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Journal Cover JACC : Heart Failure
  [SJR: 4.318]   [H-I: 18]   [8 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by Elsevier Homepage  [3031 journals]
  • Long-Term Effect of Endothelin Receptor Antagonism With Bosentan on the
           Morbidity and Mortality of Patients With Severe Chronic Heart Failure
    • Authors: Milton Packer; John J.V. McMurray; Henry Krum; Wolfgang Kiowski; Barry M. Massie; Avi Caspi; Craig M. Pratt; Mark C. Petrie; David DeMets; Isaac Kobrin; Sebastien Roux; Karl Swedberg; Milton Packer; Avi Caspi; Wolfgang Kiowski; Henry Krum; Craig Pratt; Karl Swedberg; Barry Massie; John McMurray; John McMurray; Eugene Connally; Mark Petrie; David DeMets; Susan Anderson; Jody Barnet; Robert Cody; Henry Dargie; Gary Francis; Barry Greenberg; Juerg Reichen; J. Karrasch; H. Krum; J. Horowitz; J. Amerena; A. Sindone; P. MacDonald; I. Jeffrey; I. Button; E. DeAngelis; R. Pacher; R. Davies; F. McAlister; P. Tanser; B. Sussex; G. Baumann; E. Fleck; H.-G. Olbrich; K. Werdan; H. Klein; F. Staffeld; A.M. Zeiher; C. Roediger; A. Caspi; A. Marmor; L. Reisin; Z. Vered; E. Klainman; N. Roguin; D. Tzivoni; D. David; B. Lewis; E. Abinader; M. Omary; Y. Rosenman; E. Kaluski; R.W. Breedveld; P.H. van der Burgh; P.H.J.M. Dunselman; H.J. Schaafsma; D.P. Hertzberger; N.J. Holwerda; J.A. Kragten; J. van Wijngaarden; J.L. Posma; S.A.M. Said; L.C. Slegers; R.M. Tjon Joe Gin; F.N. Wempe; J.C.L. Wesdorp; A.R. Willems; A.J.A.M. Withagen; J.M. Cornel; L.H.J. van Kempen; W. Kiowski; O. Bertel; T. Moccetti; J.J.V. McMurray; R.A. Greenbaum; P. Bennett; J. Swan; G. Davies; I. Findlay; B. Gould; S. Ball; P. Hubner; A. Lahiri; J. McLay; R. Northcote; S. Saltissi; I. Squire; J. Stephens; M. Stewart; G. Bridgen; J. Walsh; D.J. Webb; Z. Ansari; S. Baron; R. Bellinger; W. Bennet; D. Benvenuti; D. Dawley; L.C. Egbujiobi; I. Eisenstein; T. Little; A. Hertsberg; M. Greenspan; R.J. Grossman; P. Hanley; M. Jesrani; H. Kashou; R. Levites; R. Malik; B. Marmorstein; M. Schwartz; A. Nisar; R. Perelman; M.L. Schwarz; S. Sedlis; J. Srebro; M. Taveras; R. Weiss; P. Weitzman; G.K. Wetherley; M. El Shahawy; D. Kereiakes; L. Campos; G. Peterson; R.S. Small; W.R. Davis; M.-T. Olivari; W. Meengs; M. Koren; P. Slagona; S. Jennison; R. Hershberger; K.F. Browne; D.J. Farnham; S. Zelenkofske; C. Lawless; M. Nathan; T. Meyer; M. Kukin; H. Parekh; R. Berkowitz; J. Boehmer; S. Brozena; P. Dandona; G.W. Dec; V. DeQuattro; P. Fenster; M. Fowler; S. Ellaham; M. Geller; M. Gheorgiade; J. Ghali; S. Murali; S. Katz; C. Bott-Silverman; B. Singh; U. Thadani; G. Torre; J. Teerlink; T. Chandraratna; M. Kesselbrenner; A. Mukherjee; C. Che-Pin Tsai; K. Abbo; M. Goldberg; T. Smith; R.T. Martin
      Pages: 317 - 326
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Milton Packer, John J.V. McMurray, Henry Krum, Wolfgang Kiowski, Barry M. Massie, Avi Caspi, Craig M. Pratt, Mark C. Petrie, David DeMets, Isaac Kobrin, Sebastien Roux, Karl Swedberg
      Objectives The objective of this clinical trial was to evaluate the long-term effect of endothelin receptor antagonism with bosentan on the morbidity and mortality of patients with severe chronic heart failure. Background Endothelin may play a role in heart failure, but short-term clinical trials with endothelin receptor antagonists have reported disappointing results. Long-term trials are lacking. Methods In 2 identical double-blind trials, we randomly assigned 1,613 patients with New York Heart Association functional class IIIb to IV heart failure and an ejection fraction <35% to receive placebo or bosentan (target dose 125 mg twice daily) for a median of 1.5 years. The primary outcome for each trial was clinical status at 9 months (assessed by the hierarchical clinical composite); the primary outcome across the 2 trials was death from any cause or hospitalization for heart failure. Results Bosentan did not influence clinical status at 9 months in either trial (p = 0.928 and p = 0.263). In addition, 321 patients in the placebo group and 312 patients in the bosentan group died or were hospitalized for heart failure (hazard ratio [HR]: 1.01; 95% confidence interval [CI]: 0.86 to 1.18; p = 0.90). The bosentan group experienced fluid retention within the first 2 to 4 weeks, as evidenced by increased peripheral edema, weight gain, decreases in hemoglobin, and an increased risk of hospitalization for heart failure, despite intensification of background diuretics. During follow-up, 173 patients died in the placebo group and 160 patients died in the bosentan group (HR: 0.94; 95% CI: 0.75 to 1.16). About 10% of the bosentan group showed meaningful increases in hepatic transaminases, but none had acute or chronic liver failure. Conclusions Bosentan did not improve the clinical course or natural history of patients with severe chronic heart failure and but caused early and important fluid retention.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.021
       
  • Theory and Fact
    • Authors: Stephen S. Gottlieb
      Pages: 327 - 328
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Stephen S. Gottlieb
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.03.005
       
