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  JACC : Heart Failure
  [1 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by American College of Cardiology Foundation Homepage  [1 journal]
  • Are Hospitalizations for Heart Failure the Great Equalizer'
    • Authors: Lewis EF.
      Abstract: In 1964, Stein et al. (1) reported a case series of 23 boys and girls in Baragwanath Hospital in Johannesburg, South Africa, with relative homogenous clinical presentation with low-output heart failure (HF) and high mortality with pathology revealing endocardial fibroelastosis as the likely cause of many sporadic cases of cryptogenic HF. Over the subsequent 5 decades, differences and disparities in HF provide an opportunity to reflect on biological differences, clustering of risk factors, patient behaviors and preferences, and nonphysiological variables (2). It has been well established that black patients with HF represent a unique group in the United States (3): they are often younger and have more hypertension and less coronary artery disease, and a higher proportion are women. Epidemiological cohorts demonstrate higher incidence and prevalence rates of HF among blacks (4). Although mortality in ambulatory HF patients is higher among blacks (5), hospitalized patients are consistently different.
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Burden of Comorbidities and Functional and Cognitive Impairments in
           Elderly Patients at the Initial Diagnosis of Heart Failure and
           Their Impact on Total Mortality The Cardiovascular Health Study
    • Authors: Murad K, Goff DC, Jr; Morgan TM, et al.
      Abstract: ObjectivesThe purpose of this study was to determine the prevalence of clinically relevant comorbidities and measures of physical and cognitive impairment in elderly persons with incident heart failure (HF).BackgroundComorbidities and functional and cognitive impairments are common in the elderly and often associated with greater mortality risk.MethodsWe examined the prevalence of 9 comorbidities and 4 measures of functional and cognitive impairments in 558 participants from the Cardiovascular Health Study who developed incident HF between 1990 and 2002. Participants were followed prospectively until mid-2008 to determine their mortality risk.ResultsMean age of participants was 79.2 ± 6.3 years with 52% being men. Sixty percent of participants had ≥3 comorbidities, and only 2.5% had none. Twenty-two percent and 44% of participants had ≥1 activity of daily living (ADL) and ≥1 instrumental activity of daily living (IADL) impaired respectively. Seventeen percent of participants had cognitive impairment (modified mini-mental state exam score 
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Primary Prevention of Heart Failure in Older Adults ∗
    • Authors: Maron DJ; Hunt SA.
      Abstract: Heart failure is increasing in frequency and is associated with substantial morbidity and mortality. The incidence of heart failure is highest among older adults (1,2). Treatment of heart failure, a leading cause of hospitalization for people older than 65 years of age, costs more than $30 billion per year in the United States (3,4). It follows that identifying modifiable risk factors for primary prevention of heart failure is an important public health goal to reduce both the burden of disease and health care costs.
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Racial Differences in Heart Failure Outcomes Evidence From the
           Tele-HF Trial (Telemonitoring to Improve Heart Failure Outcomes)
    • Authors: Qian F; Parzynski CS, Chaudhry SI, et al.
      Abstract: ObjectivesThe purpose of this study was to determine whether there are racial differences in patient-reported health status as well as mortality and rehospitalization after hospitalization for heart failure (HF).BackgroundLittle is known about whether racial differences exist in patient-reported outcomes after HF hospitalization.MethodsWe analyzed data from 1,427 patients (636 non-Hispanic African Americans [45%]; 791 non-Hispanic whites [55%]) enrolled in the Tele-HF (Telemonitoring to Improve Heart Failure Outcomes) trial. Health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and then at 3 and 6 months. Generalized linear mixed models and propensity score methods were used to adjust for clustering within sites and differences between races.ResultsAlthough black patients reported better adjusted health status at baseline (black vs. white difference in KCCQ summary scores was 6.22; 95% confidence interval [CI]: 2.98 to 9.46; p < 0.001), after adjusting for patient demographics, comorbidities, clinical laboratory values, and baseline KCCQ score, we detected no significant racial differences in patient-reported health status at 3 months (black vs. white difference in KCCQ score: 2.28; 95% CI: −0.84 to 5.41; p = 0.15) or 6 months (black vs. white difference in KCCQ score: 1.91; 95% CI: −1.31 to 5.13; p = 0.24).ConclusionsCompared with white patients, black patients with HF had better patient-reported health status shortly after HF admission but not at 3 or 6 months. Our study failed to show that black patients were disadvantaged with regard to health status after HF hospitalization. (Tele-HF: Yale Heart Failure Telemonitoring Study; NCT00303212)
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in
           Older Adults The Cardiovascular Health Study
    • Authors: Del Gobbo LC; Kalantarian S, Imamura F, et al.
