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Latest & greatest articles for heart failure
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on heart failure or other clinical topics then use Trip today.
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Heartfailure drug treatment. Heartfailure is the most common cardiovascular reason for hospital admission for people older than 60 years of age. Few areas in medicine have progressed as remarkably as heartfailure treatment over the past three decades. However, progress has been consistent only for chronic heartfailure with reduced ejection fraction. In acutely decompensated heartfailure and heartfailure with preserved ejection fraction, none of the treatments tested to date have been (...) definitively proven to improve survival. Delaying or preventing heartfailure has become increasingly important in patients who are prone to heartfailure. The prevention of worsening chronic heartfailure and hospitalisations for acute decompensation is also of great importance. The objective of this Series paper is to provide a concise and practical summary of the available drug treatments for heartfailure. We support the implementation of the international guidelines. We offer views on the basis of our
Multimodality imaging in ischaemic heartfailure. In heartfailure, extensive evaluation with modern non-invasive imaging modalities is needed to assess causes, pathophysiology, and haemodynamics, to determine prognosis and consider therapeutic options. This systematic evaluation includes a stepwise assessment of left ventricular size and function, the presence and severity of coronary artery disease, mitral regurgitation, pulmonary hypertension, right ventricular dilation and dysfunction
Beyond pharmacological treatment: an insight into therapies that target specific aspects of heartfailure pathophysiology. Heartfailure is a common syndrome associated with substantial morbidity and mortality. The management of symptoms and the strategies for improving prognosis have largely been based on pharmacological treatments. The pathophysiology of heartfailure is complex because of the multiple causes responsible for this syndrome. This Series paper presents some examples of advances (...) in heartfailure management, in which the treatment specifically targets the underlying pathophysiological mechanisms responsible for the symptoms. These treatments include treatment of electromechanical dyssynchrony and dysrhythmia by cardiac resynchronisation and implantable cardioverter-defibrillators; neurohumoral modification by baroreflex and vagal stimulation; prevention of adverse cardiac remodelling by interatrial shunts; and finally targeting the myocardium directly by cell therapy
Association of genetically predicted testosterone with thromboembolism, heartfailure, and myocardial infarction: mendelian randomisation study in UK Biobank. To determine whether endogenous testosterone has a causal role in thromboembolism, heartfailure, and myocardial infarction.Two sample mendelian randomisation study using genetic variants as instrumental variables, randomly allocated at conception, to infer causality as additional randomised evidence.Reduction by Dutasteride of Prostate (...) Cancer Events (REDUCE) randomised controlled trial, UK Biobank, and CARDIoGRAMplusC4D 1000 Genomes based genome wide association study.3225 men of European ancestry aged 50-75 in REDUCE; 392 038 white British men and women aged 40-69 from the UK Biobank; and 171 875 participants of about 77% European descent, from CARDIoGRAMplusC4D 1000 Genomes based study for validation.Thromboembolism, heartfailure, and myocardial infarction based on self reports, hospital episodes, and death.Of the UK Biobank
Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for HeartFailure: The PACT-HF Randomized Clinical Trial. Health care services that support the hospital-to-home transition can improve outcomes in patients with heartfailure (HF).To test the effectiveness of the Patient-Centered Care Transitions in HF transitional care model in patients hospitalized for HF.Stepped-wedge cluster randomized trial of 2494 adults hospitalized for HF across 10 (...) hospitals in Ontario, Canada, from February 2015 to March 2016, with follow-up until November 2016.Hospitals were randomized to receive the intervention (n = 1104 patients), in which nurse-led self-care education, a structured hospital discharge summary, a family physician follow-up appointment less than 1 week after discharge, and, for high-risk patients, structured nurse homevisits and heart function clinic care were provided to patients, or usual care (n = 1390 patients), in which transitional care
Trends in survival after a diagnosis of heartfailure in the United Kingdom 2000-2017: population based cohort study. To report reliable estimates of short term and long term survival rates for people with a diagnosis of heartfailure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.Population based cohort study.Primary care, United Kingdom.Primary care data for 55 959 patients aged 45 and overwith a new diagnosis of heartfailure and 278 679 age (...) and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data.Survival rates at one, five, and 10 years and cause of death for people with and without heartfailure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.Overall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8
