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Management of chronic HFrEF

Nasrien E Ibrahim, James L Januzzi
PURPOSE OF REVIEW: Biomarker-guided management of patients with chronic heart failure with reduced ejection fraction (HFrEF) remains controversial. RECENT FINDINGS: Biomarkers have established roles for diagnosis and prognostication in HF. Pilot data suggested that use of natriuretic peptides might be helpful to guide HF care. The recent Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) randomized-controlled trial did not find therapy guided by NT-proBNP to be more effective than usual care in improving the primary endpoint of HF hospitalization or cardiovascular mortality amongst patients with chronic HFrEF...
February 21, 2018: Current Heart Failure Reports
Elizabeth K Pogge, Lindsay E Davis
OBJECTIVE: The objective of this research was to describe the use of pharmacist-managed sacubitril/valsartan therapy in a multi-center, outpatient cardiac group. BACKGROUND: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi), is a novel agent for the treatment of heart failure. An ARNi is recommended by national guidelines to be used in place of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy for patients who remain symptomatic...
February 17, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Sabrina M Hormann, Lindsay E Davis, Elizabeth K Pogge
BACKGROUND: Heart failure prevalence continues to rise in the United States causing significant morbidity and mortality and costing billions in healthcare expenditures. Consensus guidelines updated in 2016 recommend an angiotensin receptor-neprilysin inhibitor (ARNi) as a therapeutic option in lieu of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for the management of stage C heart failure with reduced ejection fraction (HFrEF). For chronic HFrEF patients with New York Heart Association class II or III symptoms tolerating an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, a change in therapy to an ARNi is recommended to further reduce morbidity and mortality...
March 2018: Journal of Cardiovascular Nursing
Michael Arzt, Olaf Oldenburg, Andrea Graml, Erland Erdmann, Helmut Teschler, Karl Wegscheider, Anna Suling, Holger Woehrle
BACKGROUND: Different sleep-disordered breathing (SDB) phenotypes, including coexisting obstructive and central sleep apnea (OSA-CSA), have not yet been characterized in a large sample of patients with heart failure and reduced ejection fraction (HFrEF) receiving guideline-based therapies. Therefore, the aim of the present study was to determine the proportion of OSA, CSA, and OSA-CSA, as well as periodic breathing, in HFrEF patients with SDB. METHODS AND RESULTS: The German SchlaHF registry enrolled patients with HFrEF receiving guideline-based therapies, who underwent portable SDB monitoring...
November 29, 2017: Journal of the American Heart Association
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
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
Abhinav Sharma, Susanna R Stevens, Joseph Lucas, Mona Fiuzat, Kirkwood F Adams, David J Whellan, Mark P Donahue, Dalane W Kitzman, Ileana L Piña, Faiez Zannad, William E Kraus, Christopher M O'Connor, G Michael Felker
OBJECTIVES: This study sought to determine the relationship between growth differentiation factor (GDF)-15 and clinical outcomes in ambulatory patients with heart failure and reduced ejection fraction (HFrEF). BACKGROUND: The prognostic utility of GDF-15, a member of the transforming growth factor-β cytokine family, among patients with HF is unclear. METHODS: We assessed GDF-15 levels in 910 patients enrolled in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial, a randomized clinical trial of exercise training in patients with HFrEF...
October 2017: JACC. Heart Failure
Nasrien E Ibrahim, James L Januzzi, Dustin J Rabideau, Parul U Gandhi, Hanna K Gaggin
A single heart rate (HR) measurement may inform future prognosis in chronic heart failure with reduced ejection fraction (HFrEF). The importance of elevated HR across serial assessment is uncertain, particularly with well-applied guideline-directed medical therapy (GDMT) with beta blockers (BBs). In this post hoc analysis of 129 patients with chronic HFrEF in sinus rhythm, who had aggressive medication titration over 10.6 months, HR and BB use were assessed at each visit (average of 6 visits per patient). All-cause mortality was assessed...
