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Latest & greatest articles for heart failure
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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
Suspected New-Onset and Nonacute Heart FailureNew 2018 ACR Appropriateness Criteria ® 1 Suspected New-Onset and Known Nonacute Heart FailureAmerican College of Radiology ACR Appropriateness Criteria ® Suspected New-Onset and Known Nonacute Heart FailureVariant 1: Suspected new-onset nonacute heart failure, not previously diagnosed. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US echocardiography transthoracic resting Usually Appropriate O Radiography chest (...) and inotropic stress without IV contrast Usually Not Appropriate O MRI heart with function and vasodilator stress perfusion without and with IV contrast Usually Not Appropriate O Rb-82 PET/CT heart stress Usually Not Appropriate ? ? ?? Tc-99m SPECT/CT MPI rest and stress Usually Not Appropriate ???? Tc-99m ventriculography Usually Not Appropriate ??? US echocardiography transthoracic stress Usually Not Appropriate O ACR Appropriateness Criteria ® 2 Suspected New-Onset and Known Nonacute Heart Failure
CardioMEMS for Heart FailureMonitoring Health Evidence Review Commission (HERC) Coverage Guidance: CardioMEMS™ for Heart FailureMonitoring Approved 10/4/2018 HERC Coverage Guidance CardioMEMS™ is not recommended for coverage for heart failuremonitoring (weak recommendation). Note: Definitions for strength of recommendation are in Appendix A. GRADE Table Element Descriptions. Rationales for each recommendation appear below in the GRADE table. 2 ¦ CardioMEMS™ for Heart FailureMonitoring (...) Approved 10/4/2018 Table of Contents Coverage Guidance: CardioMEMS™ for Heart FailureMonitoring 1 Table of Contents 2 Rationale for development of coverage guidances and multisector intervention reports 3 GRADE Table 3 GRADE Table 5 Should CardioMEMS™ be recommended for coverage for heart failuremonitoring? 5 Background 8 Indications 8 Technology Description 8 Evidence Review 9 Abraham et al., 2011 9 Adamson et al., 2014 11 Adamson et al., 2016 12 Abraham et al., 2016 13 Givertz et al., 2017 15
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
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
The Metabolic Syndrome, Cardiovascular Fitness and Survival in Patients With Advanced Systolic Heart Failure30172361 2018 09 02 1879-1913 2018 Aug 03 The American journal of cardiology Am. J. Cardiol. The Metabolic Syndrome, Cardiovascular Fitness and Survival in Patients With Advanced Systolic Heart Failure. S0002-9149(18)31496-6 10.1016/j.amjcard.2018.07.024 The metabolic syndrome (MetS), which incorporates insulin resistance, visceral adiposity, and dyslipidemia, is an independent risk (...) factor for incident heart failure (HF), butthe impact on survival is uncertain. We sought to determine the relation between the metabolic syndrome and survival in ambulatory systolic HFpatientsand the impact of MetS on cardiopulmonary exercise test (CPET). We identified adults with ejection fraction ≤40% who underwent CPETs between 2000 and 2011. Baseline MetS status was defined by 3 or more of: (1) Triglycerides ≥150 mg/dl; (2) High density lipoprotein <40 mg/dl males or <50 mg/dl females; (3
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
Transcatheter Mitral-Valve Repair in Patients with Heart Failure. BACKGROUND: Among patients with heart failurewho have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes. METHODS: At 78 sites in the United States and Canada, we enrolled patients with heart failureand moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses (...) of guideline-directed medical therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heart failurewithin 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%. RESULTS: Of the 614 patients
Genetic and Tissue Engineering Approaches to Modeling the Mechanics of Human Heart Failurefor Drug Discovery 30283789 2018 11 14 2297-055X 5 2018 Frontiers in cardiovascular medicine Front Cardiovasc Med Genetic and Tissue Engineering Approaches to Modeling the Mechanics of Human Heart Failurefor Drug Discovery. 120 10.3389/fcvm.2018.00120 Heart failureis the leading cause of death in the western world and as such, there is a great need for new therapies. Heart failurehas a variable (...) presentation in patients and a complex etiology; however, it is fundamentally a condition that affects the mechanics of cardiac contraction, preventing the heart from generating sufficient cardiac output under normal operating pressures. One of the major issues hindering the development of new therapies has been difficulties in developing appropriate in vitro model systems of human heart failurethat recapitulate the essential changes in cardiac mechanics seen in the disease. Recent advances in stem cell
