Journal: J Card Fail

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Abstract

Mortality and Heart Failure Hospitalization Among Young Adults With and Without Cardiogenic Shock after Acute Myocardial Infarction.

Siddiqi HK, DeFilippis EM, Biery DW, Singh A, ... Bhatt DL, Blankstein R
Objectives
To investigate risk factors and outcomes of cardiogenic shock complicating acute myocardial infarction (AMI-CS) in young AMI patients.
Background
AMI-CS is associated with high morbidity and mortality. Data regarding AMI-CS in younger individuals are limited.
Methods and results
Consecutive type 1 AMI patients aged 18-50 years admitted to two large tertiary care academic centers were included and CS adjudicated by physician review of electronic medical records using the Society for Cardiovascular Angiography and Interventions (SCAI) CS classification system. Outcomes included all-cause mortality (ACM), cardiovascular mortality (CVM) and 1-year hospitalization for heart failure (HHF). In addition to using the full population, matching was also used to define a comparator group in the non-CS cohort. Among 2097 patients (mean age 44 ± 5.1 years, 74% white, 19% female), AMI-CS was present in 148 (7%). Independent risk factors of AMI-CS included STEMI, left main disease, out of hospital cardiac arrest, female sex, peripheral vascular disease and diabetes. Over median follow-up of 11.2 years, young AMI-CS patients had a significantly higher risk of ACM (adjusted HR 2.84, 95% CI 1.68-4.81, p<0.001), CVM (adjusted HR 4.01, 95% CI 2.17-7.71, p<0.001), and 1-year HHF (adjusted HR 5.99, 95% CI 2.04-17.61, p=0.001) compared with matched non-AMI-CS patients. Over the course of the study, there was an increase in the incidence of AMI-CS among young MI patients as well as rising mortality for both AMI-CS and non-AMI-CS patients.
Conclusions
7% of young AMI patients developed AMI-CS, which was associated with a significantly elevated risk of mortality and HHF.
Brief lay summary
The epidemiology, characteristics and outcomes of young acute myocardial infarction (AMI) patients who develop cardiogenic shock (AMI-CS) is unknown. In this detailed analysis of 2097 patients in the YOUNG-MI registry, AMI patients under the age of 50 years had a 7% incidence of AMI-CS, a condition that was associated with poor short- and long-term outcomes in this population. ST-elevation myocardial infarction, left main disease, cardiac arrest, female sex, peripheral vascular disease and diabetes were all associated with risk of developing AMI-CS. The incidence of AMI-CS has been increasing despite advances in medical and surgical therapies.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 18 Sep 2022; epub ahead of print
Siddiqi HK, DeFilippis EM, Biery DW, Singh A, ... Bhatt DL, Blankstein R
J Card Fail: 18 Sep 2022; epub ahead of print | PMID: 36130688
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Abstract

Associations between Albuminuria, Estimated GFR and Cardiac Phenotype in a Cohort with Chronic Kidney Disease - The CPH-CKD ECHO Study.

Landler NE, Olsen FJ, Christensen J, Bro S, ... Gislason G, Biering-Sørensen T
Objective
Echocardiographic findings in chronic kidney disease (CKD) vary. We sought to estimate the prevalence of abnormal cardiac structure and function in patients with CKD and their association to estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (UACR).
Methods
We prospectively enrolled 825 outpatients with non-dialysis-dependent CKD, mean age 58± 13 yrs, and 175 matched healthy controls, mean age 60±12 yrs. Echocardiography included assessment of left ventricular (LV) hypertrophy, LV ejection fraction (LVEF), global longitudinal strain (GLS) and diastolic dysfunction according to ASE/EACVI guidelines.
Results
LV hypertrophy was found in 9% of patients vs. 1.7% of controls (p=0.005) was independently associated with UACR (p=0.002). Median LVEF was 59.4% (IQR 55.2, 62.8) in patients vs. 60.8% (57.7, 64.1) in controls (p=0.002). GLS was decreased in patients with eGFR <60ml/min/1.73m² (-17.6%±3.1%) vs. patients with higher eGFR (19.0%±2.2%, p<0.001), who were similar to controls. . Diastolic dysfunction was detected in 55% of patients and in 34% of controls.
Limitations
Non-random sampling, cross-sectional analysis.
Conclusions
We report lower prevalence of hypertrophy than previous studies, but similar measurements of systolic and diastolic function. Cardiac remodeling in CKD may be influenced by treatment modalities, demographics, comorbidities and renal pathology.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 17 Sep 2022; epub ahead of print
Landler NE, Olsen FJ, Christensen J, Bro S, ... Gislason G, Biering-Sørensen T
J Card Fail: 17 Sep 2022; epub ahead of print | PMID: 36126901
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Abstract

Palliative Inotropes in Advanced Heart Failure: Comparing Outcomes Between Milrinone and Dobutamine.