September 1, 2017: American Journal of Cardiology
Adam D DeVore, Laine Thomas, Nancy M Albert, Javed Butler, Adrian F Hernandez, J Herbert Patterson, John A Spertus, Fredonia B Williams, Stuart J Turner, Wing W Chan, Carol I Duffy, Kevin McCague, Xiaojuan Mi, Gregg C Fonarow
Heart failure (HF) with reduced ejection fraction (HFrEF) is a common and costly condition that diminishes patients' health status and confers a poor prognosis. Despite the availability of multiple guideline-recommended pharmacologic and cardiac device therapies for patients with chronic HFrEF, outcomes remain suboptimal. Currently, there is limited insight into the rationale underlying clinical decisions by health care providers and patient factors that guide the use and intensity of outpatient HF treatments...
July 2017: American Heart Journal
Ovidiu Chioncel, Mitja Lainscak, Petar M Seferovic, Stefan D Anker, Maria G Crespo-Leiro, Veli-Pekka Harjola, John Parissis, Cecile Laroche, Massimo Francesco Piepoli, Candida Fonseca, Alexandre Mebazaa, Lars Lund, Giuseppe A Ambrosio, Andrew J Coats, Roberto Ferrari, Frank Ruschitzka, Aldo P Maggioni, Gerasimos Filippatos
AIMS: The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group. METHODS AND RESULTS: The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF <40% (HFrEF)], mid-range EF [EF 40-50% (HFmrEF)] and preserved EF [EF >50% (HFpEF)]...
April 6, 2017: European Journal of Heart Failure
Suresh H, Arun B S, Venkatesh Moger, Mallikarjuna Swamy
INTRODUCTION: The heart and the kidneys are tightly interlinked with each other. So, primary disorder of one of these organs often results in the secondary dysfunction of other. Such interactions play a vital role in the pathogenesis of a clinical entity called cardio-renal syndrome (CRS). CRS type 4 refers to the development of cardiac failure in the patients with CKD. OBJECTIVES: To study the prevalence of various cardiac diseases in the patients with CKD and risk factors for it...
January 2017: Indian Heart Journal
Dimitrios Farmakis, Panagiotis Simitsis, Vasiliki Bistola, Filippos Triposkiadis, Ignatios Ikonomidis, Spyridon Katsanos, George Bakosis, Erifili Hatziagelaki, John Lekakis, Alexandre Mebazaa, John Parissis
BACKGROUND: Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. METHODS AND RESULTS: The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia...
May 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Anca Simioniuc, Erberto Carluccio, Stefano Ghio, Andrea Rossi, Paolo Biagioli, Gianpaolo Reboldi, Gian Giacomo Galeotti, Fei Lu, Cornelia Zara, Gillian Whalley, Pier Luigi Temporelli, Frank Lloyd Dini
BACKGROUND: B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. METHODS AND RESULTS: In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF=30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF=33%)...
December 1, 2016: International Journal of Cardiology
Chun-Chieh Wang, Hung-Yu Chang, Wei-Hsian Yin, Yen-Wen Wu, Pao-Hsien Chu, Chih-Cheng Wu, Chih-Hsin Hsu, Ming-Shien Wen, Wen-Chol Voon, Wei-Shiang Lin, Jin-Long Huang, Shyh-Ming Chen, Ning-I Yang, Heng-Chia Chang, Kuan-Cheng Chang, Shih-Hsien Sung, Kou-Gi Shyu, Jiunn-Lee Lin, Guang-Yuan Mar, Kuei-Chuan Chan, Jen-Yuan Kuo, Ji-Hung Wang, Zhih-Cherng Chen, Wei-Kung Tseng, Wen-Jin Cherng
INTRODUCTION: Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF. METHODS: The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan...
