively. Overall, 17% and 28% of eligible patients were prescribed triple therapy prior to admission and at discharge, respectively. At both admission and discharge, 1% of patients were prescribed triple therapy at target doses. Across classes of medication, multiple factors were independently associated with higher likelihood of in-hospital initiation/dosing increase (e.g., Canadian enrollment, White race, intensive care admission) and discontinuation/dosing decrease (e.g., worse renal function, intensive care admission).
Conclusions
In this contemporary North American registry of patients hospitalized for worsening chronic HFrEF, for each recommended medical therapy, the large majority of eligible patients remained on stable sub-target doses or without medication at admission and discharge. Although most patients had no alterations in medical therapy, hospitalization in Canada and multiple patient characteristics were associated with higher likelihood of favorable in-hospital medication changes.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Mar 2022; epub ahead of print
Greene SJ, Ezekowitz JA, Anstrom KJ, Demyanenko V, ... Armstrong PW, Mentz RJ
J Card Fail: 14 Mar 2022; epub ahead of print | PMID: 35301107
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Predicting Long-Term Mortality in Patients with Acute Heart Failure Using Machine Learning.

Park J, Hwang IC, Yoon YE, Park JB, Park JH, Cho GY
Background
High mortality rate in acute heart failure (AHF) necessitates proper risk stratification. However, risk assessment tools for long-term mortality are largely lacking. We aimed to develop a machine learning (ML)-based risk prediction model for long-term all-cause mortality in patients administrated for AHF.
Methods and results
ML model based on boosted Cox regression algorithm (CoxBoost) was trained over 2,704 consecutive patients hospitalized for AHF (median age 73 years, 55% male, and median left ventricular ejection fraction 38%). Twenty-seven input variables, including 19 clinical features and eight echocardiographic parameters, were selected for model development. The best performing model, along with pre-existing risk scores (BIOSTAT-CHF and AHEAD scores), was validated on an independent test cohort of 1,608 patients. During the median 32 months (interquartile range 12-54 months) of the follow-up period, 1,050 (38.8%) and 690 (42.9%) deaths occurred in the training and test cohort, respectively. The area under the receiver operating characteristic curve (AUROC) of the ML model for all-cause mortality at 3 years was 0.761 (95% CI: 0.754-0.767) in the training cohort and 0.760 (95% CI: 0.752-0.768) in the test cohort. The discrimination performance of the ML model significantly outperformed those of the pre-existing risk scores (AUROC 0.714, 95% CI 0.706-0.722 by BIOSTAT-CHF; and 0.681, 95% CI 0.672-0.689 by AHEAD). Risk stratification based on the ML model identified patients at high mortality risk regardless of heart failure phenotypes.
Conclusions
The ML-based mortality prediction model can accurately predict long-term mortality leading to optimal risk stratification in patients with AHF.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Mar 2022; epub ahead of print
Park J, Hwang IC, Yoon YE, Park JB, Park JH, Cho GY
J Card Fail: 14 Mar 2022; epub ahead of print | PMID: 35301108
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Inferior Vena Cava Diameter Measurement Provides Distinct and Complimentary Information to Right Atrial Pressure in Acute Decompensated Heart Failure.

Griffin M, Ivey-Miranda J, McCallum W, Sarnak M, ... Rao VS, Testani J
Background
Inferior vena cava (IVC) measurements only correlate modestly with right atrial pressure (RAP). Part of this inaccuracy is due to the high compliance of the venous system where a large change in blood volume may result in only a small change in pressure. As such, the information provided by the IVC may be different rather than redundant.
Methods and results
We analyzed patients in the ESCAPE trial who had both pulmonary artery catheter and IVC measurements at baseline (n =108). There was only a modest correlation between baseline RAP and IVC diameter (r =0.41, p<0.001). Hemoconcentration, defined as an increase in hemoglobin from admission to discharge, was correlated with decrease in IVC diameter (r =0.35, p =0.02), but not with a decrease in RAP (r =0.01, p =0.95). When patients had both IVC and RAP measurements below the median, survival was superior to those who had only one below the median, and both above the median fared the worst (p=0.002).
Conclusion
IVC and RAP have limited correlation with one another, and changes in intravascular volume appear to correlate better with IVC diameter rather than RAP. Furthermore, there is complimentary information provided by pressure and volume assessments in ADHF.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Mar 2022; epub ahead of print
Griffin M, Ivey-Miranda J, McCallum W, Sarnak M, ... Rao VS, Testani J
J Card Fail: 14 Mar 2022; epub ahead of print | PMID: 35301109
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Waitlist outcomes for children with congenital heart disease: lessons learned from over 5000 heart transplant listings in the United States.

