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Journal Cover JACC : Heart Failure
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   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by American College of Cardiology Foundation Homepage  [1 journal]
  • Prevalence and Predictors of Sleep-Disordered Breathing in Patients With
           Stable Chronic Heart Failure The SchlaHF Registry
    • Authors: Arzt M; Woehrle H, Oldenburg O, et al.
      Abstract: ObjectivesThis prospective study investigated the prevalence of sleep-disordered breathing (SDB) and its predictors in patients with stable chronic heart failure (HF).BackgroundSDB is increasingly recognized as being important in patients with HF.MethodsThe multicenter SchlaHF (Sleep-Disordered Breathing in Heart Failure) registry provides demographic and clinical data on chronic, stable, symptomatic patients with HF (New York Heart Association functional class ≥II; left ventricular rejection fraction ≤45%). Moderate-to-severe SDB (apnea-hypopnea index ≥15/h) was determined by a 2-channel screening device (ApneaLink, ResMed, Sydney, Australia).ResultsData from 6,876 patients were analyzed. The prevalence of moderate-to-severe SDB was 46%, with a significant sex difference: 36% in women (n = 1,448) versus 49% in men (n = 5,428). Prevalence of SDB rose with increasing age (31%, 39%, 45%, 52%, and 59% in those age ≤50, >50 to 60, >60 to 70, >70 to 80, and >80 years, respectively). Risk factors for SDB were body mass index (per 5 units; odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.22 to 1.36), left ventricular rejection fraction (per 5% decrement from 45%; OR: 1.10; 95% CI: 1.06 to 1.14), age (per 10-year difference to 60 years; OR: 1.41; 95% CI: 1.34 to 1.49), atrial fibrillation (OR: 1.19; 95% CI: 1.06 to 1.34), and male sex (OR: 1.90; 95% CI: 1.67 to 2.17).ConclusionsSchlaHF registry data demonstrate a high prevalence of SDB in a representative population of stable patients with chronic HF receiving contemporary medical management. Male sex, age, body mass index, and the severity of both symptoms and left ventricular dysfunction were clinical predictors for prevalent SDB. (Prevalence, Clinical Characteristics and Type of Sleep-disordered Breathing in Patients With Chronic, Symptomatic, Systolic Heart Failure; NCT01500759)
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • The PARADIGM of Influenza Vaccination in Heart Failure Patients
           ∗
    • Authors: Acharya D; Uyeki TM.
      Abstract: Annual seasonal influenza epidemics of variable severity are associated with substantial morbidity and mortality worldwide, with influenza activity peaking during corresponding winter months in temperate climates of the northern and southern hemispheres (1). In the tropics and subtropics, influenza activity occurs year-round, with differences in peak periods. Most influenza disease burden estimates are derived from studies conducted in developed countries. Certain populations are considered to be at increased risk for influenza complications, including infants, the elderly, immunosuppressed persons, pregnant women, and persons with chronic conditions including pulmonary and cardiac disease (2). Prevention of influenza in the United States is focused upon annual influenza vaccination of all persons ≥6 months of age, although recommended target populations and different kinds of vaccines and their availability and uses differ worldwide (3). Influenza vaccine effectiveness varies by age group, immune status, and antigenic similarities between circulating influenza virus strains and vaccine strains.
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Death of the Heart Failure Clinical Investigator Molecules and Receptors
           Win Nobel Prizes, Clinical Investigation Improves Survival
    • PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart
           Failure
    • Authors: Costanzo M; Negoianu D, Jaski BE, et al.