Sami F, Acharya P, Noonan G, Maurides S, ... Van Bakel A, Shah Z
Background
We sought to describe and compare outcomes among advanced heart failure patients (not candidates for OHT/LVAD) on long term milrinone or dobutamine which are not well studied in contemporary era.
Methods
We included adults with refractory stage D heart failure who were not candidates for OHT or LVAD and discharged on palliative dobutamine or milrinone. Primary outcome was 1 year survival. Six-month predictor of survival analysis was conducted.
Results
Total of 248 patients (133 on milrinone; 115 on dobutamine) were included. There were no differences in baseline comorbidities between milrinone and dobutamine cohorts, except prevalence of chronic kidney disease which was higher in dobutamine group. On discharge, proportion of patients on beta blocker and mineralocorticoid antagonist was higher in milrinone group. Overall, 1-year mortality was 70%. Dobutamine cohort had significantly higher 1 year mortality (84% vs 58%: p-value<0.001). Type of inotrope did not predict survival at 6-months when adjusted for discharge medications and comorbidities. Beta blockers and ACE/ARB/ARNI continued at discharge predicted survival at 6 months.
Conclusion
One-year mortality from palliative inotropes remains high. Compared to dobutamine, use of milrinone was associated with improved survival due to better optimization of GDMT, primarily beta blocker therapy.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 16 Sep 2022; epub ahead of print
Sami F, Acharya P, Noonan G, Maurides S, ... Van Bakel A, Shah Z
J Card Fail: 16 Sep 2022; epub ahead of print | PMID: 36122816
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Abstract

Atrial fibrillation, thromboembolic risk, and anticoagulation in cardiac amyloidosis: A review.

Bukhari S, Khan SZ, Bashir Z
Cardiac amyloidosis (CA) is caused by extracellular myocardial deposition of amyloid fibrils that are primary derived either from misfolding of transthyretin (ATTR) or light-chain (AL) proteins. CA is associated with atrial fibrillation (AF), potentiated by electromechanical changes as a result of amyloid infiltration in the myocardium. CA also predisposes to thromboembolism, and could potentially simultaneously elevate bleeding risk. In this review, we aim to explore and compare the prevalence and pathophysiological mechanisms of AF and thromboembolism in ATTR and AL, examine bleeding risk and factors that promote bleeding, and compare anticoagulation strategies in CA. Finally, we highlight knowledge gaps in the field of thromboembolism in CA to guide future research.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 16 Sep 2022; epub ahead of print
Bukhari S, Khan SZ, Bashir Z
J Card Fail: 16 Sep 2022; epub ahead of print | PMID: 36122817
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Abstract

Soluble Urokinase Plasminogen Activator Receptor Levels and Outcomes in Patients with Heart Failure.

Hayek SS, Tahhan AS, Ko YA, Alkhoder A, ... Reiser J, Quyyumi AA
Background
Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and pathogenic factor for kidney disease shown to predict cardiovascular outcomes including heart failure (HF) in various populations. We characterized suPAR levels in patients with HF and compared its ability to discriminate risk to that of B-type natriuretic peptide (BNP).
Methods and results
We measured plasma suPAR and BNP levels in 3,437 patients undergoing coronary angiogram and followed for a median of 6.2 years. We performed survival analyses for the following outcomes: all-cause death, cardiovascular death, and hospitalization for HF. We then assessed suPAR\'s ability to discriminate risk for the aforementioned outcomes. We identified 1116 patients with HF (age 65±12, 67.2% male, 20.0% Black, 67% with reduced ejection fraction). The median suPAR level was higher in HF compared to those without HF (3370 [IQR 2610-4371] vs. 2880 [IQR 2270-3670] pg/mL, respectively, P<0.001). In patients with HF, suPAR levels (log-base 2) were associated with outcomes including all-cause death (adjusted hazard ratio aHR 2.30, 95%CI[1.90-2.77]), cardiovascular death (aHR 2.33 95%CI[1.81-2.99]) and HF hospitalization (aHR 1.96, 95%CI[1.06-1.25]) independently of clinical characteristics and BNP levels. The association persisted across subgroups and did not differ between patients with reduced or preserved ejection fraction, or those with ischemic or non-ischemic cardiomyopathy. Addition of suPAR to a model including BNP levels significantly improved the C-statistic for death (Δ0.027), cardiovascular death (Δ0.017) and hospitalization for HF (Δ0.017).
Conclusions
SuPAR levels are higher in HF compared to non-HF, are strongly predictive of outcomes, and combined with BNP, significantly improved risk prediction.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 16 Sep 2022; epub ahead of print
Hayek SS, Tahhan AS, Ko YA, Alkhoder A, ... Reiser J, Quyyumi AA
J Card Fail: 16 Sep 2022; epub ahead of print | PMID: 36122818
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Abstract

Role of Cardiac Contractility Modulation in Heart Failure with a Higher Ejection Fraction.