Townsend M, Karamlou T, Boyle G, Daly K, ... Saarel E, Amdani S
Background
We evaluated the impact of pediatric heart allocation policy changes over time and approval of Berlin ventricular assist device (VAD) on waitlist (WL) outcomes for children with CHD.
Methods
Scientific Registry of Transplant Recipients database was evaluated to include all children (age <18) with CHD and cardiomyopathy (CMP) WL from 1999-2019 divided into four eras: Era 1 (1999-2008); Era 2 (2009 - 2011); Era 3 (2012 -2016) and; Era 4 (2016 - 2019). WL characteristics and survival outcomes were evaluated for patients with CHD overtime and compared to those with CMP listed currently (Era 4).
Results
5185 children with CHD WL during the study period; 1999 (39%) were listed in Era 1, 693 (13%) Era 2, 1196 (23%) Era 3 and 1297 (25%) Era 4. Compared to CHD WL in eras 1 and 2, those in Era 4 were less likely to be infants (48 vs. 49 vs. 43%), on mechanical ventilation (30 vs. 26 vs. 19%), extracorporeal membrane oxygenation (15 vs. 9.7 vs. 6.2%) and more likely to be on a VAD (2.4 vs. 2.2 vs. 6.0%) (p<.05 for all). WL survival improved in children with CHD from Era 1 to Era 4 (p<.001). However, in Era 4, children with CHD had lower WL survival compared to CMP (p<.001).
Conclusion
Children with CHD are increasingly being listed with less advanced heart failure and they have improved WL survival over time; however, WL outcomes remain inferior to CMP. Advances in pediatric medical and VAD therapy may improve future WL outcomes.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Mar 2022; epub ahead of print
Townsend M, Karamlou T, Boyle G, Daly K, ... Saarel E, Amdani S
J Card Fail: 14 Mar 2022; epub ahead of print | PMID: 35301110
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The HEART Camp Exercise Intervention Improves Exercise Adherence, Physical Function, and Patient-Reported Outcomes in Adults With Preserved Ejection Fraction Heart Failure.

Alonso WW, Kupzyk KA, Norman JF, Lundgren SW, ... Keteyian SJ, Pozehl BJ
Background
Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on subgroups of participants with HFpEF and heart failure with reduced ejection fraction (HFrEF).
Methods and results
This randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined as ≥120 minutes of moderate-intensity [40%-80% of heart rate reserve] exercise per week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested intervention effects on symptoms (Patient-Reported Outcomes Measurement Information System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire), and physical function (6-minute walk test). Participants with HFpEF (n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared with enhanced usual care at both 12 (43% vs 14%, phi = 0.32, medium effect) and 18 months (56% vs 0%, phi = 0.67, large effect). HEART Camp significantly improved walking distance on the 6-minute walk test (η2 = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η2 = 0.09, medium effect), clinical summary (η2 = 0.16, large effect), and total symptom (η2 = 0.14, large effect) scores. In the HFrEF subgroup, only patient-reported anxiety improved significantly in the intervention group.
Conclusions
A multicomponent, behavioral intervention is associated with improvements in long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence and improve clinical outcomes in this population.
Clinical trial registration
URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:431-442
Alonso WW, Kupzyk KA, Norman JF, Lundgren SW, ... Keteyian SJ, Pozehl BJ
J Card Fail: 28 Feb 2022; 28:431-442 | PMID: 34534664
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Subclinical Myocardial Injury and the Phenotype of Clinical Congestion in Patients With Heart Failure and Reduced Left Ventricular Ejection Fraction.