      Abstract: ObjectivesThe AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration (AUF) would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics (ALD).BackgroundCongestion in hospitalized heart failure (HF) patients portends unfavorable outcomes.MethodsThe AVOID-HF trial, designed as a multicenter, 1-to-1 randomized study of 810 hospitalized HF patients, was terminated unilaterally and prematurely by the sponsor (Baxter Healthcare, Deerfield, Illinois) after enrollment of 224 patients (27.5%). Aquadex FlexFlow System (Baxter Healthcare) was used for AUF. A Clinical Events Committee, blinded to the randomized treatment, adjudicated whether 90-day events were due to HF.ResultsA total of 110 patients were randomized to AUF and 114 to ALD. Baseline characteristics were similar. Estimated days to first HF event for the AUF and ALD group were, respectively, 62 and 34 (p = 0.106). At 30 days, compared with the ALD group, the AUF group had fewer HF and cardiovascular events. Renal function changes were similar. More AUF patients experienced an adverse effect of special interest (p = 0.018) and a serious study product-related adverse event (p = 0.026). The 90-day mortality was similar.ConclusionsCompared with the ALD group, the AUF group trended toward a longer time to first HF event within 90 days and fewer HF and cardiovascular events. More patients in the AUF group experienced special interest or serious product-related adverse event. Due to the trial’s untimely termination, additional AUF investigation is warranted.
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Understanding Mechanisms of Action of Beta-Blockers in Heart Failure
           With Reduced and Preserved Ejection Fraction ∗
    • Authors: Flather MD; Gollop ND.
      Abstract: Heart failure (HF) is a global health challenge due to ageing populations and increasing burden of disease (1). Older HF patients have higher rates of preserved ejection fraction (HFpEF) and higher numbers of females and comorbidities (2). There are uncertainties in diagnosis of HF in the elderly, who may present with atypical symptoms, and the evidence base for conventional treatments is weaker especially for HFpEF (3).
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Influenza Vaccination in Patients With Chronic Heart Failure The
           PARADIGM-HF Trial
    • Authors: Vardeny O; Claggett B, Udell JA, et al.
      Abstract: ObjectivesThis study sought to examine the prevalence and predictors of influenza vaccination among participants in the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) study and investigate associations between receiving influenza vaccine and cardiovascular death or heart failure hospitalizations, all-cause hospitalizations, and cardiopulmonary or influenza-related hospitalizations.BackgroundInfluenza is associated with an increased risk for cardiovascular events in patients with heart failure.MethodsWe used data from the PARADIGM-HF trial in which patients with heart failure were randomized to the angiotensin receptor neprilysin inhibitor LCZ696 (sacubitril/valsartan) or enalapril. We assessed predictors of receiving influenza vaccination, and examined the relationship between influenza vaccination and outcomes in a propensity-adjusted model.ResultsOf 8,099 study participants, 1,769 (21%) received influenza vaccination. We observed significant regional variation in vaccination rates, with highest rates in the Netherlands (77.5%), Great Britain (77.2%), and Belgium (67.5%), and lowest rates in Asia (2.6%), with intermediate rates in North America (52.8%). Top predictors of vaccination included enrolling country, white race, implanted defibrillator, older age, lower New York Heart Association functional class, lower heart rate, and a history of diabetes mellitus. Influenza vaccination was associated with a reduced risk for all-cause mortality in propensity-adjusted (hazard ratio: 0.81; 95% confidence interval: 0.67 to 0.97; p = 0.015) models.ConclusionsInfluenza vaccination rates varied widely in patients with heart failure with reduced ejection fraction enrolled in the PARADIGM-HF trial, and vaccination was associated with reduced risk for death, although whether this association was causal cannot be determined.
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Does What Happens During Sleep Matter for the Failing Heart'
           ∗
    • Authors: Cowie MR.
      Abstract: In this issue of JACC: Heart Failure, Arzt et al. (1) describe the prevalence of sleep-disordered breathing (SDB) in a registry of more than 6,800 patients with chronic stable systolic heart failure (HF) (heart failure with reduced ejection fraction [HFREF]) in Germany. Breathing is moderately or severely abnormal during sleep (apnea-hypopnea index ≥15) in almost one-half of such patients. Importantly, the patients are less selected than in previous reports, being recruited from a wide variety of cardiology practices, and were treated to current guidelines—with high usage of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and aldosterone antagonists.
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Determining the Feasibility of Spinal Cord Neuromodulation for
           the Treatment of Chronic Systolic Heart Failure The DEFEAT-HF Study
    • Authors: Zipes DP; Neuzil P, Theres H, et al.
