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HFrEF treatment

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https://www.readbyqxmd.com/read/29141781/heart-failure-with-preserved-borderline-and-reduced-ejection-fraction-5-year-outcomes
#1
Kevin S Shah, Haolin Xu, Roland A Matsouaka, Deepak L Bhatt, Paul A Heidenreich, Adrian F Hernandez, Adam D Devore, Clyde W Yancy, Gregg C Fonarow
BACKGROUND: Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction (EF). OBJECTIVES: This study sought to characterize differences in outcomes in patients hospitalized with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with borderline ejection fraction (HFbEF) (EF 41% to 49%), and heart failure with reduced ejection fraction (HFrEF) (EF ≤40%). METHODS: Data from GWTG-HF (Get With The Guidelines-Heart Failure) were linked to Medicare data for longitudinal follow-up...
October 31, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29138270/low-and-high-renin-heart-failure-phenotypes-with-clinical-implications
#2
Noemi Pavo, Georg Goliasch, Raphael Wurm, Johannes Novak, Guido Strunk, Mariann Gyöngyösi, Marko Poglitsch, Marcus D Säemann, Martin Hülsmann
BACKGROUND: Blockade of the renin-angiotensin system (RAS) represents a main strategy in the therapy of heart failure with reduced ejection fraction (HFrEF), but the role of active renin concentration (ARC) for guiding therapy in the presence of an RAS blockade remains to be established. This study assessed angiotensin profiles of HFrEF patients with distinct RAS activations as reflected by ARC. METHODS: Two cohorts of stable chronic HFrEF patients on optimal medical treatment (OMT) were enrolled...
November 14, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/29124734/evolution-of-a-geriatric-syndrome-pathophysiology-and-treatment-of-heart-failure-with-preserved-ejection-fraction
#3
Bharathi Upadhya, Barbara Pisani, Dalane W Kitzman
The majority of older adults who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). The prevalence of this syndrome is increasing, and the prognosis is not improving, unlike that of HF with reduced ejection fraction (HFrEF). Individuals with HFpEF have severe symptoms of effort intolerance, poor quality of life, frequent hospitalizations, and greater likelihood of death. Despite the importance of HFpEF, there are numerous major gaps in our understanding of its pathophysiology and management...
November 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29111304/who-are-they-patients-with-heart-failure-in-american-skilled-nursing-facilities
#4
Lin Li, Bill M Jesdale, Anne Hume, Giovanni Gambassi, Robert J Goldberg, Kate L Lapane
BACKGROUND: Heart failure (HF) is common among skilled nursing facility (SNF) residents, yet patients with HF in the SNF setting have not been well described. METHODS: Using Minimum Data Set 3.0 cross-linked to Medicare data (2011-2012), we studied 150,959 HF patients admitted to 13,858 SNFs throughout the USA. ICD-9 codes were used to differentiate patients with HF with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF), or unspecified HF. RESULTS: The median age of the study population was 82 years, 68% were women, 34% had HFpEF, and 27% had HFrEF...
October 27, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/29096787/structural-and-functional-phenotyping-of-the-failing-heart-is-the-left-ventricular-ejection-fraction-obsolete
#5
REVIEW
Michael R Bristow, David P Kao, Khadijah K Breathett, Natasha L Altman, John Gorcsan, Edward A Gill, Brian D Lowes, Edward M Gilbert, Robert A Quaife, Douglas L Mann
Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF)...
November 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/29094152/association-of-serial-kansas-city-cardiomyopathy-questionnaire-assessments-with-death-and-hospitalization-in-patients-with-heart-failure-with-preserved-and-reduced-ejection-fraction-a-secondary-analysis-of-2-randomized-clinical-trials
#6
Yashashwi Pokharel, Yevgeniy Khariton, Yuanyuan Tang, Michael E Nassif, Paul S Chan, Suzanne V Arnold, Philip G Jones, John A Spertus
Importance: While there is increasing emphasis on incorporating patient-reported outcome measures in routine care for patients with heart failure (HF), how best to interpret longitudinally collected patient-reported outcome measures is unknown. Objective: To examine the strength of association between prior, current, or a change in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores with death and hospitalization in patients with HF with preserved (HFpEF) and reduced (HFrEF) ejection fractions...