July 2016: Acta Cardiologica Sinica
Monique R Robinson, Guilherme H Oliveira
PURPOSE OF REVIEW: Heart failure is a major source of cardiovascular morbidity and mortality worldwide. The field has benefited from steady progress, and there are now multiple strategies - medical and surgical - to improve cardiovascular outcomes. The quest continues for enhanced pathophysiologic insights and therapies. RECENT FINDINGS: The chosen studies highlight new ways of treating heart failure with reduced ejection fraction (HFrEF) with pharmacotherapy such as sacubitril/valsartan and explore the role of antimicrobial therapy for chronic Chagas' cardiomyopathy...
July 2016: Current Opinion in Cardiology
Aditi Mallick, Parul U Gandhi, Hanna K Gaggin, Nasrien Ibrahim, James L Januzzi
OBJECTIVES: The goal of this study was to define and assess the significance of worsening heart failure (WHF) in patients with chronic ambulatory heart failure with reduced ejection fraction (HFrEF). BACKGROUND: WHF has been identified as a potentially relevant clinical event in patients with acute heart failure (HF) and is increasingly used as an endpoint in clinical trials. No standardized definition of WHF exists. It remains uncertain how WHF relates to risk for other HF events or how treatment may affect WHF...
September 2016: JACC. Heart Failure
Edoardo Gronda, GianMaria Brambilla, Gino Seravalle, Alessandro Maloberti, Matteo Cairo, Giuseppe Costantino, Eric Lovett, Emilio Vanoli, Giuseppe Mancia, Guido Grassi
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is characterized by activation of the sympathetic nervous system and increased arterial stiffness, leading to an impaired ventricular-vascular coupling. Baroreflex activation therapy (BAT) has been shown to reduce muscle sympathetic nerve activity (MSNA) and improve clinical status of patients with HFrEF. The purpose of this investigation was to determine the effects of BAT on arterial stiffness in HFrEF. METHODS AND RESULTS: MSNA, clinical variables, and parameters of central blood pressure (BP) and arterial stiffness were collected in 18 NYHA Class III HFrEF patients, nine receiving BAT and nine continuing with optimal medical management alone...
October 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Hao A Tran, Felice Lin, Barry H Greenberg
INTRODUCTION: The prevalence of heart failure (HF) has increased globally in recent decades. Advances in our understanding of underlying pathophysiologic mechanisms have given rise to new therapies for treating the growing HF population. Nonetheless, morbidity and mortality associated with HF and its financial implications are daunting. Thus, novel therapies that can improve the natural history of HF patients are urgently needed. AREAS COVERED: This article reviews new investigational drugs being developed for the treatment of both acute decompensated heart failure (ADHF) and chronic heart failure with reduced ejection fraction (HFrEF)...
July 2016: Expert Opinion on Investigational Drugs
Wayne L Miller, Brian P Mullan
OBJECTIVES: This study aimed to characterize volume profiles and their differences in heart failure (HF) patients with preserved (HFpEF) and reduced (HFrEF) ventricular systolic function. BACKGROUND: The extent and distribution of volume overload and the associated implications for volume management have not been studied in decompensated HFpEF compared with HFrEF. METHODS: Total blood volume (TBV) was quantitated using a standardized computer-based radiolabeled albumin dilution technique...
June 2016: JACC. Heart Failure
Abhishek Jaiswal, Astha Chichra, Vinh Q Nguyen, Taraka V Gadiraju, Thierry H Le Jemtel
Chronic obstructive pulmonary disease (COPD) and heart failure with reduced ejection fraction (HFrEF) commonly coexist in clinical practice. The prevalence of COPD among HFrEF patients ranges from 20 to 32 %. On the other hand; HFrEF is prevalent in more than 20 % of COPD patients. With an aging population, the number of patients with coexisting COPD and HFrEF is on rise. Coexisting COPD and HFrEF presents a unique diagnostic and therapeutic clinical conundrum. Common symptoms shared by both conditions mask the early referral and detection of the other...
February 2016: Current Heart Failure Reports
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