  • The Influence of Age on Hemodynamic Parameters During Rest and Exercise
           in Healthy Individuals
    • Authors: Emil Wolsk; Rine Bakkestrøm; Jacob H. Thomsen; Louise Balling; Mads J. Andersen; Jordi S. Dahl; Christian Hassager; Jakob E. Møller; Finn Gustafsson
      Pages: 337 - 346
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Emil Wolsk, Rine Bakkestrøm, Jacob H. Thomsen, Louise Balling, Mads J. Andersen, Jordi S. Dahl, Christian Hassager, Jakob E. Møller, Finn Gustafsson
      Objectives In this study, the authors sought to obtain hemodynamic estimates across a wide age span and in both sexes for future reference and compare these estimates with current guideline diagnostic hemodynamic thresholds for abnormal filling pressure and pulmonary hypertension. Background At present, the influence of age on hemodynamic function is largely unknown. Because many diseases with proposed cardiac impact are more prevalent in the older population, it is pivotal to know how hemodynamic parameters are affected by age itself to discern the influence of disease from that of physiological aging. Methods Sixty-two healthy participants, evenly distributed with respect to age (20 to 80 years) and sex (32 women/30 men), were prospectively enrolled in the study. Participants were all deemed healthy by medical history, echocardiography, exercise test, spirometry, blood tests, and electrocardiogram. Participants had hemodynamic parameters measured using right heart catheterization during rest, passive leg raise, and incremental exercise. Results During rest, all hemodynamic parameters were similar between age groups, apart from blood pressure. During leg raise and incremental exercise, there was augmented filling pressure (p < 0.0001) and diminished cardiac output (p = 0.001) and hence a higher pressure:flow ratio (pulmonary artery pressure/capillary wedge pressure to cardiac output) with progressive age, evident from the earliest ages. All indexed hemodynamic measures were similar between sexes. The diagnostic threshold (pulmonary capillary wedge pressure ≥25 mm Hg) currently used during exercise testing to diagnose abnormal left ventricular filling pressure was measured in 30% of our healthy elderly participants. Conclusions Cardiac aging was progressive without sex differences in healthy participants. The hemodynamic reference values obtained suggest that the diagnostic threshold for abnormal filling pressure should be individually determined according to age of the patient.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2016.10.012
       
  • Physical Activity, Obesity, and Subclinical Myocardial Damage
    • Authors: Roberta Florido; Chiadi E. Ndumele; Lucia Kwak; Yuanjie Pang; Kunihiro Matsushita; Jennifer A. Schrack; Mariana Lazo; Vijay Nambi; Roger S. Blumenthal; Aaron R. Folsom; Josef Coresh; Christie M. Ballantyne; Elizabeth Selvin
      Pages: 377 - 384
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Roberta Florido, Chiadi E. Ndumele, Lucia Kwak, Yuanjie Pang, Kunihiro Matsushita, Jennifer A. Schrack, Mariana Lazo, Vijay Nambi, Roger S. Blumenthal, Aaron R. Folsom, Josef Coresh, Christie M. Ballantyne, Elizabeth Selvin
      Objectives This study sought to evaluate the association of physical activity with chronic myocardial damage, assessed by elevated high-sensitivity cardiac troponin T (hs-cTnT), in individuals with and without obesity. Background Physical activity is associated with reduced risk of heart failure (HF), particularly among obese people. The role of chronic myocardial damage in this association is uncertain. Methods We studied 9,427 participants in the Atherosclerosis Risk in Communities Study without cardiovascular disease, with body mass index >18.5 kg/m2. Physical activity was categorized per American Heart Association guidelines as recommended, intermediate, or poor. We evaluated cross-sectional associations of physical activity and obesity with elevated hs-cTnT (≥14 ng/l). In prospective analyses, we quantified the association of elevated hs-cTnT with HF risk within cross-categories of baseline physical activity and obesity. Results People with poor physical activity were more likely to have elevated hs-cTnT than those with recommended levels (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.15 to 1.68). In cross-categories of physical activity and obesity, using the non-obese/recommended activity group as the reference, individuals with obesity and poor activity were most likely to have elevated hs-cTnT (OR: 2.46; 95% CI: 1.91 to 3.19), whereas the obese/recommended activity group had a weaker association (OR: 1.68; 95% CI: 1.28 to 2.21; p < 0.001 for interaction between physical activity and obesity). In prospective analyses, elevated hs-cTnT was strongly associated (p < 0.001) with incident HF in all obesity/physical activity cross-categories (p > 0.20 for interaction). Conclusions Physical activity is inversely associated with chronic subclinical myocardial damage. Physical activity might lessen the association between obesity and subclinical myocardial damage, which could represent a mechanism by which physical activity reduces HF risk.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.002
       
  • Physical Activity Prevents Obesity and Heart Failure
    • Authors: Tariq Ahmad; Jeffrey M. Testani
      Pages: 385 - 387
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Tariq Ahmad, Jeffrey M. Testani
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.03.006
       
  • Impact of Current Versus Previous Cardiac Resynchronization Therapy
           Guidelines on the Proportion of Patients With Heart Failure Eligible for
           Therapy
    • Authors: Kristin J. Lyons; Justin A. Ezekowitz; Li Liang; Paul A. Heidenreich; Clyde W. Yancy; Adam D. DeVore; Adrian F. Hernandez; Gregg C. Fonarow
      Pages: 388 - 392
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Kristin J. Lyons, Justin A. Ezekowitz, Li Liang, Paul A. Heidenreich, Clyde W. Yancy, Adam D. DeVore, Adrian F. Hernandez, Gregg C. Fonarow
      Objectives This study sought to ascertain the impact of heart failure (HF) guideline change on the number of patients eligible to undergo cardiac resynchronization therapy (CRT). Background The 2013 HF guideline of the American College of Cardiology Foundation and American Heart Association (ACCF/AHA) narrowed the recommendations for CRT. The impact of this guideline change on the number of eligible patients for CRT has not been described. Methods Using data from Get With The Guidelines–Heart Failure between 2012 and 2015, this study evaluated the proportion of hospitalized patients with HF who were eligible for CRT on the basis of historical and current guideline recommendations. The authors identified 25,102 hospitalizations for HF that included patients with a left ventricular ejection fraction (LVEF) ≤35% from 283 hospitals. Patients with a medical, system-related, or patient-related reason for not undergoing CRT were excluded. Results Overall, 49.1% (n = 12,336) of patients with HF, an LVEF ≤35%, and no documented contraindication were eligible for CRT on the basis of historical guidelines, and 33.1% (n = 8,299) of patients were eligible for CRT on the basis of current guidelines, a 16.1% absolute reduction in eligibility (p < 0.0001). Patients eligible for CRT on the basis of current guidelines were more likely to have CRT with an implantable cardioverter-defibrillator or CRT with pacing only placed or prescribed at discharge (57.8% vs. 54.9%; p < 0.0001) compared with patients eligible for CRT on the basis of historical guidelines. Conclusions In this population of patients with HF, an LVEF ≤35%, and no documented contraindication for CRT, the current ACCF/AHA HF guidelines reduce the proportion of patients eligible for CRT by approximately 15%.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.018
       
  • High Heart Failure Readmission Rates
    • Authors: Christopher M. O’Connor
      First page: 393
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Christopher M. O’Connor