Thibodeau JT, Pham DD, Kelly SA, Ayers CR, ... Grodin JL, Drazner MH
Background
Clinical congestion is associated with adverse outcomes in patients with heart failure. The pathophysiological mediators of this association remain uncertain.
Methods and results
We prospectively enrolled a cohort of patients with heart failure and reduced left ventricular ejection fraction and performed a detailed clinical examination followed on the same day by an invasive right heart catheterization and blood sampling for biomarkers. High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured. A clinical congestion score was calculated based on jugular venous pressure (cm H20 <10 = 0, 10-14 = 1, >14 = 2 points), bendopnea (0 vs 1), a third heart sound (0 vs 1), or peripheral edema (0-2). Congestion was categorized into tiers as absent (0 points), mild (1 point), or moderate to severe (≥ 2 points). We tested for associations of high-sensitivity troponin T, NT-proBNP, and elevated ventricular filling pressures with clinical congestion in both univariate and multivariable analyses. Of 153 participants, 65 (42%) had absent, 35 mild (23%), and 53 (35%) had moderate to severe clinical congestion. Congestion tier was associated with higher NT-proBNP and hs-troponin levels, and the right atrial pressure and pulmonary capillary wedge pressure (P < .001 for each). Increased congestion tier was also associated with the coexistent presence of elevated troponin T (≥52 ng/L), NT-proBNP (≥1000 pg/mL), and pulmonary capillary wedge pressure (≥22 mm Hg). Specifically, 78% of those with absent clinical congestion had 0 to 1 of these findings, whereas 75% of those with moderate-severe congestion had 2 or all 3 of these abnormalities (P < .001). An elevated hs-troponin was associated with mild or greater clinical congestion (odds ratio 3, 95% confidence interval 1.2-7.5, P = .02) in multivariable analysis adjusting for potential confounders including the right atrial pressure, pulmonary capillary wedge pressure, and NT-proBNP levels.
Conclusions
Clinical congestion is a phenotype in which there is a high coexistent presence of elevated ventricular filling pressures, elevated natriuretic peptide levels, and subclinical myocardial injury. An elevated troponin was associated with clinical congestion in multivariable models that adjusted for ventricular filling pressures and natriuretic peptide levels. These data strengthen the evidence base for an association of elevated troponin with clinical congestion, suggesting that subclinical myocardial injury may be an important contributor to the pathophysiology of the congested state.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:422-430
Thibodeau JT, Pham DD, Kelly SA, Ayers CR, ... Grodin JL, Drazner MH
J Card Fail: 28 Feb 2022; 28:422-430 | PMID: 34534666
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Exception-Status Listing: A Critical Pathway to Heart Transplantation for Adults With Congenital Heart Diseases.

Rali AS, Ranka S, Mazurek JA, Brinkley MD, ... Schlendorf K, Menachem JN
Adults with congenital heart diseases may not be candidates for conventional therapies to control ventricular systolic dysfunction, including mechanical circulatory support, which moves potential heart-transplantation recipients to a listing status of higher priority. This results in longer waitlist times and greater mortality rates. Exception-status listing allows a pathway for this complex and anatomically heterogenous group of patients to be listed for heart transplantation at appropriately high listing status. Our study queried the United Network for Organ Sharing registry to evaluate trends in the use of exception-status listing among adults with congenital heart diseases awaiting heart transplantation. Uptrend in the use of exception-status listing precedes the new allocation system, but it has been greatest since changes were made in the allocation system. It continues to remain a vital pathway for adults with congenital heart disease (whose waitlist mortality rates are often not characterized adequately by using the waitlist-status criteria) timely access to heart transplantation.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:415-421
Rali AS, Ranka S, Mazurek JA, Brinkley MD, ... Schlendorf K, Menachem JN
J Card Fail: 28 Feb 2022; 28:415-421 | PMID: 34670174
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Diabetes Mellitus in Advanced Heart Failure.