November 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29055972/chronic-obstructive-pulmonary-disease-and-%C3%AE-blocker-treatment-in-asian-patients-with-heart-failure
#7
Yoshiaki Kubota, Wan Ting Tay, Kuniya Asai, Koji Murai, Ikutaro Nakajima, Nobuhisa Hagiwara, Takanori Ikeda, Takashi Kurita, Tiew-Hwa Katherine Teng, Inder Anand, Carolyn S P Lam, Wataru Shimizu
AIMS: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are increasingly frequent in Asia and commonly coexist in patients. However, the prevalence of COPD among Asian patients with HF and its impact on HF treatment are unclear. METHODS AND RESULTS: We compared clinical characteristics and treatment approaches between patients with or without a history of COPD, before and after 1:2 propensity matching (for age, sex, geographical region, income level, and ethnic group) in 5232 prospectively recruited patients with HF and reduced ejection fraction (HFrEF, <40%) from 11 Asian regions (Northeast Asia: South Korea, Japan, Taiwan, Hong Kong, and China; South Asia: India; Southeast Asia: Thailand, Malaysia, Philippines, Indonesia, and Singapore)...
October 21, 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/29051336/exercise-limitations-in-heart-failure-with-reduced-and-preserved-ejection-fraction
#8
David C Poole, Russell S Richardson, Mark J Haykowsky, Daniel M Hirai, Timothy I Musch
The hallmark symptom of chronic heart failure (CHF) syndrome is severe exercise intolerance. Impaired perfusive and diffusive O2 transport are two of the major determinants of reduced physical capacity and lowered maximal O2 uptake (VO2max) in CHF patients. It has now become evident that this syndrome manifests two different phenotypic variations: heart failure with preserved or reduced ejection fraction (HFpEF and HFrEF, respectively). Unlike HFrEF, however, there is currently limited understanding of HFpEF pathophysiology leading to a lack of effective pharmacological treatments for this subpopulation...
October 19, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29042791/profile-of-sacubitril-valsartan-in-the-treatment-of-heart-failure-patient-selection-and-perspectives
#9
REVIEW
Srikanth Yandrapalli, Gabriela Andries, Medha Biswas, Sahil Khera
With an estimated prevalence of 5.8 million in the USA and over 23 million people worldwide, heart failure (HF) is growing in epidemic proportions. Despite the use of guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, angiotensin receptor blockers, and mineralocorticoid receptor antagonists for chronic systolic HF for almost two decades, HF remains a leading cause of morbidity, mortality, and health care expenditures. The Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial provided compelling evidence for the cardiovascular and mortality benefit of sacubitril/valsartan when compared to enalapril in patients with heart failure and reduced ejection fraction (HFrEF)...
2017: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/29032140/heart-failure-with-mid-range-borderline-ejection-fraction-clinical-implications-and-future-directions
#10
REVIEW
Jeffrey J Hsu, Boback Ziaeian, Gregg C Fonarow
Heart failure (HF) with borderline ejection fraction was first defined in 2013 in the American College of Cardiology/American Heart Association guidelines as the presence of the typical symptoms of HF and a left ventricular ejection fraction (LVEF) of 41% to 49%. In 2016, the European Society of Cardiology specified HF with mid-range ejection fraction (HFmrEF) as LVEF of 40% to 49%. This range of LVEF is less well studied compared with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)...
November 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/29032136/a-multicenter-randomized-double-blind-placebo-controlled-trial-of-the-efficacy%C3%A2-and-safety-of-the-oral-soluble-guanylate-cyclase-stimulator-the-victoria-trial
#11
REVIEW
Paul W Armstrong, Lothar Roessig, Mahesh J Patel, Kevin J Anstrom, Javed Butler, Adriaan A Voors, Carolyn S P Lam, Piotr Ponikowski, Tracy Temple, Burkert Pieske, Justin Ezekowitz, Adrian F Hernandez, Joerg Koglin, Christopher M O'Connor
This trial sought to evaluate whether vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, was superior to placebo, on a background of standard of care, in increasing the time to the first occurrence of the composite endpoints of cardiovascular (CV) death and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction (HFrEF). Deficiency in sGC-derived cyclic guanosine monophosphate (cGMP) causes both myocardial dysfunction and impaired endothelium-dependent vasomotor regulation that includes the myocardial microcirculation...