      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.03.011
       
  • Risk Stratification in Dilated Cardiomyopathy
    • Authors: David Heinzmann; Meinrad Gawaz; Peter Seizer
      First page: 394
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): David Heinzmann, Meinrad Gawaz, Peter Seizer


      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.004
       
  • Observational Versus Randomized
    • Authors: Dipak Kotecha; Douglas G. Altman; Giuseppe Rosano; Marcus D. Flather
      Pages: 395 - 396
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Dipak Kotecha, Douglas G. Altman, Giuseppe Rosano, Marcus D. Flather


      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.013
       
  • Interaction Between Spironolactone and Natriuretic Peptides in Patients
           With Heart Failure and Preserved Ejection Fraction
    • Authors: Inder S. Anand; Brian Claggett; Jiankang Liu; Amil M. Shah; Thomas S. Rector; Sanjiv J. Shah; Akshay S. Desai; Eileen O’Meara; Jerome L. Fleg; Marc A. Pfeffer; Bertram Pitt; Scott D. Solomon
      Pages: 241 - 252
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Inder S. Anand, Brian Claggett, Jiankang Liu, Amil M. Shah, Thomas S. Rector, Sanjiv J. Shah, Akshay S. Desai, Eileen O’Meara, Jerome L. Fleg, Marc A. Pfeffer, Bertram Pitt, Scott D. Solomon
      Objectives The aims of this study were to explore the relationship of baseline levels of natriuretic peptides (NPs) with outcomes and to test for an interaction between baseline levels of NPs and the effects spironolactone. Background Plasma NPs are considered to be helpful in the diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF), and elevated levels are associated with adverse outcomes. Levels of NPs higher than certain cutoffs are often used as inclusion criteria in clinical trials of HFpEF to increase the likelihood that patients have HF and to select patients at higher risk for events. Whether treatments have a differential effect on outcomes across the spectrum of NP levels is unclear. Methods The TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial) trial randomized patients with HFpEF and either prior hospitalization for HF or elevated natriuretic peptide levels (B-type NP [BNP] ≥100 pg/ml or N-terminal proBNP ≥360 pg/ml) to spironolactone or placebo. Baseline BNP (n = 430) or N-terminal proBNP (n = 257) levels were available in 687 patients enrolled from the Americas in the elevated-NP stratum of TOPCAT. Results Higher levels of NPs were independently associated with an increased risk for TOPCAT’s primary endpoint of cardiovascular mortality, aborted cardiac arrest, or hospitalization for HF when analyzed either continuously or grouped by terciles, adjusting for region of enrollment, age, sex, atrial fibrillation, diabetes, renal function, body mass index, and heart rate. There was a significant interaction between the effect of spironolactone and baseline NP terciles for the primary outcome (p = 0.017), with greater benefit of the drug in the lower compared with higher NP terciles. Conclusions Similar to the effects of irbesartan in the I-PRESERVE (Irbesartan in Heart Failure With Preserved Ejection Fraction) trial, a greater benefit of spironolactone was observed in the group with lower levels of NPs and overall risk in TOPCAT. Elevated NPs in HFpEF identify patients at higher risk for events but who may be less responsive to treatment. The mechanism of this apparent interaction between disease severity and response to therapy requires further exploration. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302)
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2016.11.015
       
  • Natriuretic Peptide Levels and Interaction With Treatment in HFpEF
    • Authors: Peter E. Carson
      Pages: 253 - 255
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Peter E. Carson
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2017.02.011
       
  • Limited Added Value of Circulating Inflammatory Biomarkers
           in Chronic Heart Failure
    • Authors: Ståle H. Nymo; Pål Aukrust; John Kjekshus; John J.V. McMurray; John G.F. Cleland; John Wikstrand; Pieter Muntendam; Ursula Wienhues-Thelen; Roberto Latini; Erik Tandberg Askevold; Jørgen Gravning; Christen P. Dahl; Kaspar Broch; Arne Yndestad; Lars Gullestad; Thor Ueland
      Pages: 256 - 264
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Ståle H. Nymo, Pål Aukrust, John Kjekshus, John J.V. McMurray, John G.F. Cleland, John Wikstrand, Pieter Muntendam, Ursula Wienhues-Thelen, Roberto Latini, Erik Tandberg Askevold, Jørgen Gravning, Christen P. Dahl, Kaspar Broch, Arne Yndestad, Lars Gullestad, Thor Ueland
      Objectives This study sought to evaluate whether a panel of biomarkers improved prognostication in patients with heart failure (HF) and reduced ejection fraction of ischemic origin using a systematized approach according to suggested requirements for validation of new biomarkers. Background Modeling combinations of multiple circulating markers could potentially identify patients with HF at particularly high risk and aid in the selection of individualized therapy. Methods From a panel of 20 inflammatory and extracellular matrix biomarkers, 2 different biomarker panels were created and added to the Seattle HF score and the prognostic model from the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) study (n = 1,497), which included conventional clinical characteristics and C-reactive protein and N-terminal pro–B-type natriuretic peptide. Interactions with statin treatment were also assessed. Results The two models—model 1 (endostatin, interleukin 8, soluble ST2, troponin T, galectin 3, and chemokine [C-C motif] ligand 21) and model 2 (troponin T, soluble ST2, galectin 3, pentraxin 3, and soluble tumor necrosis factor receptor 2)—significantly improved the CORONA and Seattle HF models but added only modestly to their Harrell’s C statistic and net reclassification index. In addition, rosuvastatin had no effect on the levels of a wide range of inflammatory and extracellular matrix markers, but there was a tendency for patients with a lower level of biomarkers in the 2 panels to have a positive effect from statin treatment. Conclusions In the specific HF patient population studied, a multimarker approach using the particular panel of biomarkers measured was of limited clinical value for identifying future risk of adverse outcomes.
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2017.01.008
       
  • A Multibiomarker Approach to Heart Failure Prognostication
    • Authors: Christopher R. deFilippi; Stephen L. Seliger
      Pages: 265 - 267
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Christopher R. deFilippi, Stephen L. Seliger
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2017.02.019
       
