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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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Association of Renin-Angiotensin Inhibitor Treatment With Mortality and Heart FailureReadmission in Patients With Transcatheter Aortic Valve Replacement. Importance: Data are lacking on the effect of a renin-angiotensin system (RAS) inhibitor prescribed after transcatheter aortic valve replacement (TAVR). Treatment with a RAS inhibitor may reverse left ventricular remodeling and improve function. Objective: To investigate the association of prescription of a RAS inhibitor and outcomes after (...) : Initial hospital discharge prescription of a RAS inhibitor after TAVR. Main Outcomes and Measures: Primary outcomes were all-cause death and readmission due to heart failureat 1 year after discharge, which were considered separately. The secondary outcome was health status assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ; score range: 0-100, with a higher score indicating less symptom burden and better quality of life; a small effect size was defined as 5 points) at 1 year. Results
Telemedicine programme can prolong life for heart failurepatients Telemedicine programme can prolong life for heart failurepatients Dissemination Centre Discover Portal NIHR DC Discover Telemedicine programme can prolong life for heart failurepatients 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 heart failure. A (...) year-long study of 1,571 patients who had been admitted to hospital with heart failurewithin 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
Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. BACKGROUND: Acute decompensated heart failureaccounts for more than 1 million hospitalizations in the United States annually. Whether the initiation of sacubitril-valsartan therapy is safe and effective among patients who are hospitalized for acute decompensated heart failureis unknown. METHODS: We enrolled patients with heart failurewith reduced ejection fraction who were hospitalized for acute decompensated heart failure (...) : Among patients with heart failurewith reduced ejection fraction who were hospitalized for acute decompensated heart failure, the initiation of sacubitril-valsartan therapy led to a greater reduction in the NT-proBNP concentration than enalapril therapy. Rates of worsening renal function, hyperkalemia, symptomatic hypotension, and angioedema did not differ significantly between the two groups. (Funded by Novartis; PIONEER-HFClinicalTrials.govnumber, NCT02554890 .).
Withdrawal of pharmacological treatment for heart failurein patients with recovered dilated cardiomyopathy (TRED-HF): anopen-label, pilot, randomised trial. BACKGROUND: Patients with dilated cardiomyopathy whose symptoms and cardiac function have recovered often ask whether their medications can be stopped. The safety of withdrawing treatment in this situation is unknown. METHODS: We did an open-label, pilot, randomised trial to examine the effect of phased withdrawal of heart failure (...) ), and randomly assigned (1:1) to phased withdrawal or continuation of treatment. After 6 months, patients in the continued treatment group had treatment withdrawn by the same method. The primary endpoint was a relapse of dilated cardiomyopathy within 6 months, defined by a reduction in LVEF of more than 10% and to less than 50%, an increase in LVEDV by more than 10% and to higher than the normal range, a two-fold rise in NT-pro-BNP concentration and to more than 400 ng/L, or clinical evidence of heart failure
Effect of Inorganic Nitrite vs Placebo on Exercise Capacity Among Patients With Heart FailureWith Preserved Ejection Fraction: The INDIE-HFpEF Randomized Clinical Trial. Importance: There are few effective treatments for heart failurewith preserved ejection fraction (HFpEF). Short-term administration of inorganic nitrite or nitrate preparations has been shown to enhance nitric oxide signaling, which may improve aerobic capacity in HFpEF. Objective: To determine the effect of 4 weeks (...) [95% CI, -1.2 to 1.3]; P = .93), or N-terminal fragment of the prohormone brain natriuretic peptide levels (520 vs 533 pg/mL; difference, 11 [95% CI, -53 to 75]; P = .74). Worsening heart failureoccurred in 3 participants (2.9%) during the nitrite phase and 8 (7.6%) during the placebo phase. Conclusions and Relevance: Among patients with HFpEF, administration of inhaled inorganic nitrite for 4 weeks, compared with placebo, did not result in significant improvement in exercise capacity. Trial
Reduced Salt Intake for Heart Failure: A Systematic Review 30398532 2018 11 06 2168-6114 2018 Nov 05 JAMA internal medicine JAMA Intern Med Reduced Salt Intake for Heart Failure: A Systematic Review. 10.1001/jamainternmed.2018.4673 Recent estimates suggest that more than 26 million people worldwide have heart failure. The syndrome is associated with major symptoms, significantly increased mortality, and extensive use of health care. Evidence-based treatments influence all these outcomes (...) in a proportion of patients with heart failure. Current management also often includes advice to reduce dietary salt intake, although the benefits are uncertain. To systematically review randomized clinical trials of reduced dietary salt in adult inpatients or outpatients with heart failure. Several bibliographic databases were systematically searched, including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL. The methodologic quality of the studies was evaluated, and data
