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Journal Cover JACC : Heart Failure
  [SJR: 4.318]   [H-I: 18]   [7 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by Elsevier Homepage  [3044 journals]
  • Evolution of Functional Mitral Regurgitation and Prognosis in
           
    • Authors: Riwa Nasser; Lauranne Van Assche; Anne Vorlat; Tom Vermeulen; Emeline Van Craenenbroeck; Viviane Conraads; Vicky Van der Meiren; Bharati Shivalkar; Paul Van Herck; Marc J. Claeys
      Pages: 652 - 659
      Abstract: Publication date: September 2017
      Source:JACC: Heart Failure, Volume 5, Issue 9
      Author(s): Riwa Nasser, Lauranne Van Assche, Anne Vorlat, Tom Vermeulen, Emeline Van Craenenbroeck, Viviane Conraads, Vicky Van der Meiren, Bharati Shivalkar, Paul Van Herck, Marc J. Claeys
      Objectives The purpose of this study was to assess whether medical management may alter the severity of functional mitral regurgitation (FMR) and its prognosis in patients who have heart failure with reduced ejection fraction (HFrEF). Background FMR in patients who have HFrEF is associated with a worse prognosis. It is uncertain to what extent medical management may alter the severity of FMR and its prognosis. Methods The extent of FMR was assessed at baseline and after a median follow-up period of 50 months in 163 consecutive HFrEF patients (left ventricular ejection fraction <40%). Severe FMR was defined as mitral regurgitation (MR) grade 3-4. All of the patients received the maximal tolerable doses of their heart failure (HF) medications. Major adverse cardiac events were defined as a composite of all-cause death and the need for heart transplantation or hospitalization for HF and/or malignant arrhythmias. Results A total of 50 (31%) patients had severe MR at baseline. During the follow-up period, 38% of the severe FMR patients showed an improvement to nonsevere FMR (MR grade <3), whereas 18% of the nonsevere FMR patients developed severe FMR despite optimal HF treatment. Cox regression analysis revealed that the presence of sustained severe FMR or worsening of FMR was the most important independent prognostic determinant with an adjusted odds ratio of 2.5 (95% confidence interval: 1.5 to 4.3, major adverse cardiac events 83% vs. 43%). In addition, those patients showed a 13% increase in left ventricular end-diastolic volume index (LVEDVI), whereas the patients with improvement in their severe MR showed a 2% decrease in LVEDVI (p = 0.01). Conclusions Severe FMR was successfully treated with medication in almost 40% and was associated with prevention of left ventricular adverse remodeling and with an improved long-term prognosis.
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      PubDate: 2017-09-04T19:49:05Z
      DOI: 10.1016/j.jchf.2017.06.015
       
  • Guideline-Directed Medical Therapy for Secondary Mitral Regurgitation
    • Authors: Michael Mack; Paul Grayburn
      Pages: 660 - 662
      Abstract: Publication date: September 2017
      Source:JACC: Heart Failure, Volume 5, Issue 9
      Author(s): Michael Mack, Paul Grayburn
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      PubDate: 2017-09-04T19:49:05Z
      DOI: 10.1016/j.jchf.2017.07.007
       
  • America and Apple Pie
    • Authors: Christopher M. O’Connor
      Pages: 686 - 687
      Abstract: Publication date: September 2017
      Source:JACC: Heart Failure, Volume 5, Issue 9
      Author(s): Christopher M. O’Connor


      PubDate: 2017-09-04T19:49:05Z
      DOI: 10.1016/j.jchf.2017.07.006
       
  • Adoption of Sacubitril/Valsartan Must Take Into Account Different Heart
           Failure Patient Types
    • Authors: Giuseppe Di Tano; Luca Bettari
      Pages: 688 - 689
      Abstract: Publication date: September 2017
      Source:JACC: Heart Failure, Volume 5, Issue 9
      Author(s): Giuseppe Di Tano, Luca Bettari


      PubDate: 2017-09-04T19:49:05Z
      DOI: 10.1016/j.jchf.2017.06.011
       
  • Re-Examination of the BEST Trial Using Composite Outcomes, Including
           Emergency Department Visits
    • Authors: Li Shen; Pardeep S. Jhund; Ulrik M. Mogensen; Lars Køber; Brian Claggett; Jennifer K. Rogers; John J.V. McMurray
      Pages: 591 - 599
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): Li Shen, Pardeep S. Jhund, Ulrik M. Mogensen, Lars Køber, Brian Claggett, Jennifer K. Rogers, John J.V. McMurray
      Objectives The influence of choice of endpoint on trial size, duration, and interpretation of results was examined in patients with heart failure who were enrolled in BEST (Beta-blocker Evaluation of Survival Trial). Background The choice of endpoints in heart failure trials has evolved over the past 3 decades. Methods In the BEST trial, we used Cox regression analysis to examine the effect of bucindolol on the current standard composite of cardiovascular death or heart failure hospitalization (CVD/HFH) compared with the original primary mortality endpoint and the expanded composite that included emergency department (ED) visits. We also undertook an analysis of recurrent events primarily using the Lin, Wei, Ying, and Yang model. Results Overall, 448 (33%) patients on placebo and 411 (30%) patients on bucindolol died (hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78 to 1.02; p = 0.11). A total of 730 (54%) patients experienced CVD/HFH on placebo and 624 (46%) on bucindolol (HR: 0.80; 95% CI: 0.72 to 0.89; p < 0.001). Adding ED visits increased these numbers to 768 (57%) and 668 (49%), respectively (HR: 0.81; 95% CI: 0.73 to 0.90; p < 0.001). A total of 568 (42%) patients on placebo experienced HFH compared with 476 (35%) patients on bucindolol (HR: 0.78; 95% CI: 0.69 to 0.89; p < 0.001), with a total of 1,333 and 1,124 admissions, respectively. With the same statistical assumptions, using the composite endpoint instead of all-cause mortality would have reduced the trial size by 40% and follow-up duration by 69%. The rate ratio for recurrent events (CVD/HFH) was 0.83 (95% CI: 0.73 to 0.94; p = 0.003). Conclusions Choice of endpoint has major implications for trial size and duration, as well as interpretation of results. The value of broader composite endpoints and inclusion of recurrent events needs further investigation. (Beta Blocker Evaluation in Survival Trial [BEST]; NCT00000560)
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      PubDate: 2017-08-05T16:00:04Z
      DOI: 10.1016/j.jchf.2017.04.005
       
  • Redefining “Winning” and Its Implications in Heart Failure
           Clinical Trials∗
    • Authors: Peter E. Carson
      Pages: 600 - 602
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): Peter E. Carson
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      PubDate: 2017-08-05T16:00:04Z
      DOI: 10.1016/j.jchf.2017.06.005
       
  • Aspirin Does Not Increase Heart Failure Events in Heart Failure
           Patients
    • Authors: John R. Teerlink; Min Qian; Natalie A. Bello; Ronald S. Freudenberger; Bruce Levin; Marco R. Di Tullio; Susan Graham; Douglas L. Mann; Ralph L. Sacco; J.P. Mohr; Gregory Y.H. Lip; Arthur J. Labovitz; Seitetz C. Lee; Piotr Ponikowski; Dirk J. Lok; Stefan D. Anker; John L.P. Thompson; Shunichi Homma
      Pages: 603 - 610
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): John R. Teerlink, Min Qian, Natalie A. Bello, Ronald S. Freudenberger, Bruce Levin, Marco R. Di Tullio, Susan Graham, Douglas L. Mann, Ralph L. Sacco, J.P. Mohr, Gregory Y.H. Lip, Arthur J. Labovitz, Seitetz C. Lee, Piotr Ponikowski, Dirk J. Lok, Stefan D. Anker, John L.P. Thompson, Shunichi Homma
      Objectives The aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Background Because of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue. Methods We compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events). Results After adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates. Conclusions Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938)
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      PubDate: 2017-08-05T16:00:04Z
      DOI: 10.1016/j.jchf.2017.04.011
       