  • Soluble Urokinase-Type Plasminogen Activator Receptor Improves
           Risk Prediction in Patients With Chronic Heart Failure
    • Authors: Lorenz Koller; Stefan Stojkovic; Bernhard Richter; Patrick Sulzgruber; Christos Potolidis; Florian Liebhart; Deddo Mörtl; Rudolf Berger; Georg Goliasch; Johann Wojta; Martin Hülsmann; Alexander Niessner
      Pages: 268 - 277
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Lorenz Koller, Stefan Stojkovic, Bernhard Richter, Patrick Sulzgruber, Christos Potolidis, Florian Liebhart, Deddo Mörtl, Rudolf Berger, Georg Goliasch, Johann Wojta, Martin Hülsmann, Alexander Niessner
      Objectives This study investigated the predictive value of soluble urokinase-type plasminogen activator receptor (suPAR) in patients with chronic heart failure (CHF). Background SuPAR originates from proteolytic cleavage of the membrane-bound receptor from activated immune and endothelial cells and reflects the level of immune activation. As inflammation plays a crucial role in the complex pathophysiology of CHF, we hypothesized that suPAR might be a suitable prognostic biomarker in patients with CHF. Methods SuPAR levels were determined in 319 patients with CHF admitted to our outpatient department for heart failure and in a second cohort consisting of 346 patients with CHF, for validation. Results During a median follow-up time of 3.2 years, 119 patients (37.3%) died. SuPAR was a strong predictor of mortality with a crude hazard ratio (HR) per increase of 1 SD (HR per 1 SD) of 1.96 (95% confidence interval [CI]: 1.63 to 2.35; p < 0.001) in univariate analysis and remained significant after comprehensive multivariate adjustment with an adjusted HR per 1 SD of 1.38 (95% CI: 1.04 to 1.83; p = 0.026). SuPAR added prognostic value beyond the multivariate model indicated by improvements in C-statistics (area under the curve: 0.72 vs 0.74, respectively; p = 0.02), the category-free net reclassification index (24.9%; p = 0.032), and the integrated discrimination improvement (0.011; p = 0.05). Validation in the second cohort yielded consistent results. Conclusions SuPAR is a strong and independent predictor of mortality in patients with CHF, potentially suitable to refine risk assessment in this vulnerable group of patients. Our results emphasize the impact of immune activation on survival in patients with CHF.
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2016.12.008
       
  • Prognostic Outcomes in Patients With Heart Failure
    • Authors: Christopher Pemberton
      Pages: 278 - 279
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Christopher Pemberton
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2017.02.009
       
  • Prognostic Value of Soluble Suppression of Tumorigenicity-2 in Chronic
           Heart Failure
    • Authors: Alberto Aimo; Giuseppe Vergaro; Claudio Passino; Andrea Ripoli; Bonnie Ky; Wayne L. Miller; Antoni Bayes-Genis; Inder Anand; James L. Januzzi; Michele Emdin
      Pages: 280 - 286
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Alberto Aimo, Giuseppe Vergaro, Claudio Passino, Andrea Ripoli, Bonnie Ky, Wayne L. Miller, Antoni Bayes-Genis, Inder Anand, James L. Januzzi, Michele Emdin
      Objectives The purpose of this study was to perform the first meta-analysis of currently available data. Background Soluble suppression of tumorigenesis 2 (sST2) plasma concentration is elevated in chronic heart failure (CHF) and helps to predict prognosis in this setting, although the evidence is limited. Methods Three databases (Medline, Cochrane Library, and Scopus) were searched. Inclusion criteria were: follow-up studies; papers published in English; enrollment of CHF outpatients; available data on hazard ratio (HR) for the log2 ST2 (so that the reported HRs represent the risk per doubling of sST2) and 95% confidence interval (CI) for all-cause death, and possibly also for cardiovascular (CV) death; and use of standardized sST2 assay. Exclusion criteria were: sST2 considered only as an element of a prognostic score, and studies on patients with end-stage HF. Results Seven studies were finally included for all-cause death, with a global population of 6,372 patients; data on CV death were available for 5 studies, totaling 5,051 patients. The HR was 1.75 (95% CI: 1.37 to 2.22) for all-cause death and 1.79 (95% CI: 1.22 to 2.63) for CV death (both p < 0.001). Significant heterogeneity among studies was detected in the quantification of sST2 predictive value, attributable to marked differences in pharmacological treatment among trials. The predictive power of sST2 was greater when patients were managed according to present guideline-recommended medical treatment. Conclusions sST2 is a predictor of both all-cause and CV death in CHF outpatients. The present meta-analysis supports the use of sST2 for risk stratification in patients with stable CHF.
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2016.09.010
       
  • Early Adoption of Sacubitril/Valsartan for Patients With Heart Failure
           With Reduced Ejection Fraction
    • Authors: Nancy Luo; Gregg C. Fonarow; Steven J. Lippmann; Xiaojuan Mi; Paul A. Heidenreich; Clyde W. Yancy; Melissa A. Greiner; Bradley G. Hammill; N. Chantelle Hardy; Stuart J. Turner; Warren K. Laskey; Lesley H. Curtis; Adrian F. Hernandez; Robert J. Mentz; Emily C. O’Brien
      Pages: 305 - 309
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Nancy Luo, Gregg C. Fonarow, Steven J. Lippmann, Xiaojuan Mi, Paul A. Heidenreich, Clyde W. Yancy, Melissa A. Greiner, Bradley G. Hammill, N. Chantelle Hardy, Stuart J. Turner, Warren K. Laskey, Lesley H. Curtis, Adrian F. Hernandez, Robert J. Mentz, Emily C. O’Brien
      Objectives The aim of this study was to assess the prevalence and variation in angiotensin receptor/neprilysin inhibitor (ARNI) prescription among a real-world population with heart failure with reduced ejection fraction (HFrEF). Background The U.S. Food and Drug Administration approved sacubitril/valsartan for patients with HFrEF in July 2015. Little is known about the early patterns of use of this novel therapy. Methods The study included patients discharged alive from hospitals in Get With the Guidelines–Heart Failure (GWTG-HF), a registry of hospitalized patients with heart failure, between July 2015 and June 2016 who had documentation of whether ARNIs were prescribed at discharge. Patient and hospital characteristics were compared among patients with HFrEF (ejection fraction ≤40%) with and without ARNI prescription at discharge, excluding those with documented contraindications to ARNIs. To evaluate hospital variation, hospitals with at least 10 eligible hospitalizations during the study period were assessed. Results Of 21,078 patients hospitalized with HFrEF during the study period, 495 (2.3%) were prescribed ARNIs at discharge. Patients prescribed ARNIs were younger (median age 65 years vs. 70 years; p < 0.001), had lower ejection fractions (median 23% vs. 25%; p < 0.001), and had higher use of aldosterone antagonists (45% vs. 31%; p < 0.001) at discharge. At the 241 participating hospitals with 10 or more eligible admissions, 125 (52%) reported no discharge prescriptions of ARNIs. Conclusions Approximately 2.3% of patients hospitalized for HFrEF in a national registry were prescribed ARNI therapy in the first 12 months following Food and Drug Administration approval. Further study is needed to identify and overcome barriers to implementing new evidence into practice, such as ARNI use among eligible patients with HFrEF.
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2016.12.018
       
  • Partnering With Patients to Develop Better Heart Failure Trials
    • Authors: Cynthia Chauhan
      First page: 310
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Cynthia Chauhan