Talha KM, Anker SD, Burkhoff D, Filippatos G, ... Wazni O, Butler J
Cardiac Contractility Modulation (also known as CCM) is a novel device therapy that delivers non-excitatory electric stimulation to cardiac myocytes during the absolute refractory period and has been shown to improve functional status and clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). CCM therapy is currently recommended for a subset of patients with advanced HFrEF that are not candidates for cardiac resynchronisation therapy. A growing body of evidence demonstrates the benefit of CCM therapy in HFrEF patients with ejection fraction at the upper end of the spectrum and in patients with HF with mildly reduced ejection fraction (HFmrEF). Experimental studies have also observed reversal of pathological biomolecular intra-cellular changes with CCM therapy in HF with preserved ejection fraction (HFpEF), indicating the potential for clinically meaningful benefit of CCM therapy in these patients. In this review, we sought to discuss the basis of CCM therapy and its potential for management of patients with HF with higher ejection fractions.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 16 Sep 2022; epub ahead of print
Talha KM, Anker SD, Burkhoff D, Filippatos G, ... Wazni O, Butler J
J Card Fail: 16 Sep 2022; epub ahead of print | PMID: 36122819
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Abstract

Heart Failure Duration and Mechanistic Efficacy of Sacubitril/Valsartan in Heart Failure with Reduced Ejection Fraction.

Mohebi R, Liu Y, Michael Felker G, Prescott MF, ... Solomon SD, Januzzi JL
Background
Although sacubitril/valsartan (Sac/Val) is indicated for treatment of heart failure with reduced ejection fraction (HFrEF), gaps in care continue to exist for those with newer-onset HFrEF versus those with longer durations of disease.
Methods and results
794 persons with HFrEF (EF≤40 %) were categorized according to HF duration <12 months, 12-24 months, 24-60 months, and > 60 months. Following initiation of Sac/Val, concentrations of N-terminal pro-B type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hs-cTnT), and soluble ST2 were measured, and Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 scores were obtained serially from baseline to 12 months. Left ventricular ejection fraction (LVEF) was measured by echocardiography. Significant reductions in concentrations of NT-proBNP, hs-cTnT, and soluble ST2 were observed regardless of HF duration (P <0.001). Comparable gains in KCCQ-23 scores were achieved in all HF duration categories. Moreover, consistent reverse cardiac remodeling in all HF duration categories occurred, with the absolute LVEF improvement by 12 months across HF duration groups of 12.2%, 6.9%, 8.5%, and 8.6% for HF duration <12 months, 12-24 months, 24-60 months, and > 60 months respectively.
Conclusion
Initiation of Sac/Val lowers prognostic biomarkers, improves health status, reverses cardiac remodeling processes, regardless of HF duration.
Brief lay summary
We categorized 794 persons with heart failure due to a low ejection fraction according to disease duration into 4 groups; <12 months, 12-24 months, 24-60 months, and > 60 months. Following initiation of Entresto we found that regardless of duration of heart failure significant improvements occurred in cardiac biomarkers, patients felt better with improved health status and on testing with cardiac ultrasound, improvement in the heart size and function occurred. These results suggest that regardless of heart failure duration, patients with reduced ejection fraction would benefit from use of Entresto for their care.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 16 Sep 2022; epub ahead of print
Mohebi R, Liu Y, Michael Felker G, Prescott MF, ... Solomon SD, Januzzi JL
J Card Fail: 16 Sep 2022; epub ahead of print | PMID: 36122820
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Abstract

Bioimpedance indices of fluid overload and cardiorenal outcomes in heart failure and chronic kidney disease: a systematic review.