Dunlay SM, Killian JM, Mccoy RG, Redfield MM
Background
Diabetes mellitus is associated with increased rates of mortality in patients with less severe (stage C) heart failure (HF). The prevalence of diabetes and its complications in advanced (stage D) HF and their contributions to mortality risk are unknown.
Methods and results
We conducted a retrospective population-based cohort study of all adult residents of Olmsted County, Minnesota, who had advanced HF between 2007 and 2017. Patients with diabetes were identified by using the criteria of the Healthcare Effectiveness Data and Information Set. Diabetes complications were captured by using the Diabetes Complications Severity Index. Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Overall, median survival time after development of advanced HF was 13.1 (3.9-33.1) months; mortality did not vary by diabetes status (aHR 1.06, 95% CI 0.90-1.25; P = 0.45) or by glycated hemoglobin levels in those with diabetes (aHR 1.01 per 1% increase, 95% CI 0.93-1.10; P = 0.82). However, patients with diabetes and 4 (aHR 1.24, 95% CI 0.92-1.67) or 5-7 (aHR 1.49, 95% CI 1.09-2.03) diabetes complications were at increased risk of mortality compared to those with ≤ 3 complications.
Conclusions
More than one-third of patients with advanced HF have diabetes. In advanced HF, overall prognosis is poor, but we found no evidence that diabetes is associated with a significantly higher mortality risk.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:503-508
Dunlay SM, Killian JM, Mccoy RG, Redfield MM
J Card Fail: 28 Feb 2022; 28:503-508 | PMID: 34648970
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinical Implications of the Amyloidogenic V122I Transthyretin Variant in the General Population.

Kozlitina J, Garg S, Drazner MH, Matulevicius SA, ... de Lemos JA, Grodin JL
Background
The V122I variant in transthyretin (TTR) is the most common amyloidogenic mutation worldwide. The aim of this study is to describe the cardiac phenotype and risk for adverse cardiovascular outcomes of young V122I TTR carriers in the general population.
Methods and results
TTR genotypes were extracted from whole-exome sequence data in participants of the Dallas Heart Study. Participants with African ancestry, available V122I TTR genotypes (N = 1818) and either cardiac magnetic resonance imaging (n = 1364) or long-term follow-up (n = 1532) were included. The prevalence of V122I TTR carriers (45 ± 10 years) was 3.2% (n/N = 59/1818). The V122I TTR carriers had higher baseline left ventricular wall thickness (8.52 ± 1.82 vs 8.21 ± 1.62 mm, adjusted P = .038) than noncarriers, but no differences in other cardiac magnetic resonance imaging measures (P > .05 for all). Although carrier status was not associated with amino terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline (P = .79), V122I TTR carriers had a greater increase in NT-proBNP on follow-up than noncarriers (median 28.5 pg/mL, interquartile range 11.4-104.1 pg/mL vs median 15.9 pg/mL, interquartile range 0.0-43.0 pg/mL, adjusted P = .018). V122I TTR carriers were at a higher adjusted risk of heart failure (hazard ratio 3.82, 95% confidence interval 1.80-8.13, P < .001), cardiovascular death (hazard ratio 2.65, 95% confidence interval 1.14-6.15, P = .023), and all-cause mortality (hazard ratio 1.95, 95% confidence interval 1.08-3.51, P = .026) in comparison with noncarriers.
Conclusions
V122I TTR carrier status was associated with a greater increase in NT-proBNP, slightly greater left ventricular wall thickness, and a higher risk for heart failure, cardiovascular death, and all-cause mortality. These findings suggest the need to develop amyloidosis screening strategies for V122I TTR carriers.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:403-414
Kozlitina J, Garg S, Drazner MH, Matulevicius SA, ... de Lemos JA, Grodin JL
J Card Fail: 28 Feb 2022; 28:403-414 | PMID: 34634447
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Hospitalization for Heart Failure in the United States, UK, Taiwan, and Japan: An International Comparison of Administrative Health Records on 413,385 Individual Patients.