      Abstract: ObjectivesThe goal of this study was to determine the relative contribution of major lifestyle factors on the development of heart failure (HF) in older adults.BackgroundHF incurs high morbidity, mortality, and health care costs among adults ≥65 years of age, which is the most rapidly growing segment of the U.S. population.MethodsWe prospectively investigated separate and combined associations of lifestyle risk factors with incident HF (1,380 cases) over 21.5 years among 4,490 men and women in the Cardiovascular Health Study, which is a community-based cohort of older adults. Lifestyle factors included 4 dietary patterns (Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an American Heart Association 2020 dietary goals score, and a Biologic pattern, which was constructed using previous knowledge of cardiovascular disease dietary risk factors), 4 physical activity metrics (exercise intensity, walking pace, energy expended in leisure activity, and walking distance), alcohol intake, smoking, and obesity.ResultsNo dietary pattern was associated with developing HF (p > 0.05). Walking pace and leisure activity were associated with a 26% and 22% lower risk of HF, respectively (pace >3 mph vs. 
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Why We Respect Randomized Controlled Clinical Trials in Heart Failure
    • Authors: O’Connor CM.
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Reducing Readmissions With Novel Cardiac Resynchronization Therapy
           Programming Is Meeting the 30-Day Metric Enough' ∗
    • Authors: Nohria A; Desai AS.
      Abstract: Heart failure is the leading cause of hospitalization in the Medicare population in the United States and is a primary driver of escalating health care costs (1). Although clinical outcomes have improved with advances in medical therapy, rates of readmission after heart failure hospitalization remain high, with nearly 50% of patients readmitted within 6 months and 25% readmitted within 30 days of hospital discharge (1). The widespread belief that early readmissions following heart failure hospitalization can be reduced with greater attention to improving in-hospital treatment and care transitions has driven public and private payers to target readmission rates as a focus of quality assessment and pay-for-performance initiatives. Since 2009, the Centers for Medicare and Medicaid services have publicly reported rates of hospital readmission for heart failure, and with the passage of the Patient Protection and Affordable Care Act in 2010, hospitals with higher than expected risk-standardized readmission rates at 30 days are at risk for substantial financial penalties.
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Multiple Chronic Conditions and Heart Failure ∗ Overlooking the
    • Authors: Shaffer JA; Maurer MS.
      Abstract: “Facts do not cease to exist because they are ignored.”—Aldous Huxley (1)
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Echocardiography and Continuous-Flow Left Ventricular Assist Devices
           Evidence and Limitations
    • Authors: Cohen DG; Thomas JD, Freed BH, et al.
      Abstract: Echocardiography is the most used imaging modality in the growing population of patients with advanced heart failure undergoing continuous-flow, durable mechanical circulatory support. However, no guidelines for the use of echocardiography in this population exist, evidence for core applications is limited and conflicting, and newer centrifugal-flow devices have been subject to minimal study. As a first step toward addressing these deficits, this review summarizes the evidence and expert opinion for the use of echocardiography in pre-operative planning and perioperative management, prediction of post-operative right ventricular failure, the use of echocardiographic surrogates for invasive hemodynamic measurements, and the performance of speed ramp studies for the diagnosis of thrombosis and optimization of device settings.