      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2016.12.010
       
  • Factors That May Affect Body Change During and After Hospitalization for
           Acute Heart Failure
    • Authors: Somwail Rasla; Amr El Meligy; Roy Souaid; Aaron Wheeler
      First page: 311
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Somwail Rasla, Amr El Meligy, Roy Souaid, Aaron Wheeler


      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2017.01.001
       
  • Amiodarone and Beta-Blockers in Patients With Heart Failure and Atrial
           Fibrillation
    • Authors: Julia Cadrin-Tourigny; Azadeh Shohoudi; Denis Roy; Paul Khairy
      Pages: 312 - 313
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Julia Cadrin-Tourigny, Azadeh Shohoudi, Denis Roy, Paul Khairy


      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2017.02.003
       
  • Data Sharing From the Editors' Perspective
    • Authors: Christopher M. O’Connor; Dirk J. van Veldhuisen
      Pages: 314 - 315
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Christopher M. O’Connor, Dirk J. van Veldhuisen


      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2017.02.007
       
  • Race-Related Differences in Left Ventricular Structural and
           Functional Remodeling in Response to Increased Afterload
    • Authors: Miguel M. Fernandes-Silva; Amil M. Shah; Sheila Hegde; Alexandra Goncalves; Brian Claggett; Susan Cheng; Wilson Nadruz; Dalane W. Kitzman; Suma H. Konety; Kunihiro Matsushita; Thomas Mosley; Carolyn S.P. Lam; Barry A. Borlaug; Scott D. Solomon
      Pages: 157 - 165
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Miguel M. Fernandes-Silva, Amil M. Shah, Sheila Hegde, Alexandra Goncalves, Brian Claggett, Susan Cheng, Wilson Nadruz, Dalane W. Kitzman, Suma H. Konety, Kunihiro Matsushita, Thomas Mosley, Carolyn S.P. Lam, Barry A. Borlaug, Scott D. Solomon
      Objectives The aim of this study was to evaluate racial differences in arterial elastance (Ea), which reflects the arterial afterload faced by the left ventricle, and its associations with cardiac structure and function. The hypothesis under study was that the left ventricle in blacks displays heightened afterload sensitivity compared with whites. Background Chronic increasing in arterial afterload may be an important trigger for left ventricular (LV) remodeling and dysfunction that lead to heart failure. Racial differences in the predisposition to heart failure are well described, but the underlying mechanisms remain unclear. Methods In total, 5,727 community-based, older ARIC (Atherosclerosis Risk In Community) study participants (22% black) who underwent echocardiography between 2011 and 2013 were studied. Results Blacks were younger (mean age 75 ± 5 years vs. 76 ± 5 years), were more frequently female (66% vs. 57%), and had higher prevalence rates of obesity (46% vs. 31%), hypertension (94% vs. 80%), and diabetes mellitus (47% vs. 34%) than whites. Adjusting for these baseline differences, Ea was higher among blacks (1.96 ± 0.01 mm Hg/ml vs. 1.80 ± 0.01 mm Hg/ml). In blacks, Ea was associated with greater LV remodeling (LV mass index, β = 3.21 ± 0.55 g/m2, p < 0.001) and higher LV filling pressures (E/e′ ratio, β = 0.42 ± 0.11, p < 0.001). These relationships were not observed in whites (LV mass, β = 0.16 ± 0.32 g/m2, p = 0.61, p for interaction <0.001; E/e′ ratio, β = −0.32 ± 0.06, p < 0.001, p for interaction <0.001). Conclusions These community-based data suggest that black Americans display heightened afterload sensitivity as a stimulus for LV structural and functional remodeling, which may contribute to their greater risk for heart failure compared with white Americans.
      Graphical abstract image

      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2016.10.011
       
  • Racial Tension in Hypertension
    • Authors: Walter J. Paulus; Mark T. Waddingham
      Pages: 166 - 168
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Walter J. Paulus, Mark T. Waddingham
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.004
       
  • Left Ventricular Architecture, Long-Term Reverse Remodeling, and Clinical
           Outcome in Mild Heart Failure With Cardiac Resynchronization
    • Authors: Martin St. John Sutton; Cecilia Linde; Michael R. Gold; William T. Abraham; Stefano Ghio; Jeffrey Cerkvenik; Jean-Claude Daubert
      Pages: 169 - 178
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Martin St. John Sutton, Cecilia Linde, Michael R. Gold, William T. Abraham, Stefano Ghio, Jeffrey Cerkvenik, Jean-Claude Daubert
      Objectives This study sought to determine the effects of abnormal left ventricular (LV) architecture on cardiac remodeling and clinical outcomes in mild heart failure (HF). Background Cardiac resynchronization therapy (CRT) is an established treatment for HF that improves survival in part by favorably remodeling LV architecture. LV shape is a dynamic component of LV architecture on which contractile function depends. Methods Transthoracic 2-dimensional echocardiography was used to quantify changes in LV architecture over 5 years of follow-up of patients with mild HF from the REVERSE study. REVERSE was a prospective study of patients with large hearts (LV end-diastolic dimension ≥55 mm), LV ejection fraction <40%, and QRS duration >120 ms randomly assigned to CRT-ON (n = 419) and CRT-OFF (n = 191). CRT-OFF patients were excluded from this analysis. LV dimensions, volumes, mass index, and LV ejection fraction were calculated. LV architecture was assessed using the sphericity index, as follows: (LV end-diastolic volume)/(4/3 × π × r3) × 100%. Results LV architecture improved over time and demonstrated significant associations between LV shape, age, sex, and echocardiography metrics. Changes in LV architecture were strongly correlated with changes in LV end-systolic volume index and LV end-diastolic volume index (both p < 0.0001). Sphericity index emerged as a predictor of death and HF hospitalization in spite of the low adverse event rate. A decrease in LV end-systolic volume index >15% occurred in more than two-thirds of patients, which indicates considerable reverse remodeling. Conclusions We demonstrated that change in LV architecture in patients with mild HF with CRT is associated with structural and functional remodeling. Mean LV filling pressure was elevated, and the inability to lower it was an additional predictor of HF hospitalization or death. (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction [REVERSE]; NCT00271154)
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.012
       
  • Left Ventricular Shape
    • Authors: James E. Udelson
      Pages: 179 - 181
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): James E. Udelson
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2017.01.005
       