Sundaram V, Nagai T, Chiang CE, Reddy YNV, ... Sahadevan J, Quint JK
Background
Registries show international variations in the characteristics and outcome of patients with heart failure (HF), but national samples are rarely large, and case selection may be biased owing to enrolment in academic centers. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, health care resource use (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from 4 high-income countries (United States, UK, Taiwan, Japan) on 3 continents.
Methods and results
We used electronic health record to identify unplanned HFH between 2012 and 2014. We identified 231,512, 10,991, 36,900, and 133,982 patients with a primary HFH from the United States, the UK, Taiwan, and Japan, respectively. HFH per 100,000 population was highest in the United States and lowest in Taiwan. Fewer patients in Taiwan and Japan were obese or had chronic kidney disease. The length of hospital stay was shortest in the United States (median 4 days) and longer in the UK, Taiwan, and Japan (medians of 7, 9, and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in the United States (direct standardized rates 1.8, 95% confidence interval 1.7%-1.9%) and progressively higher in Taiwan (direct standardized rates 3.9, 95% CI 3.8%-4.1%), the UK (direct standardized rates 6.4, 95% CI 6.1%-6.7%), and Japan (direct standardized rates 6.7, 95% CI 6.6%-6.8%). The 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in the United States and lowest in Japan (11.9% and 5.1%, respectively).
Conclusions
Marked international variations in patient characteristics, HRU, and clinical outcomes exist; understanding them might inform health care policy and international trial design.

Published by Elsevier Inc.

J Card Fail: 28 Feb 2022; 28:353-366
Sundaram V, Nagai T, Chiang CE, Reddy YNV, ... Sahadevan J, Quint JK
J Card Fail: 28 Feb 2022; 28:353-366 | PMID: 34634448
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates.

Sims DB, Kim Y, Kalininskiy A, Yanamandala M, ... Shah A, Jorde UP
Background
Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists is associated with decreased mortality is unclear.
Methods and results
A retrospective review of consecutive CICU admissions from January 1, 2012, to December 31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed by any cardiologist to a closed unit managed by HF specialists. Patients\' baseline characteristics were determined, and a multivariate regression analysis was performed to ascertain mortality rates in the CICU. Baseline severity of illness was higher in the closed/HF specialist CICU model (P< 0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1-4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43-0.93). Prespecified interaction with a mechanical circulatory support device and unit model showed that treatment with such a device was associated with lower mortality rates in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18-0.78; P for interaction <0.01).
Conclusion
Transition to a closed unit model staffed by a dedicated HF specialist is associated with lower CICU mortality rates.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:394-402
Sims DB, Kim Y, Kalininskiy A, Yanamandala M, ... Shah A, Jorde UP
J Card Fail: 28 Feb 2022; 28:394-402 | PMID: 34634449
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Sex Differences in Heart Failure.

Lala A, Tayal U, Hamo CE, Youmans Q, ... Yancy C, Gulati M
Heart failure (HF) continues to be a major contributor of morbidity and mortality for men and women alike, yet how the predisposition for, course and management of HF differ between men and women remains underexplored. Sex differences in traditional risk factors as well as sex-specific risk factors influence the prevalence and manifestation of HF in unique ways. The pathophysiology of HF differs between men and women and may explain sex-specific differences in clinical presentation and diagnosis. This in turn, contributes to variation in response to both pharmacologic and device/surgical therapy. This review examines sex-specific differences in HF spanning prevalence, risk factors, pathophysiology, presentation, and therapies with a specific focus on highlighting gaps in knowledge with calls to action for future research efforts.

Copyright © 2021. Published by Elsevier Inc.