October 4, 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/29018938/heart-failure-with-preserved-ejection-fraction-current-management-and-future-strategies-expert-opinion-on-the-behalf-of-the-nucleus-of-the-heart-failure-working-group-of-the-german-society-of-cardiology-dkg
#12
REVIEW
Carsten Tschöpe, Christoph Birner, Michael Böhm, Oliver Bruder, Stefan Frantz, Andreas Luchner, Lars Maier, Stefan Störk, Behrouz Kherad, Ulrich Laufs
About 50% of all patients suffering from heart failure (HF) exhibit a reduced ejection fraction (EF ≤ 40%), termed HFrEF. The others may be classified into HF with midrange EF (HFmrEF 40-50%) or preserved ejection fraction (HFpEF, EF ≥ 50%). Presentation and pathophysiology of HFpEF is heterogeneous and its management remains a challenge since evidence of therapeutic benefits on outcome is scarce. Up to now, there are no therapies improving survival in patients with HFpEF. Thus, the treatment targets symptom relief, quality of life and reduction of cardiac decompensations by controlling fluid retention and managing risk factors and comorbidities...
October 10, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28982501/pulmonary-artery-pressure-guided-management-of-patients-with-heart-failure-and-reduced-ejection-fraction
#13
RANDOMIZED CONTROLLED TRIAL
Michael M Givertz, Lynne W Stevenson, Maria R Costanzo, Robert C Bourge, Jordan G Bauman, Gregg Ginn, William T Abraham
BACKGROUND: Despite increased use of guideline-directed medical therapy (GDMT), some patients with heart failure and reduced ejection fraction (HFrEF) remain at high risk for hospitalization and mortality. Remote monitoring of pulmonary artery (PA) pressures provides clinicians with actionable information to help further optimize medications and improve outcomes. OBJECTIVES: CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients trial) analyzed PA pressure-guided heart failure (HF) management in patients with HFrEF based on their ability to tolerate GDMT...
October 10, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28980368/similar-clinical-benefits-from-below-target-and-target-dose-enalapril-in-patients-with-heart-failure-in-the-solvd-treatment-trial
#14
Phillip H Lam, Daniel J Dooley, Gregg C Fonarow, Javed Butler, Deepak L Bhatt, Gerasimos S Filippatos, Prakash Deedwania, Daniel E Forman, Michel White, Ross D Fletcher, Cherinne Arundel, Marc R Blackman, Chris Adamopoulos, Ioannis E Kanonidis, Inmaculada B Aban, Kanan Patel, Wilbert S Aronow, Richard M Allman, Stefan D Anker, Bertram Pitt, Ali Ahmed
AIMS: To examine associations of below-target and target dose of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, with outcomes in patients with heart failure and reduced ejection fraction (HFrEF) in the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial. METHODS AND RESULTS: Two thousand five hundred and sixty-nine patients with HFrEF (ejection fraction ≤35%) were randomized to below-target (5-10 mg/day) dose placebo (n = 1284) or enalapril (n = 1285)...
October 5, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28980289/heart-failure-with-recovered-ejection-fraction-clinical-characteristics-determinants-and-prognosis-cardiochus-chop-registry
#15
Rosa Agra Bermejo, Eva Gonzalez Babarro, J Nicolás López Canoa, Alfonso Varela Román, Inés Gómez Otero, Marcos Oro Ayude, Pablo Parada Vazquez, Isabel Gómez Rodríguez, Oscar Díaz Castro, Jose Ramón González Juanatey
BACKGROUND: The magnitude and the prognostic impact of recovering left ventricular ejection fraction (LVEF) in patients with heart failure (HF) and systolic dysfunction is unclear. The aim of this study was to evaluate the clinical characteristics and prognosis of patients with HFrecEF in an HF population. METHODS: 449 consecutive patients were selected with the diagnosis of HF and an evaluation of LVEF in the 6 months prior to selection who were referred to two HF units...
October 5, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28974553/safety-and-efficacy-of-the-intravenous-infusion-of-umbilical-cord-mesenchymal-stem-cells-in-patients-with-heart-failure-a-phase-1-2-randomized-controlled-trial-rimecard-trial-randomized-clinical-trial-of-intravenous-infusion-umbilical-cord-mesenchymal-stem
#16
RANDOMIZED CONTROLLED TRIAL
Jorge Bartolucci, Fernando J Verdugo, Paz L González, Ricardo E Larrea, Ema Abarzua, Carlos Goset, Pamela Rojo, Ivan Palma, Ruben Lamich, Pablo A Pedreros, Gloria Valdivia, Valentina M Lopez, Carolina Nazzal, Francisca Alcayaga-Miranda, Jimena Cuenca, Matthew J Brobeck, Amit N Patel, Fernando E Figueroa, Maroun Khoury
RATIONALE: Umbilical cord-derived mesenchymal stem cells (UC-MSC) are easily accessible and expanded in vitro, possess distinct properties, and improve myocardial remodeling and function in experimental models of cardiovascular disease. Although bone marrow-derived mesenchymal stem cells have been previously assessed for their therapeutic potential in individuals with heart failure and reduced ejection fraction, no clinical trial has evaluated intravenous infusion of UC-MSCs in these patients...