  • Left Ventricular Function Across the Spectrum of Body Mass Index in
           African Americans
    • Authors: Vivek G. Patel; Deepak K. Gupta; James G. Terry; Edmond K. Kabagambe; Thomas J. Wang; Aldolfo Correa; Michael Griswold; Herman Taylor; John Jeffrey Carr
      Pages: 182 - 190
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Vivek G. Patel, Deepak K. Gupta, James G. Terry, Edmond K. Kabagambe, Thomas J. Wang, Aldolfo Correa, Michael Griswold, Herman Taylor, John Jeffrey Carr
      Objectives This study sought to assess whether body mass index (BMI) was associated with subclinical left ventricular (LV) systolic dysfunction in African-American individuals. Background Higher BMI is a risk factor for cardiovascular disease, including heart failure. Obesity disproportionately affects African Americans; however, the association between higher BMI and LV function in African Americans is not well understood. Methods Peak systolic circumferential strain (ECC) was measured by tagged cardiac magnetic resonance in 1,652 adult African-American participants of the Jackson Heart Study between 2008 and 2012. We evaluated the association between BMI and ECC in multivariate linear regression and restricted cubic spline analyses adjusted for prevalent cardiovascular disease, conventional cardiovascular risk factors, LV mass, and ejection fraction. In exploratory analyses, we also examined whether inflammation, insulin resistance, or volume of visceral adipose tissue altered the association between BMI and ECC. Results The proportions of female, nonsmokers, diabetic, and hypertensive participants rose with increase in BMI. In multivariate-adjusted models, higher BMI was associated with worse ECC (β = 0.052; 95% confidence interval: 0.028 to 0.075), even in the setting of preserved LV ejection fraction. Higher BMI was also associated with worse ECC when accounting for markers of inflammation (C-reactive protein, E-selection, and P-selectin), insulin resistance, and volume of visceral adipose tissue. Conclusions Higher BMI is significantly associated with subclinical LV dysfunction in African Americans, even in the setting of preserved LV ejection fraction.
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      PubDate: 2017-04-02T13:44:45Z
      DOI: 10.1016/j.jchf.2016.12.020
       
  • Tetralogy of Fallow
    • Authors: Milton Packer
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Milton Packer
      Graphical abstract image

      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
      Graphical abstract image

      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
      Graphical abstract image

      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.
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      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.
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      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
       
  • Reply
    • Authors: Andrea Marco; Matthias Schmitt Ignasi Anguera
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Andrea Di Marco, Matthias Schmitt, Ignasi Anguera


      PubDate: 2017-05-14T19:07:41Z
       
  • Reply
    • Authors: Julia Cadrin-Tourigny; Azadeh Shohoudi Denis Roy Paul Khairy
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Julia Cadrin-Tourigny, Azadeh Shohoudi, Denis Roy, Paul Khairy


      PubDate: 2017-05-14T19:07:41Z
       
  • Reply
    • Authors: Lukasz Cerbin; Andrew Ambrosy Robert Mentz
      Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4
      Author(s): Lukasz P. Cerbin, Andrew P. Ambrosy, Robert J. Mentz


      PubDate: 2017-05-14T19:07:41Z
       
  • Promise of a New Role for Heart Rate Variability in the Clinical
           Management of Patients With Heart Failure∗
    • Authors: Philip F. Binkley
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Philip F. Binkley
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2017.02.008
       
  • 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).
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      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2017.02.016
       
  • Association of Holter-Derived Heart Rate Variability Parameters With the
           Development of Congestive Heart Failure in the Cardiovascular Health Study
           
    • Authors: Vaiibhav N. Patel; Brian R. Pierce; Rohan K. Bodapati; David L. Brown; Diane G. Ives; Phyllis K. Stein
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Vaiibhav N. Patel, Brian R. Pierce, Rohan K. Bodapati, David L. Brown, Diane G. Ives, Phyllis K. Stein
      Objectives This study sought to determine whether Holter-based parameters of heart rate variability (HRV) are independently associated with incident heart failure among older adults in the CHS (Cardiovascular Health Study) as evidenced by an improvement in the predictive power of the Health Aging and Body Composition Heart Failure (Health ABC) score. Background Abnormal HRV, a marker of autonomic dysfunction, has been associated with multiple adverse cardiovascular outcomes but not the development of congestive heart failure (CHF). Methods Asymptomatic CHS participants with interpretable 24-h baseline Holter recordings were included (n = 1,401). HRV measures and premature ventricular contraction (PVC) counts were compared between participants with (n = 260) and without (n = 1,141) incident CHF on follow-up. Significantly different parameters between groups were added to the components of the Health ABC score, a validated CHF prediction tool, using stepwise Cox regression. Results The final model included components of the Health ABC score, In PVC counts (adjusted hazard ratio [aHR]: 1.12; 95% confidence interval [CI]: 1.07 to 1.19; p < 0.001) and the following HRV measures: abnormal heart rate turbulence onset (aHR: 1.52; 95% CI: 1.11 to 2.08; p = 0.009), short-term fractal scaling exponent (aHR: 0.27; 95% CI: 0.14 to 0.53; p < 0.001), in very low frequency power (aHR: 1.28; 95% CI: 1.02 to 1.60; p = 0.037), and coefficient of variance of N-N intervals (aHR: 0.94; 95% CI: 0.90 to 0.99; p = 0.009). The C-statistic for the final model was significantly improved over the Health ABC model alone (0.77 vs. 0.73; p = 0.0002). Conclusions Abnormal HRV parameters were significantly and independently associated with incident CHF in asymptomatic, older adults. When combined with increased PVCs, HRV improved the predictive power of the Health ABC score.
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2016.12.015
       
  • Body Mass Index and Cardiorespiratory Fitness in Mid-Life and Risk of
           Heart Failure Hospitalization in Older Age
    • Authors: Ambarish Pandey; William K. Cornwell; Benjamin Willis; Ian J. Neeland; Ang Gao; David Leonard; Laura DeFina; Jarett D. Berry
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Ambarish Pandey, William K. Cornwell, Benjamin Willis, Ian J. Neeland, Ang Gao, David Leonard, Laura DeFina, Jarett D. Berry
      Objectives This study evaluated the contributions of obesity and changes in body mass index (BMI) in mid-life to long-term heart failure (HF) risk independent of cardiorespiratory fitness (CRF) levels. Background Obesity and low CRF are well-established risk factors for HF. However, given the inverse association between CRF and obesity, the independent contributions of BMI toward HF risk are not fully understood. Methods We included 19,485 participants from the Cooper Center Longitudinal Study who survived to receive Medicare coverage, from 1999 to 2009. CRF was estimated in metabolic equivalents (METS) according to Balke treadmill time. Associations of BMI and BMI change with HF hospitalization after age 65 were assessed by applying a proportional hazards recurrent events model to the failure time data. Results After 127,110 person-years of follow-up, we observed 1,038 HF hospitalization events. Higher mid-life BMI was significantly associated with greater risk of HF hospitalization after adjusting for established HF risk factors (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.12 to 1.26) per 3 kg/m2 higher BMI). This association was attenuated after adjusting for CRF (HR: 1.10; 95% CI: 1.03 to 1.17 per 3 kg/m2 higher BMI). CRF accounted for 47% of the HF risk associated with BMI. BMI change was not significantly associated with risk of HF in older age after adjustment for CRF change. Conclusions Higher BMI-associated risk of HF is explained largely by differences in CRF levels. Furthermore, BMI change is not significantly associated with HF risk after adjusting for CRF changes. These findings highlight the importance of CRF in mediating BMI-associated HF risk.
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2016.12.021
       