Uncertain benefits of BNP blood tests to monitor heart failuretreatment Signal - Uncertain benefits of BNP blood tests to monitor heart failuretreatment Dissemination Centre Discover Portal NIHR DC Discover Uncertain benefits of BNP blood tests to monitor heart failuretreatment Published on 6 February 2018 In specialist clinics, using B-type natriuretic peptide (BNP) blood levels to guide treatment in people with chronic heart failureshows 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 heart failurefor 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
A blood test threshold for diagnosing heart failurein general practice is reviewed Signal - A blood test threshold for diagnosing heart failurein general practice is reviewed Dissemination Centre Discover Portal NIHR DC Discover A blood test threshold for diagnosing heart failurein general practice is reviewed Published on 3 May 2017 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 heart failure. 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 heart failurebut led to 50% of people who did not have heart failurebeing referred for further investigation
The heart failuredrug levosimendan doesn’t improve outcomes in adults with severe infections Signal - The heart failuredrug levosimendan doesn’t improve outcomes in adults with severe infections Dissemination Centre Discover Portal NIHR DC Discover The heart failuredrug levosimendan doesn’t improve outcomes in adults with severe infections Published on 13 December 2016 Septic shock is a life-threatening condition resulting from serious infection. Adding levosimendan to the usual care (...) on markers of heart function and blood supply in patients with septic shock. Levosimendan is licensed in several countries to treat heart failure, 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
Home oxygen therapy prescribed for 15 hours a day did not reduce breathlessness at six months and is hard to take for people with severe chronic heart failureSignal - Home oxygen therapy prescribed for 15 hours a day did not reduce breathlessness at six months and is hard to take for people with severe chronic heart failureDissemination Centre Discover Portal NIHR DC Discover Home oxygen therapy prescribed for 15 hours a day did not reduce breathlessness at six months and is hard to take (...) for people with severe chronic heart failurePublished on 7 January 2016 This NIHR-funded trial found no evidence that long-term home oxygen therapy improves symptoms or quality of life for people with severe chronic heart failure. There were encouraging signs after three months but these were not sustained at six months by which time there was no difference between the oxygen therapy group, who continued to receive best medical care, and the control group. The trial was stopped early due to poor
Aldosterone antagonists reduce deaths, including sudden deaths, in people with heart failureSignal - Aldosterone antagonists reduce deaths, including sudden deaths, in people with heart failureDissemination Centre Discover Portal NIHR DC Discover Aldosterone antagonists reduce deaths, including sudden deaths, in people with heart failurePublished on 17 May 2016 In adults with longstanding heart failureor recent heart attack aldosterone antagonists reduced sudden cardiac deaths and deaths (...) from any cause. There were important side effects, including an increase in kidney injury. Most studies focussed specifically on left heart failure. More research is needed to establish the place of these types of drugs in practice and clinical decision making should be mindful of the impact on effectiveness and side-effects. The findings are in line with current NICE guidance, which include aldosterone antagonists as options in the management of people with this specific type of heart failureor
“Case management” can prevent people with heart failurebeing admitted again Signal - “Case management” can prevent people with heart failurebeing admitted again Dissemination Centre Discover Portal NIHR DC Discover “Case management” can prevent people with heart failurebeing admitted again Published on 30 August 2016 Case management that is initiated in hospital and led by specialist nurses may reduce unplanned hospital readmissions and length of hospital stay for adults with heart failure (...) that hospital-initiated case management is cost effective – particularly in relation to the NHS. A few studies examined case management that was started in the community. The findings are promising and may lead to further studies that confirm these findings in the UK setting. Commissioners would also need to know other things too, such as the components of case management that are most beneficial and the costs. Share your views on the research. Why was this study needed? Heart failureis a condition where