Mayne KJ, Shemilt R, Keane DF, Lees JS, Mark PB, Herrington WG
Background
Bioimpedance-based estimates of fluid overload have been widely studied and systematically reviewed in dialysis populations, but data from heart failure or non-dialysis chronic kidney disease (CKD) populations have not.
Methods and results
We conducted a systematic review of studies using whole-body bioimpedance from heart failure and non-dialysis CKD populations which reported associations with mortality, cardiovascular outcomes and/or CKD progression. We searched MEDLINE, Embase databases and the Cochrane CENTRAL registry from inception to 14th March 2022. Thirty one eligible studies were identified: 20 heart failure and 11 CKD cohorts, with 2 studies including over 1000 participants. A wide range of different bioimpedance methods were used across the studies (heart failure: 8 parameters; CKD: 6). Studies generally reported positive associations, but between-study differences in bioimpedance methods, fluid overload exposure definitions, and modelling approaches precluded meta-analysis. The largest identified study was in non-dialysis CKD (Chronic Renal Insufficiency Cohort, 3751 participants) which reported adjusted hazard ratios (95% confidence intervals) for phase angle <5.59 versus ≥6.4 of 2.02 (1.67-2.43) for all-cause mortality; 1.80 (1.46-2.23) for heart failure events; and 1.78 (1.56-2.04) for CKD progression.
Conclusions
Bioimpedance indices of fluid overload are associated with risk of important cardiorenal outcomes in heart failure and CKD. Facilitation of more widespread use of bioimpedance needs consensus on the optimum device, standardized analytical methods, and larger studies including more detailed characterization of cardiac and renal phenotypes.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 26 Aug 2022; epub ahead of print
Mayne KJ, Shemilt R, Keane DF, Lees JS, Mark PB, Herrington WG
J Card Fail: 26 Aug 2022; epub ahead of print | PMID: 36038013
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Abstract

Vitamin D Levels in Black Americans and the Association with Left Ventricular Remodeling and.

Kamimura D, Yimer WK, Shah AM, Mentz RJ, ... Butler J, Hall ME
Background
In observational studies, lower serum vitamin D3 (VitD3) concentration has been associated with increased risk of cardiovascular disease. However, the associations between serum VitD3 levels and left ventricular (LV) structure and heart failure with preserved ejection fraction (HFpEF) have not been well-characterized among Black Americans. The prevalence of VitD3 deficiency is higher among Black Americans than in other race/ethnicity groups. We hypothesized that serum VitD3 levels are associated with LV concentric remodeling and incident HFpEF in Black Americans.
Methods and results
Among 5306 Black Americans in the Jackson Heart Study cohort, we investigated the relationships between serum VitD3 levels and LV structure and function, evaluated with echocardiography, and incident HF hospitalization, categorized as either HF with reduced EF (HFrEF: EF<50%) or HFpEF (EF≥50༅). After adjustment for possible confounding factors, lower VitD3 levels were associated with greater relative wall thickness (β for 1 SD increase: -0.003, 95%CI -0.005ཞ-0.000). Over a median follow-up period of 11 (10.2-11) years, 340 participants developed incident HF (7.88 cases per 1,000 person-years), including 146 (43%) HFrEF and 194 (57%) HFpEF cases. After adjustment, higher serum Vitd3 levels were associated with decreased hazard for HF overall (HR for 1 SD increase: 0.88, 95%CI0.78ཞ0.99) driven by a significant association with HFpEF (HR for 1 SD increase: 0.84, 95%CI 0.71ཞ0.99).
Conclusion
In this community-based Black American cohort, lower serum VitD3 levels were associated with LV concentric remodeling and increased hazard for HF, mainly HFpEF. Further investigation is required to examine whether supplementation of VitD3 can prevent LV concentric remodeling and incident HFpEF in Black Americans.

Copyright © 2022 Elsevier Ltd. All rights reserved.

J Card Fail: 26 Jul 2022; epub ahead of print
Kamimura D, Yimer WK, Shah AM, Mentz RJ, ... Butler J, Hall ME
J Card Fail: 26 Jul 2022; epub ahead of print | PMID: 35905866
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Abstract

The Association of Digital Health Application Use with Heart Failure Care and Outcomes: Insights from CONNECT-HF.

