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Journal Cover JACC : Heart Failure
  [SJR: 4.318]   [H-I: 18]   [5 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by American College of Cardiology Homepage  [1 journal]
  • Redesigning Ventricular Assist Devices to Protect Ethnic Minorities
           Changing Design With Changing Times
    • Authors: Amdani SM.
      Abstract: Approximately 5.7 million adults in the United States are living with heart failure (1). For patients with advanced heart failure who are too ill to wait for a donor or who are not eligible for a heart transplant because of age or other medical problems, ventricular assist devices (VADs) offer life-saving therapy (2,3). VADs were initially designed as a temporary support to bridge patients to heart transplantation, but in recent times, these devices are increasingly being used as lifetime support or destination therapy (4). With continual improvements in device design along with advances in medical and surgical management, VAD patients can now return home, to work, and to their communities with fairly good quality of life. The durable VADs have battery pockets and a control unit (Figure 1), which needs to be carried around by the patient at all times. Recently, during an encounter with a VAD patient of African American ethnicity, the patient expressed some unique concerns.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Reply EMS, HEMS, ECMO Center, ICU Team: Are You Ready for
           Hypothermic Patients? Extracorporeal Membrane Oxygenation in Severe
           Accidental Hypothermia
    • Authors: Aubin H; Lichtenberg A, Albert A.
      Abstract: We thank Dr. Darocha and colleagues for the comment on our paper (1) in which we reported the implementation of a suprainstitutional network for rapid response remote extracorporeal life support (ECLS) for refractory circulatory failure. With great enthusiasm, we read about their efforts to implement an ECLS network for patients with unstable hemodynamics or cardiac arrest due to accidental severe hypothermia in southern Poland (2) and congratulate them on the reported early results, with very encouraging survival and outcome rates.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • EMS, HEMS, ECMO Center, ICU Team: Are You Ready for Hypothermic Patients?
           Extracorporeal Membrane Oxygenation in Severe Accidental Hypothermia
    • Authors: Darocha T; Kosinski S, Podsiadlo P, et al.
      Abstract: It was with great interest that we read the article by Aubin et al. (1) published in JACC: Heart Failure. Transport destination for patients (core body temperature 
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Reply Size Matters? Seeking High-Risk Populations Among
           “Normal” Individuals
    • Authors: Tsao CW; Vasan RS.
      Abstract: We thank Dr. Takei and colleagues for their interest in our study (1). Management of individuals at greater risk for morbidity and mortality is well-established among those with heart failure (HF) with reduced left ventricular ejection fraction (LVEF), but discrimination of risk among individuals with borderline or heart failure with preserved ejection fraction (HFPEF) is not well understood. Dr. Takei and colleagues describe that among a group of patients with HFPEF, those with a greater left ventricular (LV) end-diastolic dimension had a greater risk of adverse outcomes (HF rehospitalization, all-cause mortality) than those with diastolic diameter below the normal reference value, despite normal LVEF. These results are interesting and highlight the importance of LV cavity dimension in prognosis. These findings also imply that some of those with greater risk actually have normal LV dimensions, another area of subclinical disease for investigation.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Angiotensin Receptor-Neprilysin Inhibition in Heart Failure With
           Reduced Ejection Fraction A Paradigm for All? ∗
    • Authors: Konstam MA.
      Abstract: Image 1
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • The International Olympic Games Heart Teams and Heart Failure
    • Authors: O’Connor CM.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Size Matters? Seeking High-Risk Populations Among “Normal”
    • Authors: Takei M; Kohsaka S, Fukuda K, et al.
      Abstract: We read with great interest the paper by Tsao et al. (1) and the accompanying editorial by Fonarow and Hsu (2) in a recent issue of JACC: Heart Failure. Tsao et al. (1) reported that asymptomatic adults, even with borderline reduction of left ventricular ejection fraction (LVEF) (between 50% and 55%), were more likely to develop heart failure (HF) or die when compared with those with LVEF >55%. As Fonarow and Hsu state, to improve the outcome of HF, it is of utmost clinical importance to detect and intervene in the subjects at a higher risk. However, it is noteworthy that this borderline LVEF group was only 3.5% of the total cohort, and the observed HF events in this group accounted for only 6.8% of all events. Emphasis should also be placed on detecting high-risk individuals within the group of normal LVEF patients, who account for 85.1% of HF events. We would like to add some points to this discussion.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Efficacy of Sacubitril/Valsartan Relative to a Prior Decompensation
           The PARADIGM-HF Trial
    • Authors: Solomon SD; Claggett B, Packer M, et al.