October 27, 2017: Circulation Research
https://www.readbyqxmd.com/read/28948656/aliskiren-alone-or-in-combination-with-enalapril-vs-enalapril-among-patients-with-chronic-heart-failure-with-and-without-diabetes-a-subgroup-analysis-from-the-atmosphere-trial
#17
Søren L Kristensen, Ulrik M Mogensen, Georgia Tarnesby, Claudio R Gimpelewicz, Mohammed A Ali, Qing Shao, YannTong Chiang, Pardeep S Jhund, William T Abraham, Kenneth Dickstein, John J V McMurray, Lars Køber
AIMS: Because of concerns about the safety of aliskiren in patients with diabetes, study treatment was stopped prematurely in the Aliskiren Trial of Minimizing OutcomeS for Patients with HEart failuRE (ATMOSPHERE). We examined outcomes and treatment effect in these patients compared with those without diabetes. METHODS AND RESULTS: ATMOSPHERE included 7016 patients with heart failure and a reduced ejection fraction (HFrEF) randomly assigned to enalapril plus aliskiren, aliskiren alone, or enalapril...
September 25, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28939928/acute-heart-failure-an-unmet-medical-need
#18
REVIEW
A G Rigopoulos, C Bakogiannis, R de Vecchis, S Sakellaropoulos, M Ali, M Teren, M Matiakis, C Tschoepe, M Noutsias
Despite recent advances in the management of heart failure with reduced ejection fraction (HFrEF), the burden of acute heart failure (AHF) remains significant with a high morbidity and mortality that has not been improved by any treatment modality. A meta-analysis summarized the study results on the effects of tolvaptan on AHF, which failed to demonstrate an improvement in short-term and long-term mortality, length of hospital stay and reduced frequency of worsening heart failure (WHF). Similar trial results were also reported in other AHF studies, such as the ASCEND-HF and the RELAX-AHF-2 trials...
September 22, 2017: Herz
https://www.readbyqxmd.com/read/28915854/medical-therapy-following-hospitalization-for-heart-failure-with-reduced-ejection-fraction-and-association-with-discharge-to-long-term-care-a-cross-sectional-analysis-of-the-reasons-for-geographic-and-racial-differences-in-stroke-regards-population
#19
Emily B Levitan, Melissa K Van Dyke, Ligong Chen, Raegan W Durant, Todd M Brown, J David Rhodes, Olusola Olubowale, Oluwole Muyiwa Adegbala, Meredith L Kilgore, Justin Blackburn, Karen C Albright, Monika M Safford
BACKGROUND: Less intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life. METHODS: We compared treatment patterns between REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants discharged to long-term care versus home following HFrEF hospitalizations. We examined medical records and Medicare pharmacy claims for 147 HFrEF hospitalizations among 80 participants to obtain information about discharge disposition and medication prescriptions and fills...
September 16, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28901848/pulmonary-hypertension-secondary-to-left-heart-disease
#20
Ghazal Kabbach, Debabrata Mukherjee
Pulmonary hypertension (PH) related to left heart disease (LHD) is the most common form of PH, accounting for more than two third of all PH cases. The hemodynamic abnormalities seen in PH-LHD are complex, and there are currently minimal evidence-based recommendations for the management of PH-LHD. While it is accepted that PH in the context of left heart disease is a marker of worse prognosis, it remains unclear whether its primary treatment is beneficial or harmful. In this article, we discuss the prevalence and significance of PH in patients with heart failure (HF) with reduced ejection fraction (HFrEF) as well as HF with preserved ejection fraction (HFpEF), and those with valvular heart disease and provide insights into the complex pathophysiology of cardiopulmonary interrelationship in individuals with PH due to left heart disease...
September 12, 2017: Current Vascular Pharmacology
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