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Management of chronic HFrEF

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...
December 20, 2016: 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
Daniel M Hirai, Timothy I Musch, David C Poole
Chronic heart failure (CHF) impairs critical structural and functional components of the O2 transport pathway resulting in exercise intolerance and, consequently, reduced quality of life. In contrast, exercise training is capable of combating many of the CHF-induced impairments and enhancing the matching between skeletal muscle O2 delivery and utilization (Q̇mO2 and V̇mO2 , respectively). The Q̇mO2 /V̇mO2 ratio determines the microvascular O2 partial pressure (PmvO2 ), which represents the ultimate force driving blood-myocyte O2 flux (see Fig...
November 2015: American Journal of Physiology. Heart and Circulatory Physiology
Kadhim Sulaiman, Prashanth Panduranga, Ibrahim Al-Zakwani, Alawi A Alsheikh-Ali, Khalid F AlHabib, Jassim Al-Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Mustafa Ridha, Bassam Bulbanat, Mohammed Al-Jarallah, Nooshin Bazargani, Nidal Asaad, Haitham Amin
AIMS: The purpose of this study was to describe the clinical characteristics, management, and outcomes of acute heart failure (HF) patients from the Gulf acute heart failure registry (Gulf CARE). METHODS AND RESULTS: Data from 5005 HF patients admitted to 47 hospitals in seven Gulf countries during February to November 2012 were analysed. Fifty-five per cent of patients presented with acute decompensated chronic HF, while 45% had new-onset HF. Mean age was 59 ± 15 years, 63% were males, and 83% were Gulf citizens...
April 2015: European Journal of Heart Failure
Gregory Y H Lip, Cécile Laroche, Mircea I Popescu, Lars H Rasmussen, Laura Vitali-Serdoz, Gheorghe-Andrei Dan, Zbigniew Kalarus, Harry J G M Crijns, Mario M Oliveira, Luigi Tavazzi, Aldo P Maggioni, Giuseppe Boriani
AIMS: The purpose of this study was too describe the associated baseline features of AF patients with heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Secondly, we assessed symptomatic status and their clinical correlates. Finally, we examined independent predictors for 'heart failure' at the 1-year follow-up period. METHODS AND RESULTS: A survey of European cardiologists from nine countries, participating in the EURObservational Research Programme Pilot survey on Atrial Fibrillation (EORP-AF Pilot), was carried out...
June 2015: European Journal of Heart Failure
Robert J Mentz, Jacob P Kelly, Thomas G von Lueder, Adriaan A Voors, Carolyn S P Lam, Martin R Cowie, Keld Kjeldsen, Ewa A Jankowska, Dan Atar, Javed Butler, Mona Fiuzat, Faiez Zannad, Bertram Pitt, Christopher M O'Connor
Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes...
December 2, 2014: Journal of the American College of Cardiology
Ewa A Jankowska, Elzbieta Kalicinska, Marcin Drozd, Beata Kurian, Waldemar Banasiak, Piotr Ponikowski
OBJECTIVE: We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland. METHODS: All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF. RESULTS: Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%)...
October 20, 2014: International Journal of Cardiology
A Mark Richards, James L Januzzi, Richard W Troughton
Timely diagnosis, early introduction of appropriate treatment, accurate risk stratification, and optimal titration of therapy are all key to the management of acute and chronic heart failure (HF). Plasma concentrations of the cardiac natriuretic peptides (NPs) are valuable aids in each of these elements of care. However, most data are derived from cohorts with undifferentiated HF or HF with reduced ejection fraction (HFREF), and the performance and best application of NPs in HF with preserved ejection fraction (HFPEF) is less certain...
July 2014: Heart Failure Clinics
F Edelmann, V Grabs, M Halle
Exercise training in patients with chronic stable heart failure (HF) is a recommended and broadly accepted treatment strategy that is an integral part of an evidence-based management involving pharmacological and non-pharmacological therapies. There is ample scientific evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) improves exercise capacity, HF symptoms and quality of life. This is due to an improvement of central hemodynamics, endothelial function, neurohumoral activation, skeletal muscle structure and function as well as a decrease in inflammatory markers...
June 2014: Der Internist
F Edelmann, B Pieske
In patients with chronic but stable heart failure (HF) exercise training is a recommended and widely accepted adjunct to an evidence-based management involving pharmacological and non-pharmacological therapies. Various pathophysiological mechanisms, such as central hemodynamics, vasculature, ventilation, skeletal muscle function as well as neurohormonal activation and inflammation are responsible for exercise intolerance described in HF patients. There is sufficient and growing evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) is effective in improving exercise capacity, HF symptoms and quality of life...
September 2013: Herz
Kannayiram Alagiakrishnan, Maciej Banach, Linda G Jones, Ali Ahmed, Wilbert S Aronow
Heart failure (HF) is a common problem in older adults. Individuals aged 65 years or older are at a higher risk for developing HF, especially diastolic HF or HF with preserved ejection fraction (HFpEF). HF can be seen in up to 20 % of adults aged 85 years or older. In contrast to middle-aged (40-64 years) HF patients, multiple cardiac, non-cardiac and geriatric syndrome co-morbidities are seen in elderly HF patients. Additionally, age-related changes in pharmacokinetics and pharmacodynamics influence medication therapy...
October 2013: Drugs & Aging
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