      Abstract: ObjectivesThis study assessed whether the benefit of sacubtril/valsartan therapy varied with clinical stability.BackgroundDespite the benefit of sacubitril/valsartan therapy shown in the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, it has been suggested that switching from an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker should be delayed until occurrence of clinical decompensation.MethodsOutcomes were compared among patients who had prior hospitalization within 3 months of screening (n = 1,611 [19%]), between 3 and 6 months (n = 1,009 [12%]), between 6 and 12 months (n = 886 [11%]), >12 months (n = 1,746 [21%]), or who had never been hospitalized (n = 3,125 [37%]).ResultsTwenty percent of patients without prior HF hospitalization experienced a primary endpoint of cardiovascular death or heart failure (HF) hospitalization during the course of the trial. Despite the increased risk associated with more recent hospitalization, the efficacy of sacubitril/valsartan therapy did not differ from that of enalapril according to the occurrence of or time from hospitalization for HF before screening, with respect to the primary endpoint or with respect to cardiovascular or all-cause mortality.ConclusionsPatients with recent HF decompensation requiring hospitalization were more likely to experience cardiovascular death or HF hospitalization than those who had never been hospitalized. Patients who were clinically stable, as shown by a remote HF hospitalization (>3 months prior to screening) or by lack of any prior HF hospitalization, were as likely to benefit from sacubitril/valsartan therapy as more recently hospitalized patients. (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255)
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure
           Stages in the Community
    • Authors: Xanthakis V; Enserro DM, Larson MG, et al.
      Abstract: ObjectivesThe purpose of this study was to describe the prevalence and prognosis of HF stages in the community; to evaluate if preclinical HF stages are characterized by elevation of pro-inflammatory (C-reactive protein), neurohormonal activation (B-type natriuretic peptide, renin and aldosterone), and cardiac stress biomarkers (high-sensitivity troponin I, ST-2, and growth differentiation factor-15).BackgroundThe American Heart Association/American College of Cardiology heart failure (HF) classification has 3 stages. Knowledge regarding the community burden of HF stages is limited, and data on the biomarker profile associated with HF stages are scarce, although higher concentrations of certain biomarkers are associated with preclinical HF.MethodsWe evaluated 6,770 participants (mean age 51 years; 54% women) from the Framingham Study, defining 4 stages: 1) healthy: no risk factors; 2) stage A: presence of HF risk factors (hypertension, diabetes, obesity, coronary artery disease), no cardiac structural/functional abnormality; 3) stage B: presence of prior myocardial infarction, valvular disease, left ventricular (LV) systolic dysfunction, LV hypertrophy, regional wall motion abnormality, or LV enlargement; 4) stage C/D: prevalent HF.ResultsThe prevalence of HF stages A and B were 36.5% and 24.2%, respectively, rising with age (odds ratio: 1.70 [95% confidence interval: 1.64 to 1.77] per decade increment). In age- and sex-adjusted models, we observed a gradient of increasing biomarker levels across HF stages (p < 0.05; n = 3,416). Adjusting for age and sex, mortality rose across HF stages (232 deaths, mean follow-up 7 years), with 2- and 8-fold mortality risks for stages B and C/D, respectively, compared with healthy.ConclusionsApproximately 60% of our sample has preclinical HF, and those in stage B had higher concentrations of HF biomarkers and experienced a substantial mortality risk.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Centering the Patient in Meaningful Outcomes and Regulatory Approval
    • Authors: Lewis EF.
      Abstract: Image 1
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Patient-Reported Outcomes in Chronic Heart Failure Applicability for
           Regulatory Approval
    • Authors: Psotka MA; von Maltzahn R, Anatchkova M, et al.
      Abstract: ObjectivesThe study sought to review the characteristics of existing patient-reported outcome (PRO) instruments used with chronic heart failure (HF) patients and evaluate their potential to support an approved U.S. Food and Drug Administration (FDA) product label claim.BackgroundPROs, including symptoms and their associated functional limitations, contribute substantially to HF patient morbidity. PRO measurements capture the patient perspective and can be systematically assessed with structured questionnaires, however rigorous recommendations have been set by the FDA regarding the acceptability of PRO measures as a basis for product label claims.MethodsExtensive searches of databases and specialty guidelines identified PRO instruments used in patients with chronic HF. Information on critical properties recommended by the FDA guidance were systematically extracted and used to evaluate the selected PRO instruments.ResultsNineteen PRO instruments used with chronic HF patients were identified. The Kansas City Cardiomyopathy Questionnaire and Minnesota Living with Heart Failure Questionnaire were the most extensively evaluated and validated in studies of this population. However, judged by criteria listed in the FDA PRO guidance, no existing PRO measure met all of the criteria to support a product label claim in the United States.ConclusionsCurrently available chronic HF PRO measures do not fulfill all the recommendations provided in the FDA PRO guidance and therefore may not support an FDA-approved product label claim. Future investigations are merited to develop a PRO measure for use in patients with chronic HF in accordance with the FDA guidance.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Time for MADIT-VAD? ICDs Among LVAD Patients ∗
    • Authors: Kociol RD.