  • What Do Cardiology and Homeopathy Have in Common'
    • Authors: John G.F. Cleland
      Pages: 611 - 614
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): John G.F. Cleland
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      PubDate: 2017-08-05T16:00:04Z
      DOI: 10.1016/j.jchf.2017.06.009
       
  • Does Institutional Memory Matter'
    • Authors: Christopher M. O’Connor
      First page: 616
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): Christopher M. O’Connor


      PubDate: 2017-08-05T16:00:04Z
      DOI: 10.1016/j.jchf.2017.07.001
       
  • Cardiac Amyloidosis as a Potential Confounder in Heart Failure With
           Preserved Ejection Fraction Trials
    • Authors: Erik B. Schelbert; Christopher A. Miller
      First page: 617
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): Erik B. Schelbert, Christopher A. Miller


      PubDate: 2017-08-05T16:00:04Z
      DOI: 10.1016/j.jchf.2017.04.006
       
  • Readmissions and Diuretic Dosing
    • Authors: Harry Peled
      First page: 618
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): Harry Peled


      PubDate: 2017-08-05T16:00:04Z
      DOI: 10.1016/j.jchf.2017.05.007
       
  • Angiotensin Receptor Neprilysin Inhibition in Heart Failure With
           Preserved Ejection Fraction
    • Authors: Scott D. Solomon; Adel R. Rizkala; Jianjian Gong; Wenyan Wang; Inder S. Anand; Junbo Ge; Carolyn S.P. Lam; Aldo P. Maggioni; Felipe Martinez; Milton Packer; Marc A. Pfeffer; Burkert Pieske; Margaret M. Redfield; Jean L. Rouleau; Dirk J. Van Veldhuisen; Faiez Zannad; Michael R. Zile; Akshay S. Desai; Victor C. Shi; Martin P. Lefkowitz; John J.V. McMurray
      Pages: 471 - 482
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): Scott D. Solomon, Adel R. Rizkala, Jianjian Gong, Wenyan Wang, Inder S. Anand, Junbo Ge, Carolyn S.P. Lam, Aldo P. Maggioni, Felipe Martinez, Milton Packer, Marc A. Pfeffer, Burkert Pieske, Margaret M. Redfield, Jean L. Rouleau, Dirk J. Van Veldhuisen, Faiez Zannad, Michael R. Zile, Akshay S. Desai, Victor C. Shi, Martin P. Lefkowitz, John J.V. McMurray
      Objectives The PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction) trial is designed to determine the efficacy and safety of the angiotensin receptor neprilysin inhibitor sacubitril/valsartan compared with valsartan in patients with chronic heart failure and preserved ejection fraction (HFpEF). Background HFpEF is highly prevalent, associated with substantial morbidity and mortality, and in need of effective therapies that improve outcomes. The angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan, which has been shown to benefit patients with heart failure (HF) and reduced ejection fraction, demonstrated favorable physiologic effects in a phase II HFpEF trial. Methods The PARAGON-HF trial is a randomized, double-blind, parallel group, active-controlled, event-driven trial comparing the long-term efficacy and safety of valsartan and sacubitril/valsartan in patients with chronic HFpEF (left ventricular ejection fraction ≥45%), New York Heart Association functional class II to IV symptoms, elevated natriuretic peptides, and evidence of structural heart disease. Before randomization, all patients entered sequential single-blind run-in periods to ensure tolerability of both drugs at half the target doses (i.e., valsartan titrated to 80 mg bid followed by sacubitril/valsartan 49/51 mg [100 mg] bid). The primary outcome is the composite of cardiovascular death and total (first and recurrent) HF hospitalizations. Conclusions PARAGON-HF will determine whether sacubitril/valsartan is superior to angiotensin receptor blockade alone in patients with chronic symptomatic HFpEF. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)
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      PubDate: 2017-07-03T20:48:19Z
      DOI: 10.1016/j.jchf.2017.04.013
       
  • A History of Asthma From Childhood and Left Ventricular Mass in
           Asymptomatic Young Adults
    • Authors: Dianjianyi Sun; Tiange Wang; Yoriko Heianza; Jun Lv; Liyuan Han; Felicia Rabito; Tanika Kelly; Shengxu Li; Jiang He; Lydia Bazzano; Wei Chen; Lu Qi
      Pages: 497 - 504
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): Dianjianyi Sun, Tiange Wang, Yoriko Heianza, Jun Lv, Liyuan Han, Felicia Rabito, Tanika Kelly, Shengxu Li, Jiang He, Lydia Bazzano, Wei Chen, Lu Qi
      Objectives This study aimed to examine whether a history of asthma from childhood is associated with left ventricular (LV) mass in adulthood. Background Asthma has been related to various cardiovascular risk factors affecting LV hypertrophy. The authors saw a need for a prospective study to analyze the relationship between a history of asthma from childhood and markers of LV mass among asymptomatic young adults. Methods Prospective analyses were performed among 1,118 Bogalusa Heart Study participants (average age at follow-up 36.7 ± 5.1 years), with a baseline history of self-reported asthma collected since childhood (average age at baseline 26.8 ± 10.1 years). LV mass (g) was assessed using 2-dimensional guided M-mode echocardiography and was indexed for body height (m2.7) as LV mass index (LVMI; g/m2.7). A multivariate linear mixed model was fitted for the repeated measures. Results After an average of 10.4 ± 7.5 years of follow-up, participants with a history of asthma from childhood had a greater LV mass (167.6 vs. 156.9; p = 0.01) and LVMI (40.7 vs. 37.7; p < 0.01) with adjustment for age, sex, race, smoking status, antihypertensive medication, heart rate, and systolic blood pressure (SBP). The difference of LVMI between group with asthma and the group without asthma remained significant after additional adjustment for body mass index (39.0 vs. 37.1; p = 0.03) and high-sensitivity C-reactive protein (38.4 vs. 36.6; p = 0.04). In addition, the authors found significant interactions between SBP and asthma on LV mass and LVMI (p for interaction <0.01, respectively). The associations between asthma and LV measures appeared to be stronger among pre-hypertensive and hypertensive participants (SBP ≥130 mm Hg) compared with participants with normal SBP (<130 mm Hg) (regression coefficient: 39.5 vs. 2.3 for LV mass and 9.0 vs. 0.9 for LVMI). Conclusions The findings of this study indicate that a history of asthma is associated with higher LVMI, and this association is stronger among participants with pre-hypertension and hypertension.
      Graphical abstract image

      PubDate: 2017-07-03T20:48:19Z
      DOI: 10.1016/j.jchf.2017.03.009
       
  • Intersection of 2 Epidemics
    • Authors: John S. Gottdiener
      Pages: 505 - 506
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): John S. Gottdiener
      Graphical abstract image

      PubDate: 2017-07-03T20:48:19Z
      DOI: 10.1016/j.jchf.2017.05.003
       
  • Atrial Fibrillation in Heart Failure∗
    • Authors: Carolyn S.P. Lam; Michiel Rienstra; Wan Ting Tay; Licette C.Y. Liu; Yoran M. Hummel; Peter van der Meer; Rudolf A. de Boer; Isabelle C. Van Gelder; Dirk J. van Veldhuisen; Adriaan A. Voors; Elke S. Hoendermis
      Pages: 92 - 98
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Carolyn S.P. Lam, Bernadet T. Santema, Adriaan A. Voors
      Graphical abstract image

