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Loop diuretic, heart failure

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https://www.readbyqxmd.com/read/28763374/the-veterans-affairs-cardiac-risk-score-recalibrating-the-atherosclerotic-cardiovascular-disease-score-for-applied-use
#1
Jeremy B Sussman, Wyndy L Wiitala, Matthew Zawistowski, Timothy P Hofer, Douglas Bentley, Rodney A Hayward
BACKGROUND: Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients' risk of developing CVD. METHODS: We created a cohort using all patients ages 45-80 who used Department of Veterans Affairs (VA) ambulatory care services in 2006 with no history of CVD, heart failure, or loop diuretics...
July 31, 2017: Medical Care
https://www.readbyqxmd.com/read/28739647/compensatory-distal-reabsorption-drives-diuretic-resistance-in-human-heart-failure
#2
Veena S Rao, Noah Planavsky, Jennifer S Hanberg, Tariq Ahmad, Meredith A Brisco-Bacik, Francis P Wilson, Daniel Jacoby, Michael Chen, W H Wilson Tang, David Z I Cherney, David H Ellison, Jeffrey M Testani
Understanding the tubular location of diuretic resistance (DR) in heart failure (HF) is critical to developing targeted treatment strategies. Rodents chronically administered loop diuretics develop DR due to compensatory distal tubular sodium reabsorption, but whether this translates to human DR is unknown. We studied consecutive patients with HF (n=128) receiving treatment with loop diuretics at the Yale Transitional Care Center. We measured the fractional excretion of lithium (FELi), the gold standard for in vivo assessment of proximal tubular and loop of Henle sodium handling, to assess sodium exit after loop diuretic administration and FENa to assess the net sodium excreted into the urine...
July 24, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28735756/incidence-and-determinants-of-hyperkalemia-and-hypokalemia-in-a-large-healthcare-system
#3
Erik Nilsson, Alessandro Gasparini, Johan Ärnlöv, Hairong Xu, Karin M Henriksson, Josef Coresh, Morgan E Grams, Juan Jesus Carrero
BACKGROUND: Hypo- and hyperkalemia in clinical settings are insufficiently characterized and large-scale data from Europe lacking. We studied incidence and determinants of these abnormalities in a large Swedish healthcare system. METHODS: Observational study from the Stockholm CREAtinine Measurements project, including adult individuals from Stockholm accessing healthcare in 2009 (n=364,955). Over 3-years, we estimated the incidence of hypokalemia, defined as potassium<3...
July 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28728476/a-perspective-on-diuretic-resistance-in-chronic-congestive-heart-failure
#4
Niel Shah, Raef Madanieh, Mehmet Al Kan, Muhammad U Dogar, Constantine E Kosmas, Timothy J Vittorio
Chronic congestive heart failure (CHF) is a complex disorder characterized by inability of the heart to keep up the demands on it, followed by the progressive pump failure and fluid accumulation. Although the loop diuretics are widely used in heart failure (HF) patients, both pharmacodynamic and pharmacokinetic alterations are thought to be responsible for diuretic resistance in these patients. Strategies to overcome diuretic resistance include sodium intake restriction, changes in diuretic dose and route of administration and sequential nephron diuretic therapy...
July 1, 2017: Therapeutic Advances in Cardiovascular Disease
https://www.readbyqxmd.com/read/28711449/intrarenal-flow-alterations-during-transition-from-euvolemia-to-intravascular-volume-expansion-in-heart-failure-patients
#5
Petra Nijst, Pieter Martens, Matthias Dupont, W H Wilson Tang, Wilfried Mullens
OBJECTIVES: The goal of this study was to assess: 1) the intrarenal flow in heart failure (HF) patients during the transition from euvolemia to intravascular volume overload; and 2) the relationship between intrarenal flow and diuretic efficiency. BACKGROUND: Intrarenal blood flow alterations may help to better understand impaired volume handling in HF. METHODS: Resistance index (RI) and venous impedance index (VII) were assessed in 6 healthy subjects, 40 euvolemic HF patients with reduced ejection fraction (HFrEF) and 10 HF patients with preserved ejection fraction (HFpEF)...