Rao VN, Kaltenbach LA, Granger BB, Fonarow GC, ... Hernandez AF, DeVore AD
Background
It is unknown if digital applications may improve guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF).
Methods and results
CONNECT-HF included an optional, prospective ancillary study of a mobile health application among hospitalized patients for HFrEF. Digital users were matched to nonusers from the usual care group. Co-primary outcomes included change in opportunity-based composite HF quality scores and HF rehospitalization or all-cause mortality. Among 2,431 patients offered digital applications across the United States, 1,526 (63%) had limited digital access or insufficient data, 425 (17%) were digital users, and 480 (20%) declined use. Digital users were similar in age to those who declined use (mean 58 vs. 60 years, p=0.031). Digital users (N=368) versus matched nonusers (N=368) had improved composite HF quality scores (48.0% vs. 43.6%; +4.76% [3.27-6.24]; p=0.001) and composite clinical outcomes (33.0% vs. 39.6%; HR 0.76 [0.59-0.97]; p=0.027).
Conclusions
Among participants in CONNECT-HF, use of digital applications was modest, yet associated with higher HF quality of care scores, including use of GDMT, and better clinical outcomes. While cause and effect cannot be determined from this study, the application of technology to guide GDMT use and dosing among patients with HFrEF warrants further investigation.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 26 Jul 2022; epub ahead of print
Rao VN, Kaltenbach LA, Granger BB, Fonarow GC, ... Hernandez AF, DeVore AD
J Card Fail: 26 Jul 2022; epub ahead of print | PMID: 35905867
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Abstract

Guideline Directed Medical Therapy in Newly Diagnosed Heart Failure with Reduced Ejection Fraction in the Community.

Dunlay SM, Killian JM, Roger VL, Schulte PJ, ... Savitz ST, Redfield MM
Background
Guideline-directed medical therapy (GDMT) dramatically improves outcomes in heart failure with reduced ejection fraction (HFrEF). Our goal was to examine GDMT use in community patients with newly diagnosed HFrEF.
Methods and results
We performed a population-based, retrospective cohort study of all Olmsted County, Minnesota residents with newly diagnosed HFrEF (EF≤40%) 2007-2017. We excluded patients with contraindications to medication initiation. We examined use of beta blockers, HF beta blockers (metoprolol succinate, carvedilol, bisoprolol), ACEi/ARB/ARNI, and MRA in the first year after HFrEF diagnosis. We used Cox models to evaluate the association of being seen in a HF clinic with initiation of GDMT. From 2007-2017, 1160 patients were diagnosed with HFrEF (mean age 69.7 years, 65.6% men). Most eligible patients received beta blockers (92.6%) and ACEi/ARB/ARNI (87.0%) in the first year. However, only 63.8% of patients were treated with a HF beta blocker, and few received MRAs (17.6%). In models accounting for the role of HF clinic in initiation of these medications, being seen in a HF clinic was independently associated with initiation of new GDMT across all medication classes, with HR (95% CI) of 1.54 (1.15-2.06)for any beta blocker, 2.49 (1.95-3.20) for HF beta blockers, 1.97 (1.46-2.65) for ACEi/ARB/ARNI, and 2.14 (1.49-3.08) for MRAs.
Conclusions
In this population-based study, most patients with newly diagnosed HFrEF received beta blockers and ACEi/ARB/ARNIs. GDMT use was higher in patients seen in a HF clinic, suggesting potential benefit of referral to a HF clinic for patients with newly diagnosed HFrEF.

Copyright © 2022 Elsevier Ltd. All rights reserved.

J Card Fail: 25 Jul 2022; epub ahead of print
Dunlay SM, Killian JM, Roger VL, Schulte PJ, ... Savitz ST, Redfield MM
J Card Fail: 25 Jul 2022; epub ahead of print | PMID: 35902033
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Abstract

Electrical Dyssynchrony in Cardiac Amyloidosis - Prevalence, Predictors, Clinical Correlates, and Outcomes.