  • Therapeutic Cardiorespiratory Fitness to Prevent and Treat Heart
           Failure∗
    • Authors: Carl J. Lavie; Steven J. Keteyian; Hector O. Ventura
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Carl J. Lavie, Steven J. Keteyian, Hector O. Ventura
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2017.01.007
       
  • Correction
    • Abstract: Publication date: April 2017
      Source:JACC: Heart Failure, Volume 5, Issue 4


      PubDate: 2017-04-02T13:44:45Z
       
  • A Novel Rehabilitation Intervention for Older Patients With Acute
           Decompensated Heart Failure
    • Authors: Gordon R. Reeves; David J. Whellan; Christopher M. O'Connor; Pamela Duncan; Joel D. Eggebeen; Timothy M. Morgan; Leigh Ann Hewston; Amy Pastva; Mahesh J. Patel; Dalane W. Kitzman
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Gordon R. Reeves, David J. Whellan, Christopher M. O'Connor, Pamela Duncan, Joel D. Eggebeen, Timothy M. Morgan, Leigh Ann Hewston, Amy Pastva, Mahesh J. Patel, Dalane W. Kitzman
      Objectives This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF). Background After ADHF, older patients, who are frequently frail with multiple comorbidities, have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes. Methods The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) pilot study was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF. The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function (Short Physical Performance Battery [SPPB]) over 3 months and reduce all-cause rehospitalizations over 6 months. Results The study enrolled 27 patients with ADHF (ages 60 to 98 years; 59% women; 56% African American; 41% with preserved ejection fraction [≥45%]). At baseline, participants had marked impairments in physical function, multiple comorbidities, and frailty. Study retention (89%) and intervention adherence (93%) were excellent. At 3 months, an intervention effect size was measured for the SPPB score of +1.1 U (7.4 ± 0.5 U vs. 6.3 ± 0.5 U), and at 6 months an effect size was observed for an all-cause rehospitalization rate of −0.48 (1.16 ± 0.35 vs. 1.64 ± 0.39). The change in SPPB score was strongly related to all-cause rehospitalizations, explaining 91% of change. Conclusions These findings support the feasibility and rationale for a recently launched, National Institutes of Health–funded trial to test the safety and efficacy of this novel multidomain physical rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail patients with ADHF with multiple comorbidities. (Rehabilitation and Exercise Training After Hospitalization [REHAB-HF]; NCT01508650; A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038)
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.019
       
  • Dynamic Changes in Aortic Vascular Stiffness in Patients Bridged to
           Transplant With Continuous-Flow Left Ventricular Assist Devices
    • Authors: Amit C. Patel; R. Blair Dodson; William K. Cornwell; Kendall S. Hunter; Joseph C. Cleveland; Andreas Brieke; JoAnn Lindenfeld; Amrut V. Ambardekar
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Amit C. Patel, R. Blair Dodson, William K. Cornwell, Kendall S. Hunter, Joseph C. Cleveland, Andreas Brieke, JoAnn Lindenfeld, Amrut V. Ambardekar
      Objectives The aim of this study was to measure aortic vascular stiffness from orthotopic heart transplant (OHT) patients exposed to varying types of flow as a result of the presence or absence of left ventricular assist device (LVAD) support pre-OHT. Background The effects of continuous-flow LVADs (CF-LVADs) on vascular properties are unknown, but may contribute to the pathophysiology of CF-LVAD complications such as stroke, hypertension, and bleeding. Methods Echocardiograms were reviewed from 172 OHT patients immediately before LVAD and at 3 time points post-OHT: baseline, 6 months, and 1 year. For each study, pulse pressure and aortic end-systolic and end-diastolic dimensions were used to calculate aortic strain, distensibility, and stiffness index. Patients were categorized into 3 groups based on the presence or absence of a LVAD and a pulse pre-OHT: No LVAD (n = 111), LVAD No Pulse (n = 30), and LVAD With Pulse (n = 31). Results The aortic stiffness index among LVAD No Pulse patients increased from 2.8 ± 1.1 pre–CF-LVAD to 10.9 ± 4.7 immediately post-OHT (p < 0.001). This aortic stiffness index was also significantly higher compared with No LVAD (3.4 ± 1.1; p < 0.001) and LVAD With Pulse (3.7 ± 1.4; p < 0.001) immediately post-OHT with attenuation of these differences by 1 year post-OHT. Similar findings were noted for the other indices of aortic stiffness. Conclusions Aortic stiffness is markedly increased immediately post-OHT among patients bridged with CF-LVADs, with attenuation of this increased stiffness over the first year after transplant. These results suggest that aortic vascular properties are dynamic and may be influenced by alterations in flow pulsatility. As more patients are supported with CF-LVADs and as newer pump technology attempts to modulate pulsatility, further research examining the role of alterations in flow patterns on vascular function and the potential resultant systemic sequelae are needed.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.009
       
  • Fitness in Young Adulthood and Long-Term Cardiac Structure and Function
    • Authors: Ambarish Pandey; Norrina B. Allen; Colby Ayers; Jared P. Reis; Henrique T. Moreira; Stephen Sidney; Jamal S. Rana; David R. Jacobs; Lisa S. Chow; James A. de Lemos; Mercedes Carnethon; Jarett D. Berry
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Ambarish Pandey, Norrina B. Allen, Colby Ayers, Jared P. Reis, Henrique T. Moreira, Stephen Sidney, Jamal S. Rana, David R. Jacobs, Lisa S. Chow, James A. de Lemos, Mercedes Carnethon, Jarett D. Berry
      Objectives This study sought to evaluate the association between early-life cardiorespiratory fitness (CRF) and measures of left ventricular (LV) structure and function in midlife. Background Low CRF in midlife is associated with a higher risk of heart failure. However, the unique contributions of early-life CRF toward measures of LV structure and function in middle age are not known. Methods CARDIA (Coronary Artery Risk Development in Young Adults) study participants with a baseline maximal treadmill test and an echocardiogram at year 25 were included. Associations among baseline CRF, CRF change, and echocardiographic LV parameters (global longitudinal strain [GLS] and global circumferential strain, E/e′) were assessed using multivariable linear regression. Results The study included 3,433 participants. After adjustment for baseline demographic and clinical characteristics, lower baseline CRF was significantly associated with higher LV strain (standardized parameter estimate [Std β] = −0.06, p = 0.03 for GLS) and ratio of early transmitral flow velocity to early peak diastolic mitral annular velocity (E/e′) (Std β = −0.10, p = 0.0001 for lateral E/e′), findings suggesting impaired contractility and elevated diastolic filling pressure in midlife. After additional adjustment for cumulative cardiovascular risk factor burden observed over the follow-up period, the association of CRF with LV strain attenuated substantially (p = 0.36), whereas the association with diastolic filling pressure remained significant (Std β = −0.05, p = 0.02 for lateral E/e′). In a subgroup of participants with repeat CRF tests at year 20, greater decline in CRF was significantly associated with increased abnormalities in GLS (Std β = −0.05, p = 0.02) and higher diastolic filling pressure (Std β = −0.06, p = 0.006 for lateral E/e′) in middle age. Conclusions CRF in young adulthood and CRF change were associated with measures of LV systolic function and diastolic filling pressure in middle age. Low CRF–associated abnormalities in systolic function were related to the associated higher cardiovascular risk factor burden. In contrast, the inverse association between CRF and LV diastolic filling pressure was independent of cardiovascular risk factor burden.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.014
       