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Impact of a Novel Adaptive Optimization Algorithm on 30-Day Readmissions
           Evidence From the Adaptive CRT Trial
    • Authors: Starling RC; Krum H, Bril S, et al.
      Abstract: ObjectivesThis study investigated the impact of the Medtronic AdaptivCRT (aCRT) (Medtronic, Mounds View, Minnesota) algorithm on 30-day readmissions after heart failure (HF) and all-cause index hospitalizations.BackgroundThe U.S. Hospital Readmission Reduction Program, which includes a focus on HF, reduces Medicare inpatient payments when readmissions within 30 days of discharge exceed a moving threshold based on national averages and hospital-specific risk adjustments. Internationally, readmissions within 30 days of any discharge may attract reduced or no payment. Recently, cardiac resynchronization therapy (CRT) devices equipped with the aCRT algorithm allowing automated ambulatory device programming were introduced. The Adaptive CRT trial demonstrated the algorithm’s safety and comparable outcome against a rigorous echocardiography-based optimization protocol.MethodsWe analyzed data from the Adaptive CRT trial, which randomized patients undergoing CRT defibrillation on a 2:1 basis to aCRT (n = 318) or to CRT with echocardiographic optimization (Echo, n = 160) and followed up these patients for a mean of 20.2 months (range: 0.2 to 31.3 months). Logistic regression with generalized estimating equation methodology was used to compare the proportion of patients hospitalized for HF and for all causes who had a readmission within 30 days.ResultsFor HF hospitalizations, the 30-day readmission rate was 19.1% (17 of 89) in the aCRT group and 35.7% (15 of 42) in the Echo group (odds ratio: 0.41; 95% confidence interval [CI]: 0.19 to 0.86; p = 0.02). For all-cause hospitalization, the 30-day readmission rate was 14.8% (35 of 237) in the aCRT group compared with 24.8% (39 of 157) in the Echo group (odds ratio: 0.54; 95% CI: 0.31 to 0.94; p = 0.03). The risk of readmission after HF or all-cause index hospitalization with aCRT was also significantly reduced beyond 30 days.ConclusionsUse of the aCRT algorithm is associated with a significant reduction in the probability of a 30-day readmission after both HF and all-cause hospitalizations. (Adaptive Cardiac Resynchronization Therapy Study [aCRT]; NCT00980057)
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Racial Differences in Natriuretic Peptide Levels The Dallas
           Heart Study
    • Authors: Gupta DK; de Lemos JA, Ayers CR, et al.
      Abstract: ObjectivesThe purpose of this study was to assess whether N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels differ according to race/ethnicity.BackgroundNatriuretic peptides (NP) are hormones with natriuretic, diuretic, and vasodilatory effects. Experimental NP deficiency promotes salt-sensitive hypertension and cardiac hypertrophy, conditions that are more common among black individuals.MethodsWe examined plasma NT-proBNP levels according to race/ethnicity in 3,148 individuals (51% black, 31% white, 18% Hispanic) free of prevalent cardiovascular disease in the Dallas Heart Study. NT-proBNP values in the bottom sex-specific quartile were defined as low. Multivariable linear and logistic regression analyses were performed adjusting for clinical covariates and magnetic resonance imaging measurements of cardiac structure and function.ResultsHypertension was present in 41%, 25%, and 16% of black, white, and Hispanic individuals, respectively. Unadjusted NT-proBNP levels were lowest in black (median: 24 pg/ml; interquartile range [IQR]: 10 to 52 pg/ml) as compared with Hispanic (30 pg/ml; IQR: 14 to 59 pg/ml) and white individuals (32 pg/ml; IQR: 16 to 62 pg/ml), p 
      PubDate: Wed, 01 Jul 2015 00:00:00 GMT
  • Inside This Issue
    • PubDate: Wed, 01 Jul 2015 00:00:00 GMT
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