Martens P, Hanna M, Valent J, Mullens W, ... Rickard J, Wilson Tang WH
Background
Conduction system involvement in cardiac amyloidosis (CA) is common. The prevalence, clinical correlates and impact on outcome related to ventricular electrical dyssynchrony in CA remain insufficiently elucidated.
Methods
Data from a prospectively maintained registry of CA patients diagnosed in the Cleveland Clinic amyloidosis clinic was used to determine the frequency of ED (defined as a QRS >130msec). The relation with the clinical profile and clinical outcome was assessed. To determine the impact of hypertrophy on QRS prolongation a QRS matched cohort without CA was used for cardiac magnetic resonance imaging comparison.
Results
A total of 1,140 CA-patients (39%AL, 61% TTR) were evaluated, of whom 230 (20%) had electrical dyssynchrony. The type of conduction block was predominantly a right bundle branch block (BBB, 48%) followed by left BBB (35%) and intraventricular conduction delay (17%). Presence of transthyretin amyloidosis (ATTR-CA), older age, male gender, white race, and coronary artery disease were independently (p<0.05 for all) associated with electrical dyssynchrony and patients were more often prescribed mineralocorticoid receptor antagonist. In ATTR-CA specifically, every increase in ATTR-CA disease stage was associated with a 1.55-fold (1.23-1.95, p<0.001) increased odds for electrical dyssynchrony. In a subset of CA patients who underwent cardiac magnetic resonance imaging (n=41), left ventricular mass index was unrelated to the QRS duration (r=0.187, p=0.283) in CA, in contrast to a non-CA QRS-matched cohort (r=0.397, p<0.001). Patients with electrical dyssynchrony were more symptomatic at initial presentation as illustrated by a higher NYHA class (p=0.041). During a median follow-up of 462 days (IQR:138-996 days), a higher proportion of electrical dyssynchrony patients died from all-cause death (p=0.037) or developed a permanent pacing indication (3% vs 10.4%, p<0.001) during follow-up.
Conclusion
Electrical dyssynchrony is common in CA especially in ATTR-CA and is associated with worse functional status and clinical outcome. Given the high rate of permanent pacing indications at follow-up, additional studies are necessary to determine best monitoring and pacing strategies in CA.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 23 Jul 2022; epub ahead of print
Martens P, Hanna M, Valent J, Mullens W, ... Rickard J, Wilson Tang WH
J Card Fail: 23 Jul 2022; epub ahead of print | PMID: 35882259
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Abstract

A randomized controlled trial of mobile health intervention in patients with heart failure and diabetes.

Felker GM, Sharma A, Mentz RJ, She L, ... Ilkayeva O, Shah SH
Background
Mobile health (mHealth) platforms can affect health behaviors but have not been rigorously tested in randomized trials.
Objectives
We sought to evaluate the effectiveness of a pragmatic mHealth intervention in patients with HF and DM
Methods:
We conducted a multicenter randomized trial in 187 patients with both HF and DM to assessing a mHealth intervention to improve physical activity and medication adherence compared to usual care. The primary endpoint was change in mean daily step count from baseline through 3 months. Other outcomes included medication adherence, health related quality of life, and metabolomic profiling.
Results
The mHealth group had an increase in daily step count of 151 steps/day at 3 months whereas the usual care group had a decline of 162 steps/day (LS-mean between-group difference = 313 steps/day; 95% CI: 8, 619, p = 0.044). Medication adherence measured using the Voils Adherence Questionnaire did not change from baseline to 3 months (LS-mean change -0.08 in mHealth vs. -0.15 in usual care, p = 0.47). The mHealth group had an improvement in Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) compared to the usual care group (LS-mean difference = 5.5 points, 95% CI: 1.4, 9.6, p = 0.009). Thirteen metabolites, primarily medium- and long-chain acylcarnitines, changed differently between treatment groups from baseline to 3 months (p < 0.05).
Conclusions
In patients with HF and DM, a 3-month mHealth intervention significantly improved daily physical activity, health related quality of life and metabolomic markers of cardiovascular health, but not medication adherence.
Clinicaltrials
gov Identifier: NCT02918175 Condensed Abstract: Heart failure (HF) and diabetes (DM) have overlapping biologic and behavioral risk factors. We conducted a multicenter randomized, clinical trial in 187 patients with both HF (regardless of ejection fraction) and DM to assess whether a mHealth intervention could improve physical activity and medication adherence. The mHealth group had an increase in mean daily step count and quality of life but not medication adherence. Medium- and long-chain acylcarnitines changed differently between treatment groups from baseline to 3 months (p < 0.05). These data have important implications for designing effective lifestyle interventions in HF and DM.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 23 Jul 2022; epub ahead of print
Felker GM, Sharma A, Mentz RJ, She L, ... Ilkayeva O, Shah SH
J Card Fail: 23 Jul 2022; epub ahead of print | PMID: 35882260
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Abstract

The Intersection between Heart Failure and Critical Care Cardiology: An International Perspective on Structure, Staffing, and Design Considerations.

Sinha SS, Bohula EA, van Diepen S, Leonardi S, ... Lopes RD, Katz JN
The overall patient population in contemporary Cardiac Intensive Care Units (CICUs) has only increased with respect to patient acuity, complexity, and illness severity. The current population has more cardiac and non-cardiac comorbidities, a higher prevalence of multi-organ injury, and consumes more critical care resources than previously. Heart failure (HF) patients now occupy a large portion of contemporary tertiary or quaternary care CICU beds around the world. In this review, we will discuss core issues that relate to care of critically ill HF patients, including global perspectives on the organization, designation, and collaboration of CICUs regionally and across institutions, as well as unique models for provisioning care for HF patients within a healthcare setting. The latter will include a discussion of traditional and emerging models, specialized heart failure units, the makeup and implementation of multidisciplinary team-based decision-making, and cardiac critical care admission and triage practices. This manuscript will illustrate the ways in which critically ill HF patients have helped to shape contemporary CICUs throughout the world and explore how these very patients will similarly help to inform the future maturation of these specialized critical care units. Finally, we will critically examine broad, contemporary international models of heart failure and cardiac critical care delivery in North America, Europe, South America, and Asia, and conclude with opportunities for further investigation and generation of evidence for care delivery.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Jul 2022; epub ahead of print
Sinha SS, Bohula EA, van Diepen S, Leonardi S, ... Lopes RD, Katz JN
J Card Fail: 14 Jul 2022; epub ahead of print | PMID: 35843489
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Abstract