July 6, 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28701888/pharmacological-treatment-of-heart-failure-with-preserved-ejection-fraction
#6
REVIEW
Kazuhiro Yamamoto
Heart failure with preserved ejection fraction is a socioeconomic burden in Japan as well as other developed countries. Diuretics are widely used to attenuate symptoms and signs of congestion in both heart failure with preserved and reduced ejection fraction, although their effects on long-term prognosis of both phenotypes of heart failure have not been demonstrated because of an ethical difficulty in designing a randomized and prospective clinical trial. Guidelines do not provide any guidance on therapy choice, and physicians blindly choose furosemide among loop diuretics in current clinical settings...
June 2017: Yonago Acta Medica
https://www.readbyqxmd.com/read/28688888/observation-of-patients-transitioned-to-an-oral-loop-diuretic-before-discharge-and-risk-of-readmission-for-acute-decompensated-heart-failure
#7
Benjamin Laliberte, Brent N Reed, Sandeep Devabhakthuni, Kristin Watson, Vijay Ivaturi, Tao Liu, Stephen S Gottlieb
BACKGROUND: Heart failure (HF) is associated with high 30-day readmission rates and places significant financial burden on the health care system. The aim of this study was to determine if the duration of observation on an oral loop diuretic before discharge is associated with a reduction in 30-day HF readmission in patients with acute decompensated HF (ADHF). METHODS AND RESULTS: This was a retrospective study of adult patients admitted for ADHF at a large academic medical center...
July 5, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28645802/comparative-effects-of-long-and-short-acting-loop-diuretics-on-mortality-in-patients-with-chronic-heart-failure
#8
Shu Kasama, Takuji Toyama, Masahiko Kurabayashi
BACKGROUND: We previously reported that the long-acting loop diuretic azosemide improves cardiac sympathetic nerve activity (CSNA) in patients with chronic heart failure (CHF), compared with short-acting furosemide. However, its influence on mortality has not been determined. METHODS: The present study was a further analysis of our previously published study in which azosemide showed improved (123)I-metaiodobenzylguanidine scintigraphic findings compared with furosemide in CHF patients with reduced left ventricular ejection fraction (LVEF)...
June 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28641794/time-to-furosemide-treatment-and-mortality-in-patients-hospitalized-with-acute-heart-failure
#9
Yuya Matsue, Kevin Damman, Adriaan A Voors, Nobuyuki Kagiyama, Tetsuo Yamaguchi, Shunsuke Kuroda, Takahiro Okumura, Keisuke Kida, Atsushi Mizuno, Shogo Oishi, Yasutaka Inuzuka, Eiichi Akiyama, Ryuichi Matsukawa, Kota Kato, Satoshi Suzuki, Takashi Naruke, Kenji Yoshioka, Tatsuya Miyoshi, Yuichi Baba, Masayoshi Yamamoto, Koji Murai, Kazuo Mizutani, Kazuki Yoshida, Takeshi Kitai
BACKGROUND: Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics. OBJECTIVES: The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome. METHODS: REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED)...
June 27, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28633650/effects-of-tolvaptan-in-patients-with-acute-heart-failure-a-systematic-review-and-meta-analysis
#10
Chunbin Wang, Bo Xiong, Lin Cai
BACKGROUND: Acute heart failure, which requires urgent evaluation and treatment, is a leading cause for admission to the emergency department. The aim of this meta-analysis was to evaluate the effects of tolvaptan on acute heart failure and compare them with the effects of conventional therapy or placebo. METHODS: The electronic databases PubMed, EMBASE, and the Cochrane Controlled Trial registry were searched from their starting dates to October 24, 2016. Two authors independently read the trials and extracted related information from the included studies...
June 20, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28633477/loop-diuretics-for-chronic-heart-failure-a-foe-in-disguise-of-a-friend
#11
Chris J Kapelios, Konstantinos Malliaras, Elisabeth Kaldara, Stella Vakrou, John N Nanas
Loop diuretics are recommended for relieving symptoms and signs of congestion in patients with chronic heart failure and are administered to more than 80% of them. However, several of their effects have not systematically been studied. Numerous cohort and four interventional studies have addressed the effect of diuretics on renal function; apart from one prospective study, which showed that diuretics withdrawal is accompanied by increase in some markers of early-detected renal injury, all others converge to the conclusion that diuretics receipt, especially in high doses is associated with increased rates of renal dysfunction...