J Card Fail: 28 Feb 2022; 28:477-498
Lala A, Tayal U, Hamo CE, Youmans Q, ... Yancy C, Gulati M
J Card Fail: 28 Feb 2022; 28:477-498 | PMID: 34774749
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Comparative effectiveness of cardiac resynchronization therapy in older patients with heart failure: Systematic review and meta-analysis.

Juggan S, Ponnamreddy PK, Reilly CA, Dodge SE, Gilstrap LG, Zeitler EP
Background
Pivotal CRT trials enrolled patients with HFrEF significantly younger than the typical contemporary patient with HFrEF. Thus, the risks and benefits in this older population with HFrEF are largely unknown. We sought to perform meta-analyses comparing safety and effectiveness of cardiac resynchronization therapy (CRT) in older vs younger patients with heart failure with reduced ejection fraction (HFrEF).
Methods and results
PubMed, The Cochrane Library, Scopus, and Web of Science were queried for comparative effectiveness studies of CRT in older patients with HFrEF. Title, abstract, and full-text screening was performed to identify studies comparing at least 1 prespecified end point between older and younger adult patients with at least 50 participants. Random effects meta-analysis in the left ventricular ejection fraction (LVEF) mean difference (older minus younger) and the relative risk (RR) of death, improvement in New York Heart Association (NYHA) functional class, and complications are reported along with estimates of heterogeneity. In 7 studies, there was similar LVEF improvement between groups (mean difference 1.14, 95% confidence interval [CI] -0.04 to 2.32, P = .06, I2 = 53%). Older patients were equally likely as younger patients to see an improvement in NYHA functional class of at least 1 in 6 studies (RR 0.99, 95% CI 0.93-1.06, P = .76, I2 = 25%). No significant differences in the incidence of hematoma, pneumothorax, lead dislodgment, cardiac perforation, or infection requiring explant was observed. The RR of mortality in 11 studies demonstrated higher risk of all-cause mortality in older patients (RR 1.05, 95% CI 1.03-1.08, P < .01, I2 = 0%).
Conclusions
Compared with younger patients, older patients receiving CRT were equally likely to experience improvement in LVEF, left ventricular end-diastolic diameter, and NYHA functional class. There was no difference in procedural complications. The higher rate of all-cause mortality in older patients likely reflects a greater underlying risk of death from competing causes.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:443-452
Juggan S, Ponnamreddy PK, Reilly CA, Dodge SE, Gilstrap LG, Zeitler EP
J Card Fail: 28 Feb 2022; 28:443-452 | PMID: 34774750
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Comparative Effectiveness of Dosing of Medical Therapy for Heart Failure: From the CHAMP-HF Registry.