Telehealth can help people with heart failureavoid hospital admission Signal - Telehealth can help people with heart failureavoid hospital admission Dissemination Centre Discover Portal NIHR DC Discover Telehealth can help people with heart failureavoid hospital admission Published on 18 January 2016 Home telephone or telemonitoring support can bring some aspects of specialised care and monitoring into the homes of people with heart failure. This updated Cochrane review confirmed that people (...) with heart failurewho received home telehealth support were less likely to die or go into hospital for problems relating to their heart failurethan those getting usual care. Usual care involved visiting a GP surgery or hospital for care and monitoring, which may be difficult for frail people with limited mobility. The review included seventeen new trials since the last review was published five years ago. More evidence is needed on which people would gain most benefit, particularly considering
Specialist nurses can manage heart failuredrug dosing successfully Signal - Specialist nurses can manage heart failuredrug dosing successfully Dissemination Centre Discover Portal NIHR DC Discover Specialist nurses can manage heart failuredrug dosing successfully Published on 9 February 2016 Use of specialist nurses to optimise drug dosages using protocols in people with heart failurewas more effective than dose monitoring by other health professionals. These nurses had advanced practice (...) certification. This finding came from a review of seven trials with more than 1600 patients. International guidelines recommend two or three first-line medications for people with heart failure. These drugs (beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors and angiotensin receptor blockers) can improve survival and are usually started at low doses by cardiologists and then gradually increased over time, a process managed between cardiologists and GPs. This can be a prolonged process
‘Virtual wards’ reduce readmissions in people after hospitalisation for heart failure ‘Virtual wards’ reduce readmissions in people after hospitalisation for heart failureDissemination Centre Discover Portal NIHR DC Discover ‘Virtual wards’ reduce readmissions in people after hospitalisation for heart failurePublished on 14 August 2018 doi: People with heart failurewho receive care via virtual wards following discharge from hospital have lower rates of heart failure-related readmission (...) the idea that an enhanced and more rounded approach to care may improve post-discharge outcomes in people with heart failure. The review described interventions that are applicable to UK care models. The evidence may be a starting point for further evaluation or trials of these. Share your views on the research. Why was this study needed? Unplanned readmissions of people within a short time after discharge from hospital are detrimental to both patients and healthcare systems. From 2009 to 2010
Acute exacerbation of congestive heart failureAcute exacerbation of congestive heart failure - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Acute exacerbation of congestive heart failureLast reviewed: September 2018 Last updated: October 2018 Summary Clinical syndrome of reduced cardiac output, tissue hypoperfusion, increased pulmonary pressure, and tissue congestion. Presents with dyspnoea, decreased exercise (...) tolerance, swelling of the legs, fatigue, and generalised weakness. Clinical diagnosis is supported by ancillary tests such as ECG, chest x-ray, B-type natriuretic peptide, and echocardiogram. In cases where echocardiographic images are suboptimal or when an unusual cause of heart failureis suspected, and for diagnosis of specific cardiomyopathies, other tests (e.g., cardiac catheterisation with haemodynamic measurements, computed tomography, and cardiac magnetic resonance imaging) are used. Diuretics
Parity and Heart Failurein Postmenopausal Women "Parity and Heart Failurein Postmenopausal Women" by Erin Dingman < > > > > > Title Author Date of Graduation Summer 8-11-2018 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies Rights . Abstract Background: Previous research has identified physiologic changes post-menopause with cardiovascular disease, but little research has been conducted investigating a link with heart failureor the influence of parity (...) for risk stratification. Methods: An exhaustive search of available medical literature was performed. MEDLINE OVID, CINAHL, and Web of Science databases were searched using the keywords nulliparity, postmenopause, and heart failure. The articles were evaluated using GRADE. Results: The search resulted in 2 studies evaluating the incidence of heart failurein a postmenopausal population and accounting for gravidity. Conclusion: There is an association between nulliparity, grand multiparity, and increase
Heart FailureAfter Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone 29934374 2018 08 17 1524-4539 2018 Jun 22 Circulation Circulation Heart FailureAfter Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone. CIRCULATIONAHA.118.034763 10.1161/CIRCULATIONAHA.118.034763 Background -The Insulin Resistance Intervention after Stroke (IRIS) trial demonstrated that pioglitazone reduced risk for both (...) cardiovascular events and diabetes in insulin resistant patients. However, concern remains that pioglitazone may increase risk for heart failure (HF) insusceptible individuals. Methods -In IRIS, patients with insulin resistance but without diabetes were randomized to pioglitazone or placebo (1:1) within 180 days of an ischemic stroke or TIA and followed for up to 5 years. To identify patients at higher HFriskwith pioglitazone we performed a secondary analysis of IRIS participants without HFhistoryat