      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/j.jchf.2016.10.005
       
  • The Transition From Hypertension to Heart Failure
    • Authors: Franz H Messerli; Urs Fischer; Stefano F Rimoldi; Sripal Bangalore
      First page: 153
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Franz H. Messerli, Stefano F. Rimoldi, Sripal Bangalore
      Longstanding hypertension ultimately leads to heart failure (HF), and as a consequence most patients with HF have a history of hypertension. Conversely, absence of hypertension in middle age is associated with lower risks for incident HF across the remaining life course. Cardiac remodeling to a predominant pressure overload consists of diastolic dysfunction and concentric left ventricular (LV) hypertrophy. When pressure overload is sustained, diastolic dysfunction progresses, filling of the concentric remodeled LV decreases, and HF with preserved ejection fraction ensues. Diastolic dysfunction and HF with preserved ejection fraction are the most common cardiac complications of hypertension. The end stage of hypertensive heart disease results from pressure and volume overload and consists of dilated cardiomyopathy with both diastolic dysfunction and reduced ejection fraction. “Decapitated hypertension” is a term used to describe the decrease in blood pressure resulting from reduced pump function in HF. Progressive renal failure, another complication of longstanding hypertension, gives rise to the cardiorenal syndrome (HF and renal failure). The so-called Pickering syndrome, a clinical entity consisting of flash pulmonary edema and bilateral atheromatous renovascular disease, is a special form of the cardiorenal syndrome. Revascularization of renal arteries is the treatment of choice. Most antihypertensive drug classes when used as initial therapy decelerate the transition from hypertension to HF, although not all of them are equally efficacious. Low-dose, once daily hydrochlorothiazide should be avoided, but long-acting thiazide-like diuretics chlorthalidone and indapamide seem to have an edge over other antihypertensive drugs in preventing HF.
      Graphical abstract image

      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/s0140-6736(17)30017-x
       
  • The Fastest Way to the Failing Heart Is Through the Kidneys∗
    • Authors: Jozine M. ter Maaten; Aldo Pietro Maggioni; Roberto Latini; Serge Masson; Gianni Tognoni; Luigi Tavazzi; Stefano Signorini; Adriaan A. Voors; Kevin Damman
      Pages: 189 - 195
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Kevin Damman, Adriaan A. Voors
      Graphical abstract image

      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/j.ahj.2017.01.017
       
  • Impact of Center Left Ventricular Assist Device Volume on
           Outcomes After Implantion
    • Authors: Jennifer A. Cowger; John M. Stulak; Palak Shah; Todd F. Dardas; Francis D. Pagani; Shannon M. Dunlay; Simon Maltais; Keith D. Aaronson; Ramesh Singh; Nahush A. Mokadam; James K. Kirklin; Christopher T. Salerno
      Abstract: Publication date: Available online 6 September 2017
      Source:JACC: Heart Failure
      Author(s): Jennifer A. Cowger, John M. Stulak, Palak Shah, Todd F. Dardas, Francis D. Pagani, Shannon M. Dunlay, Simon Maltais, Keith D. Aaronson, Ramesh Singh, Nahush A. Mokadam, James K. Kirklin, Christopher T. Salerno
      Objectives This study examined patient outcomes after left ventricular assist device (LVAD) implantation across a range of center surgical volumes. Background In order for a center to qualify for reimbursement, Centers for Medicare and Medicaid Services (CMS) requires it to implant ≥10 LVADs or total artificial hearts over a 3-year period. The impact of center LVAD surgical volumes on patient outcomes has not been thoroughly scrutinized. Methods Center volumes were provided for 7,416 patients undergoing LVAD implantation who were enrolled in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Center LVAD volume was categorized as either very low (≤10 implants/year, n = 617), low (11 to 30 implants/year, n = 2,561), medium (31 to 50 implants/year, n = 2,458), or high (>50 implants/year, n = 1,750). The main outcome of interest was patient survival based on center volume derived from Kaplan-Meier and multivariate Cox regression. Results Overall survival was associated with center volume (p = 0.003), as follows: 71 ± 1.8% (very low volume), 81 ± 0.8% (low volume), 83 ± 0.8% (medium volume), and 79 ± 1.0% (high volume) at 1 year. Compared with medium volume centers, the 90-day mortality was higher in very low volume (odds ratio [OR]: 1.35; p = 0.04) and high volume (OR: 1.28; p = 0.018) VAD centers. The adjusted hazard ratios (HRs) for mortality were 1.32 (95% confidence interval [CI]: 1.11 to 1.56), 1.07 (95% CI: 0.95 to 1.21), and 1.17 (95% CI: 1.03 to 1.30) for very low, low, and high volume centers, respectively. Center volume did not predict mortality (p = 0.25; n = 3,688) in INTERMACS profile 1 patients (patients who had sustained cardiogenic shock) and profile 2 patients (patients with progressive hemodynamic decline despite inotropes). Conclusions Center volume correlates with post-VAD survival, with worse survival noted at very-low-volume centers. These findings suggest that current U.S. VAD center standards warrant reconsideration.
      Graphical abstract image

      PubDate: 2017-09-09T20:53:58Z
      DOI: 10.1016/j.jchf.2017.05.011
       
  • Are Outcomes Related to Left Ventricular Assist Device Center Volume'
    • Authors: Randall C. Starling; Andrew Xanthopoulos
      Abstract: Publication date: Available online 6 September 2017
      Source:JACC: Heart Failure
      Author(s): Randall C. Starling, Andrew Xanthopoulos
      Graphical abstract image

      PubDate: 2017-09-09T20:53:58Z
      DOI: 10.1016/j.jchf.2017.07.003
       
  • Sleep Disordered Breathing and Heart Failure
    • Authors: Martin R. Cowie; Angela M. Gallagher
      Abstract: Publication date: Available online 6 September 2017
      Source:JACC: Heart Failure
      Author(s): Martin R. Cowie, Angela M. Gallagher
      Most patients with heart failure (HF) have sleep-disordered breathing (SDB), with central (rather than obstructive) sleep apnea becoming the predominant form in patients with more severe disease. Cyclical apnea and hypopneas are associated with sleep disturbance, hypoxemia, hemodynamic changes, and sympathetic activation. These patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and can partially normalize the sleep and respiratory physiology. However, recent randomized trials of cardiovascular outcomes in central sleep apnea in chronic HF with reduced ejection fraction have had neutral findings or suggested the possibility of harm, likely from an increased rate of sudden death. Further randomized outcome studies are required to determine whether mask-based treatment is appropriate for patients with chronic HF with reduced ejection fraction and obstructive sleep apnea, for patients with heart failure with preserved ejection fraction, and for patients with decompensated heart failure. New therapies for sleep apnea (e.g., implantable phrenic nerve stimulators) also require robust assessment. No longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with HF and sleep apnea.
      Graphical abstract image

      PubDate: 2017-09-09T20:53:58Z
      DOI: 10.1016/j.jchf.2017.06.016
       
  • No Fun at All
    • Authors: Reiss Tatum
      Abstract: Publication date: September 2017
      Source:JACC: Heart Failure, Volume 5, Issue 9
      Author(s): Reiss Tatum


      PubDate: 2017-09-04T19:49:05Z
       
  • Reply
    • Authors: Nancy Luo; Robert Mentz Emily
      Abstract: Publication date: September 2017
      Source:JACC: Heart Failure, Volume 5, Issue 9
      Author(s): Nancy Luo, Robert J. Mentz, Emily C. O’Brien