  • Unraveling the Relationship Between Aging and Heart Failure With
           Preserved Ejection Fraction
    • Authors: Dalane W. Kitzman; Thomas J. O’Neill; Peter H. Brubaker
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Dalane W. Kitzman, Thomas J. O’Neill, Peter H. Brubaker
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2017.01.009
       
  • Acute Heart Failure
    • Authors: Reka Zsilinszka; Robert J. Mentz; Adam D. DeVore; Zubin J. Eapen; Peter S. Pang; Adrian F. Hernandez
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Reka Zsilinszka, Robert J. Mentz, Adam D. DeVore, Zubin J. Eapen, Peter S. Pang, Adrian F. Hernandez
      Acute heart failure (HF) is a major public health problem with substantial associated economic costs. Because most patients who present to hospitals are admitted irrespective of their level of risk, novel approaches to manage acute HF are needed, such as the use of same-day access clinics for outpatient diuresis and observation units from the emergency department. Current published data lacks a comprehensive overview of the present state of acute HF management in various clinical settings. This review summarizes the strengths and limitations of acute HF care in the outpatient and emergency department settings. Finally, a variety of innovative technologies that have the potential to improve acute HF management are discussed.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.014
       
  • Moving Beyond the Walls of the Clinic
    • Authors: Ariane M. Fraiche; Zubin J. Eapen; Mark B. McClellan
      Abstract: Publication date: Available online 8 February 2017
      Source:JACC: Heart Failure
      Author(s): Ariane M. Fraiche, Zubin J. Eapen, Mark B. McClellan
      Telehealth offers an innovative approach to improve heart failure care that expands beyond traditional management strategies. Yet the use of telehealth in heart failure is infrequent because of several obstacles. Fundamentally, the evidence is inconsistent across studies of telehealth interventions in heart failure, which limits the ability of cardiologists to make general conclusions. Where encouraging evidence exists, there are logistical challenges to broad-scale implementation as a result of insufficient understanding of how to transform telemedicine strategies into clinical practice effectively. Ultimately, when implementation is reasonable, the application of these efforts remains hampered by regulatory, reimbursement, and other policy issues. The primary aim of this paper is to describe these challenges and to outline a path forward to apply telehealth approaches to heart failure in conjunction with payment reform and pragmatic research study design.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.013
       
  • Meta-Analysis of Soluble Suppression of Tumorigenicity-2 and
           Prognosis in Acute Heart Failure
    • Authors: Alberto Aimo; Giuseppe Vergaro; Andrea Ripoli; Antoni Bayes-Genis; Domingo A. Pascual Figal; Rudolf A. de Boer; Johan Lassus; Alexandre Mebazaa; Etienne Gayat; Tobias Breidthardt; Zaid Sabti; Christian Mueller; Hans-Peter Brunner-La Rocca; W.H. Wilson Tang; Justin L. Grodin; Yuhui Zhang; Paulo Bettencourt; Alan S. Maisel; Claudio Passino; James L. Januzzi; Michele Emdin
      Abstract: Publication date: Available online 8 February 2017
      Source:JACC: Heart Failure
      Author(s): Alberto Aimo, Giuseppe Vergaro, Andrea Ripoli, Antoni Bayes-Genis, Domingo A. Pascual Figal, Rudolf A. de Boer, Johan Lassus, Alexandre Mebazaa, Etienne Gayat, Tobias Breidthardt, Zaid Sabti, Christian Mueller, Hans-Peter Brunner-La Rocca, W.H. Wilson Tang, Justin L. Grodin, Yuhui Zhang, Paulo Bettencourt, Alan S. Maisel, Claudio Passino, James L. Januzzi, Michele Emdin
      Objectives The aim of this study was to perform a meta-analysis of currently available data regarding the prognostic significance of soluble suppression of tumorigenecity–2 (sST2) concentration in acute heart failure (AHF). Background Concentration of sST2 may have prognostic value in AHF. A comprehensive assessment of all available studies regarding sST2 in AHF is lacking. Methods Three databases (MEDLINE, Cochrane Library, and Scopus) were searched. Inclusion criteria were follow-up studies, papers published in English, enrollment of patients with AHF, and availability of median hazard ratios for all-cause death and other outcome measures, when available. Results Ten studies were included, with a global population of 4,835 patients and a median follow-up duration of 13.5 months. The following global hazard ratios calculated for log2(sST2) were admission sST2 and all-cause death, 2.46 (95% confidence interval [CI]: 1.80 to 3.37; p < 0.001); discharge sST2 and all-cause death, 2.06 (95% CI: 1.37 to 3.11; p < 0.001); admission sST2 and cardiovascular death, 2.29 (95% CI: 1.41 to 3.73; p < 0.001); discharge sST2 and cardiovascular death, 2.20 (95% CI: 1.48 to 3.25; p < 0.001); admission sST2 and heart failure (HF) hospitalization, 1.21 (95% CI: 0.96 to 1.52; p = 0.060); discharge sST2 and HF hospitalization, 1.54 (95% CI: 1.03 to 2.32; p = 0.007); admission sST2 and all-cause death or HF hospitalization, 1.74 (95% CI: 1.24 to 2.45; p < 0.001); and discharge sST2 and all-cause death or HF hospitalization, 1.63 (95% CI: 1.14 to 2.33; p < 0.001). Conclusions Plasma sST2 has prognostic value with respect to all-cause and cardiovascular death as well as the composite outcome of all-cause death or HF hospitalization, with both admission and discharge values having prognostic efficacy. Discharge sST2, but not admission sST2, is predictive of HF rehospitalization during follow-up.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.016
       
 
 
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