The Association of Cardiac Biomarkers, the Intensity of Tc99 Pyrophosphate Uptake, and Survival in Patients Evaluated for Transthyretin Cardiac Amyloidosis in the Early Therapeutics Era.

Martyn T, Saef J, Hussain M, Ives L, ... Hanna M, Jaber WA
Background
Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. Given the expansion of non-invasive diagnosis with 99mTc-pyrophosphate [99mTc-PYP] scanning, and clinical use of the transthyretin stabilizer, tafamidis, we sought to examine the interplay of planar imaging heart-to-contralateral lung (H/CL) ratio, cardiac biomarkers, and survival probability in a contemporary cohort of patients referred for non-invasive evaluation of ATTR-CM.
Methods
Single-Center retrospective cohort study of 351 consecutive patients who underwent a standardized imaging protocol with 99mTc-PYP scanning for the evaluation of ATTR-CM from January 1st 2018 to January 1st, 2020. After the exclusion of light chain amyloidosis, patients were characterized as scan consistent with ATTR (+ATTR-CM) or scan not consistent with ATTR (-ATTR-CM) using current guidelines. Linear regression was used to examine the relationship between biomarkers and H/CL and univariate Cox proportional hazards models were used to assess probability of transplant free survival.
Results
318 patients were included in the analysis (n=86 patients +ATTR-CM; n= 232 patients -ATTR-CM). Median time of follow-up was 20.1 months. 67% of +ATTR-CM received tafamidis during the study period (median treatment duration of 17 months). Median H/CL ratio was 1.58 [IQR1.40, 1.75]). H/CL ratio above or below 1.6 did not appear to have an impact on survival probability in +ATTR-CM patients (p = 0.30; HR, 0.65[95% CI, 0.31-1.41]. Cardiac biomarkers were poorly correlated with H/CL (Troponin T, R2 = 0.024; NT-proBNP - R2 =0.023). The Gillmore staging system predicted survival probability in +ATTR-CM as well as in the entire cohort referred for scanning. There was a trend toward longer survival among those who were -ATTR-CM compared to +ATTR-CM (p= 0.051; HR .64 [95% CI, 0.40-1.00]).
Conclusions
At a large referral center, the intensity of 99mTc-PYP uptake (H/CL ratio) has neither correlation with cardiac biomarker concentrations nor prognostic utility in an analysis of \"intermediate term\" outcomes in the early therapeutics era. H/CL ratio has diagnostic value, but offers little prognostic value in patients with ATTR-CM. Established staging schema were predictive of survival in this contemporary cohort, re-emphasizing the importance of cardiac biomarkers and renal function in assessing disease severity and prognosis.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 14 Jul 2022; epub ahead of print
Martyn T, Saef J, Hussain M, Ives L, ... Hanna M, Jaber WA
J Card Fail: 14 Jul 2022; epub ahead of print | PMID: 35843490
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Abstract

Palliative Care for Patients with Heart Failure: Results from a Heart Failure Society of America Survey.