      Abstract: ObjectivesThe primary objective of the study was a change in left ventricular end-systolic volume index (LVESVi) from baseline to 6 months of spinal cord stimulation (SCS) therapy in the treatment arm compared to the control arm as measured by echocardiography. Secondary objectives were changes in peak oxygen uptake and N-terminal pro–B-type natriuretic peptide (NT-proBNP) between the treatment arm and control arm from baseline through 6 months.BackgroundAbnormal neurohormonal activation is often responsible for progression of heart failure (HF). Treatment has often included drug therapy to modulate the neurohormonal axis. The purpose of the DEFEAT-HF (Determining the Feasibility of Spinal Cord Neuromodulation for the Treatment of Chronic Heart Failure) clinical study was to evaluate whether direct modulation of the nervous system through SCS improved HF metrics, including heart size, biomarkers, functional capacity, and symptoms.MethodsThe DEFEAT-HF study was a prospective, multicenter randomized (3:2), parallel, single-blind, controlled study to investigate whether SCS was a feasible therapy for the treatment of systolic HF for patients with New York Heart Association functional class III HF, left ventricular ejection fraction (LVEF) ≤35%, QRS duration 
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Spinal Cord Stimulation for Heart Failure in the DEFEAT-HF Study Lost
           Battle or Lasting Opportunities' ∗
    • Authors: Upadhyay GA; Singh JP.
      Abstract: “I have not failed. I've just found 10,000 ways that won't work.”— Thomas A. Edison (1)
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Tolerability and Feasibility of Beta-Blocker Titration in HFpEF Versus
           HFrEF Insights From the CIBIS-ELD Trial
    • Authors: Edelmann F; Musial-Bright L, Gelbrich G, et al.
      Abstract: ObjectivesThis study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction.BackgroundBroad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain.MethodsIn the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro–B-type natriuretic peptide).ResultsFor both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23% vs. HFrEF: 34%, p < 0.001). Mean E/e′ and left atrial volume index did not change in either group, although E/A increased in HFpEF.ConclusionsBB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure [HF] Patients: A Randomised, Double-Blind Multicentre Study [CIBIS-ELD]; ISRCTN34827306)
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • When Business and Science Clash, How Can We Avoid Harming
           Patients' The Case of AVOID-HF ∗
    • Abstract: The ethics of using randomization to figure out what works in medicine have been aggressively debated since the first randomized trials were performed, more than 60 years ago (1,2). Traditionally, the practicing physician has a duty to put the best interests of the patient above all else. Tradition has had little to say, however, about physicians often lacking adequate information to assess what those best interests actually are. The central ethical conflict raised by randomized trials is that, in most trials, patients voluntarily forgo the pursuit of maximum personal benefit to support the larger social goal of enhancing generalizable knowledge. Under those circumstances, for a randomized trial to be ethical by modern sensibilities, certain conditions must be met (3). These include not only true informed consent, but also the potential to enhance knowledge, use of scientifically sound methodology, and a favorable risk-benefit relationship.
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
  • Heart Rate or Beta-Blocker Dose' Association With Outcomes in
           Ambulatory Heart Failure Patients With Systolic Dysfunction
           Results From the HF-ACTION Trial
    • Authors: Fiuzat M; Wojdyla D, Pina I, et al.
      Abstract: ObjectivesThis study aimed to compare whether reduced heart rate (HR) or higher beta-blocker (BB) dose affected outcomes to a greater extent in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial population.BackgroundRecent data have shown that HR is an important modifiable factor in reducing mortality in heart failure (HF) patients. It has also been shown that titration of doses of BBs improves outcomes of morbidity and mortality in chronic HF patients with reduced ejection fraction. We aimed to compare whether reduced HR or higher BB dose affected outcomes to a greater extent in the HF-ACTION trial population.MethodsHF-ACTION was a randomized, multicenter trial enrolling 2,331 ambulatory HF patients with systolic dysfunction (New York Heart Association functional class II to IV, left ventricular ejection fraction 
      PubDate: Mon, 01 Feb 2016 00:00:00 GMT
       
 
 
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