      PubDate: 2017-09-04T19:49:05Z
       
  • Discordant Perceptions of Prognosis and Treatment Options Between
           Physicians and Patients With Advanced Heart Failure
    • Authors: Amrut V. Ambardekar; Jennifer T. Thibodeau; Adam D. DeVore; Michelle M. Kittleson; Rhondalyn C. Forde-McLean; Maryse Palardy; Maria M. Mountis; Linda Cadaret; Jeffrey J. Teuteberg; Salpy V. Pamboukian; Rongbing Xie; Lynne W. Stevenson; Garrick C. Stewart
      Abstract: Publication date: Available online 16 August 2017
      Source:JACC: Heart Failure
      Author(s): Amrut V. Ambardekar, Jennifer T. Thibodeau, Adam D. DeVore, Michelle M. Kittleson, Rhondalyn C. Forde-McLean, Maryse Palardy, Maria M. Mountis, Linda Cadaret, Jeffrey J. Teuteberg, Salpy V. Pamboukian, Rongbing Xie, Lynne W. Stevenson, Garrick C. Stewart
      Objectives This study assessed patient and physician perceptions of heart failure (HF) disease severity and treatment options. Background The prognosis for ambulatory patients with advanced HF on medical therapy is uncertain, yet has important implications for decision making regarding transplantation and left ventricular assist device (LVAD) placement. Methods Ambulatory patients with advanced HF (New York Heart Association functional class III to IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4 to 7) on optimized medical therapy were enrolled across 11 centers. At baseline, treating cardiologists rated patients for perceived risk for transplant, LVAD, or death in the upcoming year. Patients were also surveyed about their own perceptions of life expectancy and willingness to undergo various interventions. Results At enrollment, physicians regarded 111 of 161 patients (69%) of the total cohort to be at high risk for transplant, LVAD, or death, whereas only 23 patients (14%) felt they were at high risk. After a mean follow-up of 13 months, 61 patients (38%) experienced an endpoint of 33 deaths (21%), 13 transplants (8%), and 15 LVAD implants (9%). There was poor discrimination between risk prediction among both patients and physicians. Among physician-identified high-risk patients, 77% described willingness to consider LVAD, but 63% indicated that they would decline 1 or more other simpler forms of life-sustaining therapy such as ventilation, dialysis, or a feeding tube. Conclusions Among patients with advanced HF, physicians identified most to be at high risk for transplantation, LVAD, or death, whereas few patients recognized themselves to be at high risk. Patients expressed inconsistent attitudes toward lifesaving treatments, possibly indicating poor understanding of these therapies. Educational interventions regarding disease severity and treatment options should be introduced prior to the need for advanced therapies such as intravenous inotropic therapy, transplantation, or LVAD.
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      PubDate: 2017-08-25T18:14:02Z
      DOI: 10.1016/j.jchf.2017.04.009
       
  • Aldosterone, Renin, Cardiovascular Events, and All-Cause Mortality Among
           African Americans
    • Authors: Joshua J. Joseph; Justin B. Echouffo-Tcheugui; Rita R. Kalyani; Hsin-Chieh Yeh; Alain G. Bertoni; Valery S. Effoe; Ramon Casanova; Mario Sims; Wen-Chih Wu; Gary S. Wand; Adolfo Correa; Sherita H. Golden
      Abstract: Publication date: Available online 16 August 2017
      Source:JACC: Heart Failure
      Author(s): Joshua J. Joseph, Justin B. Echouffo-Tcheugui, Rita R. Kalyani, Hsin-Chieh Yeh, Alain G. Bertoni, Valery S. Effoe, Ramon Casanova, Mario Sims, Wen-Chih Wu, Gary S. Wand, Adolfo Correa, Sherita H. Golden
      Objectives This study examined the association of aldosterone and plasma renin activity (PRA) with incident cardiovascular disease (CVD), using a composite endpoint of coronary heart disease, stroke, and/or heart failure and mortality among African Americans in the Jackson Heart Study. Background There is a paucity of data for the association of aldosterone and PRA with incident CVD or all-cause mortality among community-dwelling African Americans. Methods A total of 4,985 African American adults, 21 to 94 years of age, were followed for 12 years. Aldosterone, PRA, and cardiovascular risk factors were collected at baseline (from 2000 to 2004). Incident events included coronary heart disease and stroke (assessed from 2000 to 2011) and heart failure (assessed from 2005 to 2011). Cox models were used to estimate hazard ratios (HR) for incident CVD and mortality, adjusting for age, sex, education, occupation, current smoking, physical activity, dietary intake, and body mass index. Results Among 4,160 participants without prevalent CVD over a median follow-up of 7 years, there were 322 incident CVD cases. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HR of 1.26 (95% confidence intervals [CI]: 1.14 to 1.40) and 1.16 (95% CI: 1.02 to 1.33) for incident CVD, respectively. Over a median of 8 years, 513 deaths occurred among 4,985 participants. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HRs of 1.13 (95% CI: 1.04 to 1.23) and 1.12 (95% CI: 1.01 to 1.24) for mortality, respectively. Conclusions Elevated aldosterone and PRA may play a significant role in the development of CVD and all-cause mortality among African Americans.
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      PubDate: 2017-08-25T18:14:02Z
      DOI: 10.1016/j.jchf.2017.05.012
       
  • Medical Management of Patients With a Left Ventricular Assist Device for
           the Non-Left Ventricular Assist Device Specialist
    • Authors: Adam D. DeVore; Priyesh A. Patel; Chetan B. Patel
      Abstract: Publication date: Available online 16 August 2017
      Source:JACC: Heart Failure
      Author(s): Adam D. DeVore, Priyesh A. Patel, Chetan B. Patel
      More than 2,400 continuous-flow left ventricular assist devices (LVADs) are implanted each year in the United States alone. Both the number of patients living with LVADs and the life expectancy of these patients are increasing. As a result, patients with LVADs are increasingly encountered by non-LVAD specialists who do not have training in managing advanced heart failure for general medical care, cardiovascular procedures, and other subspecialty care. An understanding of the initial evaluation and management of patients with LVADs is now an essential skill for many health care providers. In this State-of-the-Art Review, we discuss current LVAD technology, summarize our clinical experience with LVADs, and review the current data for the medical management of patients living with LVADs.
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      PubDate: 2017-08-25T18:14:02Z
      DOI: 10.1016/j.jchf.2017.06.012
       
  • Why Ruin a Good Story With a Few Facts'∗
    • Authors: Maria Rosa Costanzo
      Abstract: Publication date: Available online 16 August 2017
      Source:JACC: Heart Failure
      Author(s): Maria Rosa Costanzo
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      PubDate: 2017-08-25T18:14:02Z
      DOI: 10.1016/j.jchf.2017.06.008
       
  • Outcomes of Early Adolescent Donor Hearts in Adult Transplant Recipients
    • Authors: Shivank Madan; Snehal R. Patel; Peter Vlismas; Omar Saeed; Sandhya Murthy; Stephen Forest; William Jakobleff; Daniel Sims; Jacqueline M. Lamour; Daphne T. Hsu; Julia Shin; Daniel Goldstein; Ulrich P. Jorde
      Abstract: Publication date: Available online 16 August 2017
      Source:JACC: Heart Failure
      Author(s): Shivank Madan, Snehal R. Patel, Peter Vlismas, Omar Saeed, Sandhya Murthy, Stephen Forest, William Jakobleff, Daniel Sims, Jacqueline M. Lamour, Daphne T. Hsu, Julia Shin, Daniel Goldstein, Ulrich P. Jorde
      Objectives This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts. Background Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established. Methods All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics. Results Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95% confidence interval: 0.62 to 1.01; p = 0.07). Conclusions In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.
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      PubDate: 2017-08-25T18:14:02Z
      DOI: 10.1016/j.jchf.2017.05.004
       