Greene SJ, Butler J, Hellkamp AS, Spertus JA, ... Hernandez AF, Fonarow GC
Background
The comparative effectiveness of differing dosages of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) on clinical and patient-reported outcomes in clinical practice in the United States is unknown. This study sought to characterize associations between the dosing of GDMT and outcomes for patients with HFrEF in U.S. clinical practice.
Methods
This analysis included 4832 outpatients who had chronic HFrEF across 150 practices in the U.S. in the Change the Management of Patients with Heart Failure (CHAMP-HF) registry with no contraindication and available dosing data for at least 1 GDMT at baseline. Baseline dosing of angiotensin-converting enzyme (ACEI)/angiotensin II receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA) therapies were examined. For each medication class, multivariable models assessed associations between medication dosing and clinical outcomes over 24 months (all-cause mortality, HF hospitalization) and patient-reported outcomes at 12 months (change in the Kansas City Cardiomyopathy Questionnaire Overall Summary score [KCCQ-OS]).
Results
After adjustment, compared with target dosing, lower dosing was associated with higher all-cause mortality for ACEIs/ARBs/ARNIs (50% to < 100% target dosage, HR 1.16 [95% CI 0.87-1.55]; < 50% target dosage, HR 1.37 [95% CI 1.05-1.79]; none, HR 1.75 [95% CI 1.32-2.34; overall P< 0.001) and beta-blockers (50% to < 100% target dosage, HR 1.30 [95% CI 1.00-1.69]; < 50% target dosage, HR 1.41 [95% CI 1.11-1.79; none, HR 1.24 [95% CI 0.92-1.67]; overall P= 0.042). Lower dosing of ACEIs/ARBs/ARNIs was independently associated with higher risk of HF hospitalization (50% to < 100% target dosage, HR 1.08 [95% CI 0.90-1.30]; < 50% target dosage, HR 1.23 [1.04-1.47]; none, HR 1.29 [1.04-1.60]; overall P= 0.046), but beta-blocker dosing was not (overall P= 0.085). Target dosing of MRAs was not associated with risk of mortality or HF hospitalization. For each GDMT, compared with target dosing, lower dosing was not associated with change in the KCCQ-OS at 12 months, with the potential exception of worsening KCCQ-OS scores with lower dosing of ACEIs/ARBs/ARNIs.
Conclusions
In this contemporary U.S. outpatient HFrEF registry, target dosing of ACEI/ARB/ARNI and beta-blocker therapy was associated with reduced mortality and was variably associated with HF hospitalization and patient-reported outcomes. MRA dosing was not associated with outcomes. The totality of these findings support the benefits of target dosing of GDMT in routine practice, as tolerated, with unmeasured differences among patients receiving differing dosages potentially explaining the differing results seen here compared with randomized clinical trials.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 28 Feb 2022; 28:370-384
Greene SJ, Butler J, Hellkamp AS, Spertus JA, ... Hernandez AF, Fonarow GC
J Card Fail: 28 Feb 2022; 28:370-384 | PMID: 34793971
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Renal Hemodynamics and Renin-Angiotensin-Aldosterone System Profiles in Patients With Heart Failure.

Lytvyn Y, Burns KD, Testani JM, Lytvyn A, ... Cherney DZI, Parker JD
Objective
Understanding cardiorenal pathophysiology in heart failure (HF) is of clinical importance. We sought to characterize the renal hemodynamic function and the transrenal gradient of the renin-angiotensin-aldosterone system (RAAS) markers in patients with HF and in controls without HF.
Methods
In this post hoc analysis, the glomerular filtration rate (GFRinulin), effective renal plasma flow (ERPFPAH) and transrenal gradients (arterial-renal vein) of angiotensin converting enzyme (ACE), aldosterone, and plasma renin activity (PRA) were measured in 47 patients with HF and in 24 controls. Gomez equations were used to derive afferent (RA) and efferent (RE) arteriolar resistances. Transrenal RAAS gradients were also collected in patients treated with intravenous dobutamine (HF, n = 11; non-HF, n = 11) or nitroprusside (HF, n = 18; non-HF, n = 5).
Results
The concentrations of PRA, aldosterone and ACE were higher in the renal vein vs the artery in patients with HF vs patients without HF (P < 0.01). In patients with HF, a greater ACE gradient was associated with greater renal vascular resistance (r = 0.42; P 0.007) and greater arteriolar resistances (RA: r = 0.39; P = 0.012; RE: r = 0.48; P = 0.002). Similarly, a greater aldosterone gradient was associated with lower GFR (r = -0.51; P = 0.0007) and renal blood flow (RBF), r = -0.32; P = 0.042) whereas greater PRA gradient with lower ERPF (r = -0.33; P = 0.040), GFR (r = -0.36; P = 0.024), and RBF (r = -0.33; P = 0.036). Dobutamine and nitroprusside treatment decreased the transrenal gradient of ACE (P = 0.012, P < 0.0001, respectively), aldosterone (P = 0.005, P = 0.030) and PRA (P = 0.014, P = 0.002) in patients with HF only.
Conclusions
A larger transrenal RAAS marker gradient in patients with HF suggests a renal origin for neurohormonal activation associated with a vasoconstrictive renal profile.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 27 Feb 2022; 28:385-393
Lytvyn Y, Burns KD, Testani JM, Lytvyn A, ... Cherney DZI, Parker JD
J Card Fail: 27 Feb 2022; 28:385-393 | PMID: 34487814
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Why Levosimendan Improves the Clinical Condition of Patients With Advanced Heart Failure: A Holistic Approach.