Chuzi S, Pensa AV, Allen LA, Cross SH, Feder SL, Warraich HJ
Background
Multiple guidelines recommend specialty palliative care (PC) for patients with heart failure (HF), including patients with left ventricular assist devices (LVADs). However, the degree of integration and clinicians\' perceptions of PC in HF care remain incompletely characterized.
Methods and results
A 36-item survey was sent to 2,109 members of the Heart Failure Society of America. Eighty respondents (53% physicians), including 51 respondents from at least 42 medical centers completed the survey, with the majority practicing in urban (76%) academic medical centers (62%) that implanted LVADs (81%). Among the 42 unique medical centers identified, respondents reported both independent (40%) and integrated (40%) outpatient PC clinic models, while 12% reported not having outpatient PC at their institutions. A minority (12%) reported that their institution utilized triggered PC referrals based on objective clinical data. Of respondents from LVAD sites, the majority reported that a clinician from the PC team was required to see all patients prior to implantation, but there was variability in practices. Among all respondents, the most common reasons for PC referral in HF were poor prognosis, consideration of advanced cardiac therapies or other high-risk procedures, and advance care planning or goals of care discussions. The most frequent perceived barriers to PC consultation included lack of PC clinicians, unpredictable HF clinical trajectories, and limited understanding of how PC can complement traditional HF care.
Conclusion
PC integration and clinician perceptions of services vary in HF care. More research and guidance regarding evidence-based models of PC delivery in HF are needed.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 13 Jul 2022; epub ahead of print
Chuzi S, Pensa AV, Allen LA, Cross SH, Feder SL, Warraich HJ
J Card Fail: 13 Jul 2022; epub ahead of print | PMID: 35842103
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Abstract

Is the mRNA COVID-19 vaccine safe in patients with a prior history of myocarditis?

Shahid R, Tang WHW, Klein AL, Kwon D, Amdani S
Background
Numerous studies have reported myocarditis resulting from mRNA COVID-19 vaccination. However, to date, there have been no reports highlighting the safety of mRNA COVID-19 vaccines in children and adults with a prior history of myocarditis, which was the intent of this study.
Methods and results
Children and adults cared for at the Cleveland Clinic were identified through the electronic health records, who had a history of myocarditis prior to the COVID-19 pandemic AND had subsequently received at least two doses of the mRNA COVID-19 vaccines (n=34). Only 1 patient in this series had recurrence of myocarditis confirmed by cardiac MRI after receiving the second dose. He was a White male, who had his first episode of myocarditis at age 20 and was 27 years of age at the time of recurrence. He was hospitalized for 2 days with no need for cardiac support or reported arrhythmias and was stable at outpatient follow up.
Conclusions
In patients with an old history of non-COVID 19 myocarditis, the risk of recurrent myocarditis after receipt of mRNA COVID-19 vaccination is low, and when occurs appears to be self-limiting. Our study will be valuable to clinicians while discussing risk-benefit ratio of vaccinations in those with a prior history of myocarditis.

Copyright © 2022 Elsevier Inc. All rights reserved.

J Card Fail: 13 Jul 2022; epub ahead of print
Shahid R, Tang WHW, Klein AL, Kwon D, Amdani S
J Card Fail: 13 Jul 2022; epub ahead of print | PMID: 35842104
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Abstract

Subjective Financial Hardship from Medical Bills Among Patients with Heart Failure in the United States: The 2014-2018 Medical Expenditure Panel Survey.

Ali HR, Valero-Elizondo J, Wang SY, Cainzos-Achirica M, ... Khera R, Nasir K
Background
Heart failure (HF) poses a substantial economic burden to the United States (US) healthcare system. In contrast, little is known about the financial challenges faced by patients with HF. In this study, we examined the scope and sociodemographic predictors of subjective financial hardship from medical bills in patients with HF.
Methods
In the Medical Expenditure Panel Survey (MEPS; years 2014-2018), a US nationally representative database, we identified all patients who reported having HF. Any subjective financial hardship from medical bills was assessed based on patients reporting either themselves or their families 1) having difficulties paying medical bills in the past 12 months, 2) paid bills late, or 3) unable to pay bills at all. Logistic regression was used to evaluate independent predictors of financial hardship among patients with HF. All analyses took into consideration the survey\'s complex design.
Results
A total of 116,563 MEPS participants were included in the analysis, of whom 858 (0.7%) had a diagnosis of HF, representing 1.8 million (95% CI 1.6 to 2.0) patients annually. Overall, 33% (95% CI 29% to 38%) reported any financial hardship from medical bills with 13.2% not being able to pay bills at all. Age ≤65 years and lower educational attainment were independently associated with higher odds of subjective financial hardship from medical bills.
Conclusion
Subjective financial hardship is a prevalent issue among patients with HF in the US, particularly those who are younger and have lower educational attainment. There is a need for policies that reduce out-of-pocket costs in the care of HF, an enhanced identification of this phenomenon in the clinical setting, and approaches to help minimize financial toxicity in patients with HF while ensuring optimal quality of care.

Copyright © 2022. Published by Elsevier Inc.

J Card Fail: 12 Jul 2022; epub ahead of print
Ali HR, Valero-Elizondo J, Wang SY, Cainzos-Achirica M, ... Khera R, Nasir K
J Card Fail: 12 Jul 2022; epub ahead of print | PMID: 35839928
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This program is still in alpha version.