  • Out of Nowhere
    • Authors: Reiss Tatum
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): Reiss Tatum


      PubDate: 2017-08-05T16:00:04Z
       
  • Reply
    • Authors: Maneesh Sud; Bing Harindra Wijeysundera Peter Austin Dennis Juarez Braga
      Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8
      Author(s): Maneesh Sud, Bing Yu, Harindra C. Wijeysundera, Peter C. Austin, Dennis T. Ko, Juarez Braga, Peter Cram, John A. Spertus, Michael Domanski, Douglas S. Lee


      PubDate: 2017-08-05T16:00:04Z
       
  • Correction
    • Abstract: Publication date: August 2017
      Source:JACC: Heart Failure, Volume 5, Issue 8


      PubDate: 2017-08-05T16:00:04Z
       
  • Intrarenal Flow Alterations During Transition From Euvolemia to
           Intravascular Volume Expansion in Heart Failure Patients
    • Authors: Petra Nijst; Frederik H. Verbrugge; Pieter Martens; Matthias Dupont; W.H. Wilson Tang; Wilfried Mullens
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Petra Nijst, Pieter Martens, Matthias Dupont, W.H. Wilson Tang, Wilfried Mullens
      Objectives The goal of this study was to assess: 1) the intrarenal flow in heart failure (HF) patients during the transition from euvolemia to intravascular volume overload; and 2) the relationship between intrarenal flow and diuretic efficiency. Background Intrarenal blood flow alterations may help to better understand impaired volume handling in HF. Methods Resistance index (RI) and venous impedance index (VII) were assessed in 6 healthy subjects, 40 euvolemic HF patients with reduced ejection fraction (HFrEF) and 10 HF patients with preserved ejection fraction (HFpEF). Assessments were performed by using Doppler ultrasonography at baseline, during 3 h of intravascular volume expansion with 1 l of hydroxyethyl starch 6%, and 1 h after the administration of a loop diuretic. Clinical parameters, echocardiography, and biochemistry were assessed. Urine output was collected after 3 and 24 h. Results In response to volume expansion, VII increased significantly in HFrEF patients (0.4 ± 0.3 to 0.7 ± 0.2; p < 0.001) and in HFpEF patients (0.4 ± 0.3 to 0.7 ± 0.2; p = 0.002) but not in healthy subjects (0.2 ± 0.2 to 0.3 ± 0.1; p = 0.622). This outcome was reversed after loop diuretic administration. In contrast, RI did not change significantly after volume expansion. Echocardiographic-estimated filling pressures did not change significantly. VII during volume expansion was significantly correlated with diuretic response in HF patients independent of baseline renal function (R2 = 0.35; p < 0.001). Conclusions In HF patients, intravascular volume expansion resulted in significant blunting of venous flow before a significant increase in cardiac filling pressures could be demonstrated. The observed impaired renal venous flow is correlated with less diuretic efficiency. Intrarenal venous flow patterns may be of interest for evaluating renal congestion.
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      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/j.ijcard.2017.05.041
       
  • Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and
           Reduced Ejection Fraction
    • Authors: Ulrik Sartipy; Ulf Michael Lars Lund
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Ulrik Sartipy, Ulf Dahlström, Michael Fu, Lars H. Lund
      Objectives The study sought to assess the independent risk factors for, consequences of, and outcomes with atrial fibrillation (AF) compared with sinus rhythm (SR) in heart failure (HF) with preserved ejection fraction (HFpEF) versus HF with mid-range ejection fraction (HFmrEF) versus HF with reduced ejection fraction (HFrEF). Background AF is common in HF, but most data are from HFrEF. The importance of AF in HFpEF and MFmrEF is less well known. Methods In patients from 2000 to 2012 in the SwedeHF (Swedish Heart Failure Registry) registry, enriched with patient-level data from national health care registries, the authors assessed prevalence of, associations with and prognostic impact of AF in HFpEF versus HFmrEF versus HFrEF. Results Of 41,446 patients, 23% had HFpEF, 22% had HFmrEF, and 55% had HFrEF. The prevalence of AF was 65%, 60%, and 53% in HFpEF, HFmrEF, and HFrEF, respectively. Independent associations with AF were similar in HFpEF, HFmrEF, and HFrEF and included greater age, male, duration of HF, prior myocardial infarction, and prior stroke or transient ischemic attack (TIA). The adjusted hazard ratios for AF versus SR in HFpEF, HFmrEF, and HFrEF were the following: for death, 1.11 (95% confidence interval [CI]: 1.02 to 1.21), 1.22 (95% CI: 1.12 to 1.33), and 1.17 (95% CI: 1.11 to 1.23); for HF hospitalization or death, 1.17 (95% CI: 1.09 to 1.26), 1.29 (95% CI: 1.20 to 1.40), and 1.15 (95% CI: 1.10 to 1.20); and for stroke or TIA or death, 1.15 (95% CI: 1.07 to 1.25), 1.23 (95% CI: 1.13 to 1.34), and 1.19 (95% CI: 1.14 to 1.26). Conclusions AF was progressively more common with increasing ejection fraction, but was associated with similar clinical characteristics in HFpEF, HFmrEF, and HFrEF. AF was associated with similarly increased risk of death, HF hospitalization, and stroke or TIA in all ejection fraction groups. In contrast, AF and SR populations were considerably different regarding associated patient characteristics and outcomes.
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      PubDate: 2017-07-12T21:18:38Z
       
  • The Paradox in Demonstrating Hydralazine-Nitrate Efficacy∗
    • Authors: Jay Cohn
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Jay N. Cohn
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      PubDate: 2017-07-12T21:18:38Z
       
  • Clinical Effectiveness of Hydralazine–Isosorbide Dinitrate in
           African-American Patients With Heart Failure
    • Authors: Boback Ziaeian; Gregg Fonarow Paul Heidenreich
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Boback Ziaeian, Gregg C. Fonarow, Paul A. Heidenreich
      Objectives This study sought to evaluate the effectiveness of hydralazine–isosorbide dinitrate (H-ISDN) in African Americans with heart failure (HF) with reduced ejection fraction (HFrEF). Background Among African-American patients with HFrEF, H-ISDN was found to improve quality of life and lower HF-related hospitalization and mortality rates in the A-HEFT (African-American Heart Failure Trial). Few studies have evaluated the effectiveness of this therapy in clinical practice. Methods Veterans Affairs patients with a hospital admission for HF between 2007 and 2013 were screened. Inclusion criteria included African-American race, left ventricular ejection fraction <40%, and receipt of Veterans Affairs medications. Exclusions were documented contraindications to H-ISDN, creatinine >2.0 mg/dl, or intolerance to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Adjusted hazard ratios were calculated for patients who received H-ISDN 6-months before admission compared with patients who did not receive H-ISDN, by using inverse probability weighting of propensity scores and a time to death analysis for 18 months of follow-up. Propensity scores were generated using patients’ characteristics, left ventricular ejection fraction, laboratory values, and hospital characteristics. Results The final cohort included 5,168 African-American patients with HF (mean age 65.2 years), with 15.2% treated with H-ISDN before index admission. After 18 months, there were 1,275 reported deaths (24.7%). The adjusted mortality rate at 18 months was 22.1% for patients receiving H-ISDN treatment and 25.2% for untreated patients (p = 0.009); adjusted hazard ratio: 0.85 (95% confidence interval: 0.73 to 1.00; p = 0.057). Conclusions H-ISDN remains underused in African-American patients with HFrEF. In this cohort, the study found that H-ISDN use was associated with lower mortality rates in African-American patients with HFrEF when controlling for patient selection by using an inverse probability weighting of propensity scores.