June 19, 2017: European Heart Journal. Cardiovascular Pharmacotherapy
https://www.readbyqxmd.com/read/28602369/heart-failure-complicating-acute-mtyocardial-infarction
#12
REVIEW
Wilbert S Aronow
Factors predisposing the older person with acute myocardial infarction (MI) to develop heart failure (HF) include an increased prevalence of MI, multivessel coronary artery disease, decreased left ventricular (LV) contractile reserve, impairment of LV diastolic relaxation, increased hypertension, LV hypertrophy, diabetes mellitus, valvular heart disease, and renal insufficiency. HF associated with acute MI should be treated with a loop diuretic. The use of nitrates, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists, beta-blockers, digoxin, and positive inotropic drugs; treatment of arrhythmias and mechanical complications; and indications for use of implantable cardioverter-defibrillators and cardiac resynchronization is discussed...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28597798/ultrafiltration-versus-intravenous-loop-diuretics-in-patients-with-acute-decompensated-heart-failure-a-meta-analysis-of-clinical-trials
#13
Mohamad Kabach, Hassan Alkhawam, Sachil Shah, Georges Joseph, Elie M Donath, Noah Moss, Robert S Rosenstein, Robert Chait
Background Intravenous loop diuretics are the first-line therapy for acute decompensated heart failure (ADHF) but many patients are discharged with unresolved congestion resulting in higher re-hospitalization and mortality rates. Ultrafiltration (UF) is a promising intervention for ADHF. However, studies comparing UF to diuretics have been inconsistent in their clinical outcomes. Methods A comprehensive literature search was performed. Trials were included if they met the following criteria: (1) randomization with a control group, (2) comparison of UF with a loop diuretic, and (3) a diagnosis of ADHF...
April 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28572743/design-and-rationale-of-the-high-sensitivity-troponin-t-rules-out-acute-cardiac-insufficiency-trial
#14
Benton R Hunter, Sean P Collins, Gregory J Fermann, Phillip D Levy, Changyu Shen, Syed Imran Ayaz, Mette L Cole, Karen F Miller, Adam A Soliman, Peter S Pang
BACKGROUND: Acute heart failure (AHF) is a common presentation in the Emergency Department (ED), and most patients are admitted to the hospital. Identification of patients with AHF who have a low risk of adverse events and are suitable for discharge from the ED is difficult, and an objective tool would be useful. METHODS: The highly sensitive Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) will enroll ED patients being treated for AHF. Patients will undergo standard ED evaluation and treatment...
2017: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/28552097/community-acquired-staphylococcus-aureus-bacteremia-studies-of-risk-and-prognosis-with-special-attention-to-diabetes-mellitus-and-chronic-heart-failure
#15
Jesper Smit
Community-acquired Staphylococcus aureus bacteremia (CA-SAB) is a serious infection with detrimental clinical effects. Chronic diseases constitute some of the most important risk and prognostic factors for CA-SAB. The prevalence of diabetes and chronic heart failure (CHF) is rapidly increasing on a global scale, nevertheless, there are few data available specifically elucidating the influence of these chronic conditions on CA-SAB risk and outcome. Therefore, to extend the current knowledge, we aimed to I) elucidate the impact of different definitions of healthcare-associated (HCA) infection on the prevalence of HCA-SAB, patient characteristics, and mortality, II) to investigate whether diabetes is a risk factor for CA-SAB, III) to ascertain the prognostic influence of diabetes on CA-SAB outcome, and IV) to investigate the influence of CHF on mortality in patients with CA-SAB...