Association of Left Ventricular Ejection Fraction and Symptoms With Mortality After Elective Noncardiac Surgery Among Patients With HeartFailure. Heartfailure is an established risk factor for postoperative mortality, but how left ventricular ejection fraction and heartfailure symptoms affect surgical outcomes is not fully described.To determine the risk of postoperative mortality among patients with heartfailure at various levels of echocardiographic (left ventricular systolic dysfunction (...) ) and clinical (symptoms) severity compared with those without heartfailure and to evaluate how risk varies across levels of surgical complexity.US multisite retrospective cohort study of all adult patients receiving elective, noncardiac surgery in the Veterans Affairs Surgical Quality Improvement Project database from 2009 through 2016. A total of 609 735 patient records were identified and analyzed with 1 year of follow-up after having surgery (final study follow-up: September 1, 2017).Heartfailure, left
Repetitive levosimendan infusions for patients with advanced chronic heartfailure in the vulnerable post-discharge period. Hospitalization for acute heartfailure (HF) is associated with a substantial morbidity burden and with associated healthcare costs and an increased mortality risk. However, few if any major medical innovations have been witnessed in this area in recent times. Levosimendan is a first-in-class calcium sensitizer and potassium channel opener indicated for the management (...) of acute HF. Experience in several clinical studies has indicated that administration of intravenous levosimendan in intermittent cycles may reduce hospitalization and mortality rates in patients with advanced HF; however, none of those trials were designed or powered to give conclusive insights into that possibility. This paper describes the rationale and protocol of LeoDOR (levosimendan infusions for patients with advanced chronic heartfailure), a randomized, double-blind, placebo-controlled
Pro-gastrin-releasing peptide and outcome in patients with heartfailure and anaemia: results from the RED-HF study. Neuroendocrine activation is associated with poor outcome in heartfailure (HF). The neuropeptide gastrin-releasing peptide (GRP), derived from the precursor proGRP1-125 (proGRP), has recently been implicated in inflammation and wound repair. We investigated the predictive value of proGRP on clinical outcomes in HF patients with reduced ejection fraction.The association between (...) plasma proGRP (time-resolved immunofluorometric assay) and the primary endpoint of death from any cause or first hospitalization for worsening of HF was evaluated using multivariable Cox proportional hazard models in 1541 patients with systolic HF and mild to moderate anaemia, enrolled in the Reduction of Events by Darbepoetin alfa in HeartFailure (RED-HF) trial. Median proGRP levels in the RED-HF cohort were markedly increased [95 ng/L (25th, 75th percentile, 69-129 ng/L)] with 64% patients above
Liraglutide and weight loss among patients with advanced heartfailure and a reduced ejection fraction: insights from the FIGHT trial. Obesity is present in up to 45% of patients with heartfailure (HF). Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor antagonist, facilitates weight loss in obese patients. The efficacy of liraglutide as a weight loss agent among patients with HF and reduced ejection fraction (HFrEF) and a recent acute HF hospitalization remains unknown.The Functional (...) Impact of GLP-1 for HeartFailure Treatment study randomized 300 patients with HFrEF (ejection fraction ≤ 40%), both with and without diabetes and a recent HF hospitalization to liraglutide or placebo. The primary outcome for this post hoc analysis was the change in weight from baseline to last study visit. We conducted an 'on-treatment' analysis of patients with at least one follow-up visit on study drug (123 on liraglutide and 124 on placebo). The median age was 61 years, 21% were female, and 69
Exercise-based cardiac rehabilitation for adults with heartfailure. Chronic heartfailure (HF) is a growing global health challenge. People with HF experience substantial burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous (2014) Cochrane systematic review reported that exercise-based cardiac rehabilitation (CR) compared to no exercise control shows improvement (...) , number needed to treat: 25). After CR, a clinically important improvement in short-term disease-specific health-related quality of life may be evident (Minnesota Living With HeartFailure questionnaire - 17 trials, 18 comparisons (1995 participants): mean difference (MD) -7.11 points, 95% CI -10.49 to -3.73; low-quality evidence). Pooling across all studies, regardless of the HRQoL measure used, shows there may be clinically important improvement with exercise (26 trials, 29 comparisons (3833
External Validation of the MEESSI Acute HeartFailure Risk Score: A Cohort Study. The MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score was developed to predict 30-day mortality in patients presenting with acute heartfailure (AHF) to emergency departments (EDs) in Spain. Whether it performs well in other countries is unknown.To externally validate the MEESSI-AHF score in another country.Prospective cohort study (...) for missing values in the overall cohort of 1572 patients.External validation was done using a reduced model. Findings are specific to patients with AHF who present to the ED and are clinically stable enough to provide informed consent. Performance in patients with terminal kidney failure who are receiving long-term dialysis cannot be commented on.External validation of the MEESSI-AHF risk score showed excellent discrimination. Recalibration may be needed when the score is introduced to new