      PubDate: 2017-07-12T21:18:38Z
       
  • Instructions For Authors
    • Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7


      PubDate: 2017-07-03T20:48:19Z
       
  • A Decade With Editorial Mentors
    • Authors: Christopher
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): Christopher M. O’Connor


      PubDate: 2017-07-03T20:48:19Z
       
  • Biomarker Profiles of Acute Heart Failure Patients With a Mid-Range
           Ejection Fraction
    • Authors: Jasper Tromp; Mohsin A.F. Khan; Robert J. Mentz; Christopher M. O’Connor; Marco Metra; Howard C. Dittrich; Piotr Ponikowski; John R. Teerlink; Gad Cotter; Beth Davison; John G.F. Cleland; Michael M. Givertz; Daniel M. Bloomfield; Dirk J. van Veldhuisen; Hans L. Hillege; Adriaan A. Voors; Peter van der Meer
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Jasper Tromp, Mohsin A.F. Khan, Robert J. Mentz, Christopher M. O’Connor, Marco Metra, Howard C. Dittrich, Piotr Ponikowski, John R. Teerlink, Gad Cotter, Beth Davison, John G.F. Cleland, Michael M. Givertz, Daniel M. Bloomfield, Dirk J. van Veldhuisen, Hans L. Hillege, Adriaan A. Voors, Peter van der Meer
      Objectives In this study, the authors used biomarker profiles to characterize differences between patients with acute heart failure with a midrange ejection fraction (HFmrEF) and compare them with patients with a reduced (heart failure with a reduced ejection fraction [HFrEF]) and preserved (heart failure with a preserved ejection fraction [HFpEF]) ejection fraction. Background Limited data are available on biomarker profiles in acute HFmrEF. Methods A panel of 37 biomarkers from different pathophysiological domains (e.g., myocardial stretch, inflammation, angiogenesis, oxidative stress, hematopoiesis) were measured at admission and after 24 h in 843 acute heart failure patients from the PROTECT trial. HFpEF was defined as left ventricular ejection fraction (LVEF) of ≥50% (n = 108), HFrEF as LVEF of <40% (n = 607), and HFmrEF as LVEF of 40% to 49% (n = 128). Results Hemoglobin and brain natriuretic peptide levels (300 pg/ml [HFpEF]; 397 pg/ml [HFmrEF] 521 pg/ml [HFrEF]; ptrend <0.001) showed an upward trend with decreasing LVEF. Network analysis showed that in HFrEF interactions between biomarkers were mostly related to cardiac stretch, whereas in HFpEF, biomarker interactions were mostly related to inflammation. In HFmrEF, biomarker interactions were both related to inflammation and cardiac stretch. In HFpEF and HFmrEF (but not in HFrEF), remodeling markers at admission and changes in levels of inflammatory markers across the first 24 h were predictive for all-cause mortality and rehospitalization at 60 days (pinteraction <0.05). Conclusions Biomarker profiles in patients with acute HFrEF were mainly related to cardiac stretch and in HFpEF related to inflammation. Patients with HFmrEF showed an intermediate biomarker profile with biomarker interactions between both cardiac stretch and inflammation markers. (PROTECT-1: A Study of the Selective A1 Adenosine Receptor Antagonist KW-3902 for Patients Hospitalized With Acute HF and Volume Overload to Assess Treatment Effect on Congestion and Renal Function; NCT00328692)
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.04.007
       
  • Modifiable Risk Factors for Incident Heart Failure in Atrial
           Fibrillation
    • Authors: Neal A. Chatterjee; Claudia U. Chae; Eunjung Kim; M. Vinayaga Moorthy; David Conen; Roopinder K. Sandhu; Nancy R. Cook; I-Min Lee; Christine M. Albert
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Neal A. Chatterjee, Claudia U. Chae, Eunjung Kim, M. Vinayaga Moorthy, David Conen, Roopinder K. Sandhu, Nancy R. Cook, I-Min Lee, Christine M. Albert
      Objectives This study sought to identify modifiable risk factors and estimate the impact of risk factor modification on heart failure (HF) risk in women with new-onset atrial fibrillation (AF). Background Incident HF is the most common nonfatal event in patients with AF, although strategies for HF prevention are lacking. Methods We assessed 34,736 participants in the Women’s Health Study who were free of prevalent cardiovascular disease at baseline. Cox models with time-varying assessment of risk factors after AF diagnosis were used to identify significant modifiable risk factors for incident HF. Results Over a median follow-up of 20.6 years, 1,495 women developed AF without prevalent HF. In multivariable models, new-onset AF was associated with an increased risk of HF (hazard ratio [HR]: 9.03; 95% confidence interval [CI]: 7.52 to 10.85). Once women with AF developed HF, all-cause (HR: 1.83; 95% CI: 1.37 to 2.45) and cardiovascular mortality (HR: 2.87; 95% CI: 1.70 to 4.85) increased. In time-updated, multivariable models accounting for changes in risk factors after AF diagnosis, systolic blood pressure >120 mm Hg, body mass index ≥30 kg/m2, current tobacco use, and diabetes mellitus were each associated with incident HF. The combination of these 4 modifiable risk factors accounted for an estimated 62% (95% CI: 23% to 83%) of the population-attributable risk of HF. Compared with women with 3 or 4 risk factors, those who maintained or achieved optimal risk factor control had a progressive decreased risk of HF (HR for 2 risk factors: 0.60; 95% CI: 0.37 to 0.95; 1 risk factor: 0.40; 95% CI: 0.25 to 0.63; and 0 risk factors: 0.14; 95% CI: 0.07 to 0.29). Conclusions In women with new-onset AF, modifiable risk factors including obesity, hypertension, smoking, and diabetes accounted for the majority of the population risk of HF. Optimal levels of modifiable risk factors were associated with decreased HF risk. Prospective assessment of risk factor modification at the time of AF diagnosis may warrant future investigation.
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.04.004
       
  • Time to Take the Failure Out of Heart Failure
    • Authors: John G.F. Cleland; Pierpaolo Pellicori; Andrew L. Clark; Mark C. Petrie
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): John G.F. Cleland, Pierpaolo Pellicori, Andrew L. Clark, Mark C. Petrie
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.04.003
       
  • The Changing Landscape of Atrial Fibrillation
    • Authors: Darae Ko; Renate B. Schnabel; Ludovic Trinquart; Emelia J. Benjamin
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Darae Ko, Renate B. Schnabel, Ludovic Trinquart, Emelia J. Benjamin
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.05.002
       