May 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28545850/renal-response-to-intravascular-volume-expansion-in-euvolemic-heart-failure-patients-with-reduced-ejection-fraction-mechanistic-insights-and-clinical-implications
#16
Petra Nijst, Frederik H Verbrugge, Pieter Martens, Matthias Dupont, W H Wilson Tang, Wilfried Mullens
BACKGROUND: Untreated and preclinical heart failure patients with reduced ejection fraction (HFrEF) have an impaired ability to alleviate excess intravascular volume. OBJECTIVES: To investigate 1) the renal response to intravascular volume expansion in euvolemic and optimally treated HFrEF patients and 2) loop diuretic efficiency. METHODS: 14 healthy and 28 HFrEF patients underwent intravascular volume expansion with 1l hydroxyl ethyl starch 6% during 3h after which a loop diuretic was administered...
September 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28532770/changes-in-loop-diuretic-dose-and-outcome-after-cardiac-resynchronization-therapy-in-patients-with-heart-failure-and-reduced-left-ventricular-ejection-fractions
#17
Pieter Martens, Frederik H Verbrugge, Petra Nijst, Matthias Dupont, Wilfried Mullens
Cardiac resynchronization therapy (CRT) improves cardiac hemodynamics. Therefore, the maintenance dose of loop diuretic therapy might be reduced. Consecutive patients who underwent CRT (n = 648) were retrospectively evaluated. Loop diuretic dose was recorded at baseline before implantation and 6 months later with patients classified into 4 groups: (1) no loop diuretic, (2) down-titration, (3) unchanged dose, and (4) up-titration. Afterward total loop diuretic exposure was calculated. Renal function trajectories were evaluated as the difference between implantation and censoring serum creatinine (Cr) value...
July 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28515029/tolvaptan-utilization-in-children-with-chronic-hyponatremia-due-to-inappropriate-antidiuretic-hormone-secretion-siadh-three-case-reports-and-review-of-the-literature
#18
Gerdi Tuli, Daniele Tessaris, Luisa De Sanctis, Patrizia Matarazzo
Hyponatremia is the most common electrolyte disorder among hospitalized patients and it is sometimes considered as a poor outcome predictor. Its correction is thus indicated, even in asymptomatic patients. The conventional treatment is represented by fluid restriction in presence of euvolemia or hypervolemia; whereas loop diuretics are used in some hypervolemic conditions (cardiac heart failure, liver cirrhosis and nephrotic syndrome) and intravenous isotonic or hypertonic solution are administered in hypovolemic conditions...
May 17, 2017: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/28484958/markers-of-diuretic-resistance-in-emergency-department-patients-with-acute-heart-failure
#19
Andrew Doering, Cathy A Jenkins, Alan B Storrow, JoAnn Lindenfeld, Gregory J Fermann, Karen F Miller, Matthew Sperling, Sean P Collins
BACKGROUND: Loop diuretics are common therapy for emergency department (ED) patients with acute heart failure (AHF). Diuretic resistance (DR) is a term used to describe blunted natriuretic response to loop diuretics. It would be important to detect DR prior to it becoming clinically apparent, so early interventions can be initiated. However, several definitions have been proposed, and it is not clear if they identify similar patients. We compared these definitions and described the clinical characteristics of patients who fulfilled them...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28484118/effects-of-tolvaptan-with-or-without-the-pre-administration-of-renin-angiotensin-system-blockers-in-hospitalized-patients-with-acute-decompensated-heart-failure
#20
Sen Adachi, Shin-Ichiro Miura, Yuhei Shiga, Tadaaki Arimura, Joji Morii, Takashi Kuwano, Ken Kitajima, Atsushi Iwata, Natsumi Morito, Kanta Fujimi, Eiji Yahiro, Hiroaki Nishikawa, Keijiro Saku
We examined whether tolvaptan combined with an angiotensin II receptor blocker (ARB) or angiotensin converting enzyme inhibitor (ACE-I) is more effective than tolvaptan alone in the treatment of patients with heart failure (HF). Sixty-five hospitalized patients with acute decompensated HF were included in this study. They were divided into 2 groups; an ARB/ACE-I group (n = 44, who received ARB or ACE-I before the use of tolvaptan) and a non-ARB/ACE-I group (n = 21). There were no significant differences in patient characteristics including medications at baseline between the non-ARB/ACE-I and ARB/ACE-I groups with the exception of the percentages of hypertension and ischemic heart disease...
May 31, 2017: International Heart Journal
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