Apostolo A, Vignati C, Della Rocca M, De Martino F, ... Pezzuto B, Agostoni P
Background
In advanced heart failure (HF), levosimendan increases peak oxygen uptake (VO2). We investigated whether peak VO2 increase is linked to cardiovascular, respiratory, or muscular performance changes.
Methods and results
Twenty patients hospitalized for advanced HF underwent, before and shortly after levosimendan infusion, 2 different cardiopulmonary exercise tests: (a) a personalized ramp protocol with repeated arterial blood gas analysis and standard spirometry including alveolar-capillary gas diffusion measurements at rest and at peak exercise, and (b) a step incremental workload cardiopulmonary exercise testing with continuous near-infrared spectroscopy analysis and cardiac output assessment by bioelectrical impedance analysis.Levosimendan significantly decreased natriuretic peptides, improved peak VO2 (11.3 [interquartile range 10.1-12.8] to 12.6 [10.2-14.4] mL/kg/min, P < .01) and decreased minute ventilation to carbon dioxide production relationship slope (47.7 ± 10.7 to 43.4 ± 8.1, P < .01). In parallel, spirometry showed only a minor increase in forced expiratory volume, whereas the peak exercise dead space ventilation was unchanged. However, during exercise, a smaller edema formation was observed after levosimendan infusion, as inferable from the changes in diffusion components, that is, the membrane diffusion and capillary volume. The end-tidal pressure of CO2 during the isocapnic buffering period increased after levosimendan (from 28 ± 3 mm Hg to 31 ± 2 mm Hg, P < .01). During exercise, cardiac output increased in parallel with VO2. After levosimendan, the total and oxygenated tissue hemoglobin, but not deoxygenated hemoglobin, increased in all exercise phases.
Conclusions
In advanced HF, levosimendan increases peak VO2, decreases the formation of exercise-induced lung edema, increases ventilation efficiency owing to a decrease of reflex hyperventilation, and increases cardiac output and muscular oxygen delivery and extraction.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 27 Feb 2022; 28:509-514
Apostolo A, Vignati C, Della Rocca M, De Martino F, ... Pezzuto B, Agostoni P
J Card Fail: 27 Feb 2022; 28:509-514 | PMID: 34763079
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Innovations in Heart Transplantation: A Review.

Coniglio AC, Patel CB, Kittleson M, Schlendorf K, Schroder JN, DeVore AD
Advanced heart failure affects tens of thousands of people in the United States alone with high morbidity and mortality. Cardiac transplantation offers the best treatment strategy, but has been limited historically by donor availability. Recently, there have been significant advances in organ allocation, donor-recipient matching, organ preservation, and expansion of the donor pool. The current heart allocation system prioritizes the sickest patients to minimize waitlist mortality. Advances in donor organ selection, including predicted heart mass calculations and more sophisticated antibody detection methods for allosensitized patients, offer more effective matching of donors and recipients. Innovations in organ preservation such as with organ preservation systems have widened the donor pool geographically. The use of donors with hepatitis C is possible with the advent of effective direct-acting antiviral agents to cure donor-transmitted hepatitis C. Finally, further expansion of the donor pool is occurring with the use of higher risk donors with advanced age, medical comorbidities, and left ventricular dysfunction and advances in donation after circulatory death. This review provides an update on the new technologies and transplantation strategies that serve to widen the donor pool and more effectively match donors and recipients so that heart transplant candidates may derive the best outcomes from heart transplantation.

Copyright © 2021 Elsevier Inc. All rights reserved.

J Card Fail: 27 Feb 2022; 28:467-476
Coniglio AC, Patel CB, Kittleson M, Schlendorf K, Schroder JN, DeVore AD
J Card Fail: 27 Feb 2022; 28:467-476 | PMID: 34752907
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:

This program is still in alpha version.