  • Progression to Stage D Heart Failure Among Outpatients With Stage C Heart
           Failure and Reduced Ejection Fraction
    • Authors: Andreas P. Kalogeropoulos; Ayman Samman-Tahhan; Jeffrey S. Hedley; Andrew A. McCue; Jonathan B. Bjork; David W. Markham; Kunal N. Bhatt; Vasiliki V. Georgiopoulou; Andrew L. Smith; Javed Butler
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Andreas P. Kalogeropoulos, Ayman Samman-Tahhan, Jeffrey S. Hedley, Andrew A. McCue, Jonathan B. Bjork, David W. Markham, Kunal N. Bhatt, Vasiliki V. Georgiopoulou, Andrew L. Smith, Javed Butler
      Objectives This study sought to estimate the rate of progression to Stage D heart failure (HF) among outpatients with Stage C HF and to identify risk factors for progression. Background The pool of patients who may be candidates for advanced HF therapies is growing. Methods We estimated 3-year progression to clinically determined Stage D HF and competing mortality among 964 outpatients with Stage C heart failure with reduced ejection fraction (HFrEF), where ejection fraction is ≤40%. Results The mean age of patients was 62 ± 15 years; 35% were women; 47% were white; 46% were black, and 7% were of other races; median baseline ejection fraction was 28% (25th to 75th percentile: 20% to 35%); and 47% had ischemic heart disease. After 3.0 years (25th to 75th percentile: 1.7 to 3.2 years), 112 patients progressed to Stage D (3-year incidence: 12.2%; 95% confidence interval [CI]: 10.2% to 14.6%; annualized: 4.5%; 95% CI: 3.8% to 5.5%), and 116 patients died before progression (3-year competing mortality: 12.9%; annualized: 4.7%; 95% CI: 3.9% to 5.6%). By 3 years, 25.1% of patients (95% CI: 22.2% to 28.1%) had either progressed to Stage D or died (annualized: 9.2%; 95% CI: 8.1% to 10.5%). Annualized progression rates were higher in black versus white patients (6.3% vs. 2.7%, respectively; p < 0.001), nonischemic versus ischemic patients (6.1% vs. 2.9%, respectively; p < 0.001), and in New York Heart Association functional class III to IV versus I to II patients (7.5% vs. 1.9%, respectively; p < 0.001) but were similar for men and women (4.7% vs. 4.2%, respectively; p = 0.53). Lower ejection fraction and blood pressure, renal and hepatic dysfunction, and chronic lung disease rates were additional predictors of progression. Predictors of competing mortality were different from those of disease progression. Conclusions Among patients with Stage C HFrEF receiving care in a referral center, 4.5% progressed to Stage D HF each year, with earlier progression among black and nonischemic patients. These findings have implications for healthcare planning and resource allocation for these patients.
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.02.020
       
  • Tetralogy of Fallow
    • Authors: Milton Packer
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Milton Packer
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.004
       
  • Do We Need Another Walking Test?∗
    • Authors: Clinton A. Brawner; Steven J. Keteyian
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Clinton A. Brawner, Steven J. Keteyian
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.001
       
  • Holding the Readmission Gates
    • Authors: Gregg C. Fonarow; Boback Ziaeian
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Gregg C. Fonarow, Boback Ziaeian
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.04.002
       
  • Can Heart Failure With Preserved Ejection Fraction Shed Light on the
           Mortality-Readmissions Paradox?∗
    • Authors: Jennifer
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Jennifer E. Ho
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      PubDate: 2017-05-14T19:07:41Z
       
  • Race/Ethnic Differences in Outcomes Among Hospitalized Medicare Patients
           With Heart Failure and Preserved Ejection Fraction
    • Authors: Boback Ziaeian; Paul A. Heidenreich; Haolin Xu; Adam D. DeVore; Roland A. Matsouaka; Adrian F. Hernandez; Deepak L. Bhatt; Clyde W. Yancy; Gregg C. Fonarow
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Boback Ziaeian, Paul A. Heidenreich, Haolin Xu, Adam D. DeVore, Roland A. Matsouaka, Adrian F. Hernandez, Deepak L. Bhatt, Clyde W. Yancy, Gregg C. Fonarow
      Objectives This study analyzed HFpEF patient characteristics and clinical outcomes according to race/ethnicity and adjusted for patient and hospital characteristics along with socioeconomic status (SES). Background The proportion of hospitalizations for heart failure with preserved ejection fraction (HFpEF) has increased over the last decade. Whether the short- and long-term outcomes differ between racial/ethnic groups is not well described. Methods The Get With The Guidelines–Heart Failure registry was linked to Medicare administrative data to identify hospitalized patients with HFpEF ≥65 years of age with left ventricular ejection fraction ≥50% between 2006 and 2014. Cox proportional hazards models were used to report hazard ratios (HRs) for 30-day and 1-year readmission and mortality rates with sequential adjustments for patient characteristics, hospital characteristics, and SES. Results The final cohort included 53,065 patients with HFpEF. Overall 30-day mortality was 5.87%; at 1 year, it was 33.1%. The 30-day all-cause readmission rate was 22.2%, and it was 67.0% at 1 year. After adjusting for patient characteristics, hospital characteristics, and SES, 30-day mortality was lower for black patients (HR: 0.84; 95% confidence interval [CI]: 0.71 to 0.98; p = 0.031) and Hispanic patients (HR: 0.78; 95% CI: 0.64 to 0.96; p = 0.017) compared with white patients. One-year mortality was lower for black patients (HR: 0.93; 95% CI: 0.87 to 0.99; p = 0.031), Hispanic patients (HR: 0.83; 95% CI: 0.75 to 0.91; p < 0.001), and Asian patients (HR: 0.76; 95% CI: 0.66 to 0.88; p < 0.001) compared with white patients. Black patients had a higher risk of readmission at 30 days (HR: 1.09; 95% CI: 1.02 to 1.16; p = 0.012) and 1 year (HR: 1.14; 95% CI: 1.09 to 1.20; p < 0.001) compared with white patients. Conclusions Black, Hispanic, and Asian patients had a lower mortality risk after a hospitalization for HFpEF compared with white patients; black patients had higher readmission rates. These differences in mortality and readmission risk according to race/ethnicity persisted after adjusting for patient characteristics, SES, and hospital factors.
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.02.012
       
  • Associations Between Short or Long Length of Stay and 30-Day Readmission
           and Mortality in Hospitalized Patients With Heart Failure
    • Authors: Maneesh Sud; Bing Yu; Harindra C. Wijeysundera; Peter C. Austin; Dennis T. Ko; Juarez Braga; Peter Cram; John A. Spertus; Michael Domanski; Douglas S. Lee
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Maneesh Sud, Bing Yu, Harindra C. Wijeysundera, Peter C. Austin, Dennis T. Ko, Juarez Braga, Peter Cram, John A. Spertus, Michael Domanski, Douglas S. Lee
      Objectives This study sought to examine the associations between heart failure (HF)-related hospital length of stay and 30-day readmissions and HF hospital length of stay and mortality rates. Background Although reducing HF readmission and mortality rates are health care priorities, how HF-related hospital length of stay affects these outcomes is not fully known. Methods A population-level, multicenter cohort study of 58,230 patients with HF (age >65 years) was conducted in Ontario, Canada between April 1, 2003 and March 31, 2012. Results When length of stay was modeled as continuous variable, its association with the rate of cardiovascular readmission was nonlinear (p < 0.001 for nonlinearity) and U-shaped. When analyzed as a categorical variable, there was a higher rate of cardiovascular readmission for short (1 to 2 days; adjusted hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 1.04 to 1.21; p = 0.003) and long (9 to 14 days; HR: 1.11; 95% CI: 1.04 to 1.19; p = 0.002) lengths of stay as compared with 5 to 6 days (reference). Hospital readmissions for HF demonstrated a similar nonlinear (p = 0.005 for nonlinearity) U-shaped relationship with increased rates for short (HR: 1.15; 95% CI: 1.04 to 1.27; p = 0.006) and long (HR: 1.14; 95% CI: 1.04 to 1.25; p = 0.004) lengths of stay. Noncardiovascular readmissions demonstrated increased rates with long (HR: 1.17; 95% CI: 1.07 to 1.29; p < 0.001) and decreased rates with short (HR: 0.87; 95% CI: 0.79 to 0.96; p = 0.006) lengths of stay (p = 0.53 for nonlinearity). The 30-day mortality risk was highest after a long length of stay (HR: 1.28; 95% CI: 1.14 to 1.43; p < 0.001). Conclusions A short length of stay after hospitalization for HF is associated with increased rates of cardiovascular and HF readmissions but lower rates of noncardiovascular readmissions. A long length of stay is associated with increased rates of all types of readmission and mortality.
      Graphical abstract image