Home-based cardiac rehabilitation for heartfailure has high rates of participation Home-based cardiac rehabilitation for heartfailure has high participation Discover Portal Discover Portal Home-based cardiac rehabilitation for heartfailure has high rates of participation Published on 8 January 2019 doi: Home-based cardiac rehabilitation for people with heartfailure improves quality of life at 12 months compared with usual care. Among those allocated to rehabilitation, 90% remained (...) was this study needed? Heartfailure affects around 900,000 people in the UK. Despite the effectiveness of cardiac rehabilitation in reducing re-admission and risk of death from heart disease, and in improving quality of life, availability and attendance in the UK are poor. On average, only 43% of people eligible actually attend, and this varies from 13 to 88% around the country. Efforts to improve access by exploring newer more accessible alternative strategies to hospital-based rehabilitation are required
Telemedicine programme can prolong life for heartfailure patients Telemedicine programme can prolong life for heartfailure patients Discover Portal Discover Portal Telemedicine programme can prolong life for heartfailure patients Published on 20 November 2018 doi: A comprehensive programme of daily telemedicine monitoring and 24-hour access to a physician-led hotline can reduce the number of deaths and the time spent in hospital, among patients with heartfailure. A year-long study of 1,571 (...) patients who had been admitted to hospital with heartfailure within the past 12 months found that those assigned to daily telemonitoring, monthly health education and telephone support from specialist staff, were 30% less likely to die than those assigned to usual care. This was a 3 percentage point reduction from 11% per year in the control group to 8% in the telemedicine group. This group also spent around a third fewer days in hospital. This suggests telemedicine could make a real difference
Uncertain benefits of BNP blood tests to monitor heartfailure treatment Uncertain benefits of BNP blood tests to monitor heartfailure treatment Discover Portal Discover Portal Uncertain benefits of BNP blood tests to monitor heartfailure treatment Published on 6 February 2018 doi: In specialist clinics, using B-type natriuretic peptide (BNP) blood levels to guide treatment in people with chronic heartfailure shows promise but did not improve survival for all groups. In this review (...) , the benefit was only seen in patients aged less than 75, who survived an extra 1.5 years on average, and possibly those with poor heart function (reduced ejection fraction). However, there was a reduction in hospital admissions for heartfailure for everyone. BNP is a hormone released from the heart muscle, and higher levels may indicate more severe disease. It is currently used for diagnosis, but its use in monitoring treatment has become the subject of recent research interest. This research pooled data
The heartfailure drug levosimendan doesn’t improve outcomes in adults with severe infections The heartfailure drug levosimendan doesn’t improve outcomes in adults with severe infections Discover Portal Discover Portal The heartfailure drug levosimendan doesn’t improve outcomes in adults with severe infections Published on 13 December 2016 doi: Septic shock is a life-threatening condition resulting from serious infection. Adding levosimendan to the usual care of adults with septic shock did (...) supply in patients with septic shock. Levosimendan is licensed in several countries to treat heartfailure, but does not currently have approval from the US Food and Drug Administration. Share your views on the research. Why was this study needed? There are 150,000 cases of severe sepsis in the UK every year, with 44,000 deaths. Mortality is very high, 30 to 40% even with the best available treatment. Severe infections can lead to septic shock with failure of the heart, kidneys and other essential
A blood test threshold for diagnosing heartfailure in general practice is reviewed A blood test threshold for diagnosing heartfailure in general practice is reviewed Discover Portal Discover Portal A blood test threshold for diagnosing heartfailure in general practice is reviewed Published on 3 May 2017 doi: The cut-off level for the blood test NTproBNP appears to provide the best balance of detecting true cases while excluding false positives when lowered to 125 pg/ml. The trial supported (...) by the NIHR included a sample of people presenting to their GP with suspected heartfailure. It aimed to see which method was best for identifying those who needed referral: the blood test alone; clinical decision rules based on clinical symptoms; or the combination of both. The blood test alone at the 125 pg/ml cut-off correctly identified 94% of people with heartfailure but led to 50% of people who did not have heartfailure being referred for further investigation. This threshold is lower than