The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failurewith reduced ejection fraction: a systematic review and meta-analysis 29984598 2018 07 09 1477-0873 2018 Jul 01 Clinical rehabilitation Clin Rehabil The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failurewith reduced ejection fraction: a systematic review and meta-analysis. 269215518784345 10.1177 (...) /0269215518784345 Inspiratory muscle training (IMT) improves prognostic clinical variables in patients with heart failure. However, the optimal intensity for increasing those outcomes remains unclear. Thus, we aimed to determine whether high-intensity inspiratory muscle training (HIIMT) improves exercise capacity and respiratory muscle strength in patients with heart failurewith reduced ejection fraction (HFrEF). We searched for randomized controlled clinical trials at MEDLINE, the Cochrane Central Register
Myocardial expression of the anaphylatoxin receptor C3aR is associated with cardiac inflammation and prognosis in patients with nonâ€ischaemic heart failure30168657 2018 11 29 2055-5822 5 5 2018 10 ESC heart failureESCHeart Fail Myocardial expression of the anaphylatoxin receptor C3aR is associated with cardiac inflammation and prognosis in patients with non-ischaemic heart failure. 846-857 10.1002/ehf2.12298 The aim of this study is to analyse the prognostic value of complement (...) anaphylatoxin receptors in patients with non-ischaemic cardiomyopathy undergoing endomyocardial biopsy. In 102 patients (72.5% male patients, median age 54 years) with non-ischaemic cardiomyopathy, myocardial expression of C3aR was assessed among other parameters. The primary study endpoint was a composite of death, heart transplantation, heart failure-related re-hospitalization, and deterioration of left ventricular ejection fraction within a mean follow-up of 11.9 months. The number of cells, which
Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease. Background Heart failureis associated with activation of thrombin-related pathways, which predicts a poor prognosis. We hypothesized that treatment with rivaroxaban, a factor Xa inhibitor, could reduce thrombin generation and improve outcomes for patients with worsening chronic heart failureand underlying coronary artery disease. Methods In this double-blind, randomized trial, 5022 patients who had chronic heart failure (...) , a left ventricular ejection fraction of 40% or less, coronary artery disease, and elevated plasma concentrations of natriuretic peptides and who did not have atrial fibrillation were randomly assigned to receive rivaroxaban at a dose of 2.5 mg twice daily or placebo in addition to standard care after treatment for an episode of worsening heart failure. The primary efficacy outcome was the composite of death from any cause, myocardial infarction, or stroke. The principal safety outcome was fatal
Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. BACKGROUND: Remote patient management in patients with heart failuremight help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a full manifestation of a heart failuredecompensation. We aimed to investigate the efficacy of our remote patient management (...) intervention on mortality and morbidity in a well defined heart failurepopulation. METHODS: The Telemedical Interventional Management in Heart FailureII (TIM-HF2) trial was a prospective, randomised, controlled, parallel-group, unmasked (with randomisation concealment), multicentre trial with pragmatic elements introduced for data collection. The trial was done in Germany, and patients were recruited from hospitals and cardiology practices. Eligible patients had heart failure, were in New York Heart
Prediction of readmissions and mortality in patients with heart failure: lessons from the IMPEDANCEâ€HFextendedtrial 30094959 2018 11 29 2055-5822 5 5 2018 10 ESC heart failureESCHeart Fail Prediction of readmissions and mortality in patients with heart failure: lessons from the IMPEDANCE-HFextendedtrial. 788-799 10.1002/ehf2.12330 Readmissions for heart failure (HF) area major burden. We aimed to assess whether the extent of improvement in pulmonary fluid content (ΔPC) during HF (...) hospitalizationevaluated by lung impedance (LI), or indirectly by other clinical and laboratory parameters, predicts readmissions. The present study is based on pre-defined secondary analysis of the IMPEDANCE-HFextendedtrial comprising 266 HFpatientsat New York Heart Association Class II-IV and left ventricular ejection fraction ≤ 35% randomized to LI-guided or conventional therapy during long-term follow-up. Lung impedance-guided patients were followed for 58 ± 36 months and the control patients for 46
Iron deficiency in chronic heart failure: caseâ€based practical guidance 30073785 2018 11 29 2055-5822 5 5 2018 10 ESC heart failureESCHeart Fail Iron deficiency in chronic heart failure: case-based practical guidance. 764-771 10.1002/ehf2.12333 In patients with chronic heart failure, iron deficiency, even in the absence of anaemia, can aggravate the underlying disease and have a negative impact on clinical outcomes and quality of life. The 2016 European Society of Cardiology guidelines (...) for the diagnosis and treatment of acute and chronic heart failurerecognize iron deficiency as a co-morbidity in chronic heart failureand recommend iron status screening in all newly diagnosed patients with chronic heart failure. Furthermore, the guidelines specifically recommend considerations of intravenous iron therapy, ferric carboxymaltose, for the treatment of iron deficiency. However, in spite of these recommendations, iron deficiency remains often overlooked and undertreated. This may be due, in part