      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.012
       
  • A New Clinically Applicable Measure of Functional Status in Patients With
           Heart Failure
    • Authors: Kristie M. Harris; David S. Krantz; Willem J. Kop; Joanne Marshall; Shawn W. Robinson; Jennifer M. Marshall; Stephen S. Gottlieb
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Kristie M. Harris, David S. Krantz, Willem J. Kop, Joanne Marshall, Shawn W. Robinson, Jennifer M. Marshall, Stephen S. Gottlieb
      Objectives This study reports the development and predictive value of the 60-foot walk test (60ftWT), a brief functional status measure for patients with heart failure (HF). The goal was to develop a test suitable for clinical settings and appropriate for patients with walking impairments. Background The 6-min walk test (6MWT) has considerable predictive value, but requires a long walking course and has limited utility in patients with mobility-related comorbidities. A shorter, more clinically practical test is therefore needed. Methods A total of 144 patients (age 57.4 ± 11.4 years; 111 males) with symptomatic HF received baseline assessments using the 60ftWT, 6MWT, and self-reported symptom and health status. Patients were tested 3 months later to determine stability of assessments. HF hospitalizations or death from any cause were recorded for 3.5 years following baseline. Results Median 60ftWT completion time was 26 seconds (interquartile range: 22 to 31). Longer 60ftWT time was associated with shorter 6MWT distance (r = -0.75; p < 0.001), and with higher symptom severity at baseline (r = –0.40; p < 0.001). Longer 60ftWT times also predicted increases in 6MWT and symptoms from baseline to 3 months (p < 0.01). Both WTs predicted long-term clinical outcomes, with patients taking longer than 31 seconds to complete the 60ftWT at greatest risk for HF hospitalization or death (hazard ratio: 2.13; 95% confidence interval: 1.18 to 3.84; p = 0.01). Conclusions The 60ftWT is an easily administered functional status measure that predicts adverse events, symptoms, and health status. It has the potential for considerable clinical utility to help identify patients at risk for future events and to calibrate treatments designed to improve functional status and quality of life.
      Graphical abstract image

      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.02.005
       
  • Long-Term Effects of Flosequinan on the Morbidity and Mortality of
           Patients With Severe Chronic Heart Failure
    • Authors: Milton Packer; Bertram Pitt; Jean-Lucien Rouleau; Karl Swedberg; David L. DeMets; Lloyd Fisher
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Milton Packer, Bertram Pitt, Jean-Lucien Rouleau, Karl Swedberg, David L. DeMets, Lloyd Fisher
      Objectives The objective of this clinical trial was to evaluate the long-term effects of flosequinan on the morbidity and mortality of patients with severe chronic heart failure. Background Flosequinan was the first oral vasodilator to be used in the clinic to augment the effects of digitalis, diuretics, and angiotensin-converting enzyme inhibitors in heart failure. However, the drug activated neurohormonal systems and exerted both positive inotropic and chronotropic effects, raising concerns about its safety during long-term use. Methods Following a run-in period designed to minimize the risk of tachycardia, we randomly assigned 2,354 patients in New York Heart functional class III to IV heart failure and with an ejection fraction ≤35% to receive long-term treatment with placebo or flosequinan (75 or 100 mg/day) in addition to their usual therapy. The primary outcome was all-cause mortality. Results The trial was terminated after a recommendation of the Data and Safety Monitoring Board, because during an average of 10 months of follow-up, 192 patients died in the placebo group and 255 patients died in the flosequinan group (hazard ratio: 1.39, 95% confidence interval: 1.15 to 1.67; p = 0.0006). Flosequinan also increased the risk of disease progression, which was paralleled by drug-related increases in heart rate and neurohormonal activation. However, during the first month, patients in the flosequinan group were more likely to report an improvement in well-being and less likely to experience worsening heart failure. Similarly, during the month following drug withdrawal at the end of the trial, patients withdrawn from flosequinan were more likely than those withdrawn from placebo to report symptoms of or to require treatment for worsening heart failure. Conclusions Although flosequinan produced meaningful symptomatic benefits during short- and long-term treatment, the drug increased the risk of death in patients with severe chronic heart failure.
      Graphical abstract image

      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.003
       
  • Risk Assessment and Comparative Effectiveness of Left Ventricular Assist
           Device and Medical Management in Ambulatory Heart Failure Patients
    • Authors: Randall C. Starling; Jerry D. Estep; Douglas A. Horstmanshof; Carmelo A. Milano; Josef Stehlik; Keyur B. Shah; Brian A. Bruckner; Sangjin Lee; James W. Long; Craig H. Selzman; Vigneshwar Kasirajan; Donald C. Haas; Andrew J. Boyle; Joyce Chuang; David J. Farrar; Joseph G. Rogers
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Randall C. Starling, Jerry D. Estep, Douglas A. Horstmanshof, Carmelo A. Milano, Josef Stehlik, Keyur B. Shah, Brian A. Bruckner, Sangjin Lee, James W. Long, Craig H. Selzman, Vigneshwar Kasirajan, Donald C. Haas, Andrew J. Boyle, Joyce Chuang, David J. Farrar, Joseph G. Rogers
      Objectives The authors sought to provide the pre-specified primary endpoint of the ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) trial at 2 years. Background The ROADMAP trial was a prospective nonrandomized observational study of 200 patients (97 with a left ventricular assist device [LVAD], 103 on optimal medical management [OMM]) that showed that survival with improved functional status at 1 year was better with LVADs compared with OMM in a patient population of ambulatory New York Heart Association functional class IIIb/IV patients. Methods The primary composite endpoint was survival on original therapy with improvement in 6-min walk distance ≥75 m. Results Patients receiving LVAD versus OMM had lower baseline health-related quality of life, reduced Seattle Heart Failure Model 1-year survival (78% vs. 84%; p = 0.012) predominantly INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 4 (65% vs. 34%; p < 0.001) versus profiles 5 to 7. More LVAD patients met the primary endpoint at 2 years: 30% LVAD versus 12% OMM (odds ratio 3.2 [95% confidence interval 1.3 to 7.7]; p = 0.012). Survival as treated on original therapy at 2 years was greater for LVAD versus OMM (70 ± 5% vs. 41 ± 5%; p < 0.001), but there was no difference in intent-to-treat survival (70 ± 5% vs. 63 ± 5%; p = 0.307). In the OMM arm, 23 of 103 (22%) received delayed LVADs (18 within 12 months; 5 from 12 to 24 months). LVAD adverse events declined after year 1 for bleeding (primarily gastrointestinal) and arrhythmias. Conclusions Survival on original therapy with improvement in 6-min walk distance was superior with LVAD compared with OMM at 2 years. Reduction in key adverse events beyond 1 year was observed in the LVAD group. The ROADMAP trial provides risk-benefit information to guide patient- and physician-shared decision making for elective LVAD therapy as a treatment for heart failure. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients [ROADMAP]; NCT01452802).
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2017.02.016
       
 
 
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