      Abstract: Image 1
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Oxygen Therapy in Patients With Acute Heart Failure Friend or
    • Authors: Sepehrvand N; Ezekowitz JA.
      Abstract: Supplemental oxygen, a therapy that has been used for more than a century, is recommended in all practice guidelines in the management of hypoxemic (peripheral oxygen saturation 
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Body Composition and Advanced Heart Failure Therapy Weighing the Options
           and Outcomes ∗
    • Authors: Lavie CJ; Mehra MR, Ventura HO.
      Abstract: Image 1
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • Implantable Cardioverter-Defibrillator Use in Patients With Left
           Ventricular Assist Devices A Systematic Review and Meta-Analysis
    • Authors: Vakil K; Kazmirczak F, Sathnur N, et al.
      Abstract: ObjectivesThis study evaluated the impact of implantable cardioverter-defibrillators (ICDs) on mortality in patients with left ventricular assist devices (LVADs) by conducting a systematic review and meta-analysis of published studies.BackgroundThe burden of ventricular arrhythmias in patients with LVADs is high. Prior studies assessing the impact of ICD on survival of patients with LVADs have yielded conflicting results.MethodsRelevant studies from January 2000 through October 2015 were identified in the databases PubMed and OVID. Weighted relative risks were estimated using random effects meta-analysis techniques.ResultsSix observational studies (n = 937) were included. Patients were 53 ± 12 years of age, and 80% were male. Bridge-to-transplantation was the indication for LVAD use in 93% of the patients. A continuous-flow (CF) LVAD was present in 39% of patients. Mean left ventricular ejection fraction was 16 ± 6%. An ICD was present in 355 patients (38%). During a mean follow-up of 7 months, 241 patients (26%) died (16% in the ICD group vs. 32% in the no-ICD group). Presence of an ICD was associated with a 39% relative risk reduction in all-cause mortality (RR: 0.61; 95% confidence interval [CI]: 0.46 to 0.82; p < 0.01). Among subgroup of patients with CF-LVAD (n = 361), ICD use was associated with a statistically nonsignificant trend toward improved survival (RR: 0.76; 95% CI: 0.51 to 1.12; p = 0.17).ConclusionsICD use was associated with a significant reduction in mortality in LVAD patients, however, this effect was not significant in patients with CF-LVADs. Although these data support the use of ICDs, larger randomized trial data are strongly warranted to evaluate ICD effectiveness in patients with current generation LVADs.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
  • The Impact of Obesity on Patients Bridged to Transplantation With
           Continuous-Flow Left Ventricular Assist Devices
    • Authors: Clerkin KJ; Naka Y, Mancini DM, et al.
      Abstract: ObjectivesThis study sought to determine if obese patients had worse post–left ventricular assist device (LVAD) implantation outcomes and if the implantation of an LVAD allowed for weight loss.BackgroundObesity is a risk factor for cardiovascular disease including heart failure. Obese heart failure patients have better outcomes than those with normal weight; however, obese patients have worse outcomes after heart transplantation.MethodsPatients were identified in the United Network for Organ Sharing (UNOS) database that underwent LVAD implantation as bridge to transplantation from May 2004 and April 2014, with follow-up through June 2014. Patients were grouped according to body mass index (BMI) based on the World Health Organization classification.ResultsAmong 3,856 patients, the risk of death or delisting was not significantly different between BMI groups (p = 0.347). There was no increased risk of death (p = 0.234) or delisting (p = 0.918). The risk of complication requiring UNOS status upgrade was increased for those with class II obesity or greater (hazard ratio: 1.48; p = 0.004), driven by increased infection and thromboembolism. Obese patients had worse post-transplantation outcomes. Weight loss substantial enough to decrease BMI group was achieved by a small proportion of patients listed with class I obesity or greater (9.6% to 15.5%).ConclusionsPatients with obesity had similar freedom from death or delisting while on LVAD support. However, class II obese or greater patients had an increased risk of complications requiring UNOS status upgrade compared with those with normal BMI during LVAD support and decreased post-transplantation survival. Weight loss on device therapy was possible, but uncommon. Careful consideration is needed when a bridge to weight loss strategy is proposed.
      PubDate: Sat, 01 Oct 2016 00:00:00 GMT
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