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Spironolactone and preserved heart failure

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https://www.readbyqxmd.com/read/28247180/registry-based-pragmatic-trials-in-heart-failure-current-experience-and-future-directions
#1
REVIEW
Lars H Lund, Jonas Oldgren, Stefan James
PURPOSE OF REVIEW: Randomized controlled trials (RCTs) in heart failure (HF) are becoming increasingly complex and expensive to conduct and if positive deliver expensive therapy tested only in selected populations. RECENT FINDINGS: Electronic health records and clinical cardiovascular quality registries are providing opportunities for pragmatic and registry-based prospective randomized clinical trials (RRCTs). Simplified regulatory, ethics, and consent procedures; recruitment integrated into real-world care; and simplified or automated baseline and outcome collection allow assessment of study power and feasibility, fast and efficient recruitment, delivery of generalizable findings at low cost, and potentially evidence-based and novel use of generic drugs with low costs to society...
April 2017: Current Heart Failure Reports
https://www.readbyqxmd.com/read/28184100/clinical-question-in-congestive-heart-failure-patients-with-preserved-ejection-fraction-does-spironolactone-improve-cardiac-outcomes
#2
Leslie Williams, Cheyn Onarecker
CLINICAL QUESTION: In congestive heart failure patients with preserved ejection fraction, does spironolactone improve cardiac outcomes? ANSWER: No. A randomized controlled trial of patients with heart failure and an ejection fraction > 45% showed that spironolactone did not significantly reduce the incidence of the primary composite outcome of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for the management of heart failure. LEVEL OF EVIDENCE FOR THE ANSWER: A...
September 2016: Journal of the Oklahoma State Medical Association
https://www.readbyqxmd.com/read/28010940/-profile-of-heart-failure-according-to-the-department-of-admission-implications-for-multidisciplinary-management
#3
Lourdes Vicent, Ana Ayesta, María Teresa Vidán, José María de Miguel-Yanes, Jorge García, María Tamargo, Víctor Gómez, Samuel Véliz, Francisco Fernández-Avilés, Manuel Martínez-Sellés
INTRODUCTION: Population aging has led to notable changes in heart failure admissions. The aim of this study was to analyse the characteristics, comorbidity, management, and outcomes of this patient population in three hospital departments. METHODS: An analysis was made of a prospective register that included all patients admitted due to heart failure in Internal Medicine, Cardiology, and Geriatrics over a period of 45 days. RESULTS: Of a total of 235 patients, 124 (52...
December 20, 2016: Revista Española de Geriatría y Gerontología
https://www.readbyqxmd.com/read/27871223/patients-with-hfpef-and-hfref-have-different-clinical-characteristics-but-similar-prognosis-a-retrospective-cohort-study
#4
Tamrat Befekadu Abebe, Eyob Alemayehu Gebreyohannes, Yonas Getaye Tefera, Tadesse Melaku Abegaz
BACKGROUND: Globally, heart failure (HF) has been recognized as one of the major cardiovascular disorder with high morbidity, mortality and considerable social impact. In Sub Saharan African countries, HF has turned out as a leading form of cardiovascular diseases, and has considerable socioeconomic impact. However, there are differences in clinical characteristics and survival status among patients with preserved (HFpEF) and reduced (HFrEF) ejection fraction. The aim of this study is to outline the clinical characteristics and medication profile, assess the survival status and prognostic factors of Ethiopian HF patients with HFrEF and HFpEF...
November 21, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27765184/effect-of-aldosterone-antagonism-on%C3%A2-exercise-tolerance-in-heart-failure-with%C3%A2-preserved-ejection-fraction
#5
Wojciech Kosmala, Aleksandra Rojek, Monika Przewlocka-Kosmala, Leah Wright, Andrzej Mysiak, Thomas H Marwick
BACKGROUND: Impaired functional capacity is a hallmark of patients with heart failure with preserved ejection fraction (HFpEF). Despite the association of HFpEF with reduced myocardial compliance attributed to fibrosis, spironolactone has not been shown to alter outcomes-perhaps reflecting the heterogeneity of underlying pathological mechanisms. OBJECTIVES: The authors sought to identify improvement in exercise capacity with spironolactone in the subset of patients with HFpEF with exercise-induced increase in ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') reflecting elevation of left ventricular (LV) filling pressure...
October 25, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27754008/js-ish-esh-4-what-do-clinical-trials-teach-us-about-selection-of-antihypertensive-drugs
#6
William C Cushman
Beginning with the Veterans Administration (VA) Cooperative Hypertension Study of the 1960 s, blood pressure (BP) lowering with antihypertensive medications has been shown to reduce major cardiovascular (CV) outcomes, including coronary heart disease, stroke, heart failure (HF) and CV and all-cause mortality in randomized controlled CV outcome trials. Multiple drugs were usually required in these trials to lower BP in treated participants. Medication regimens in the early trials, including the VA trial, included a thiazide-type diuretic (TTD) as initial therapy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27747305/detection-and-management-of-geographic-disparities-in-the-topcat-trial-lessons-learned-and-derivative-recommendations
#7
Michael R Bristow, Jorge Silva Enciso, Bernard J Gersh, Christine Grady, Madeline Murguia Rice, Steven Singh, George Sopko, Robin Boineau, Yves Rosenberg, Barry H Greenberg
TOPCAT was a multinational clinical trial of 3,445 heart failure with preserved ejection fraction (HFpEF) patients that enrolled in 233 sites in six countries in North America, Eastern Europe and South America. Patients with a heart failure hospitalization in the last 12 months or an elevated B-type natriuretic peptide (BNP) were randomized to the mineralocorticoid receptor antagonist spironolactone vs. placebo. Sites in Russia and the Republic of Georgia provided the majority of early enrollment, primarily based on the hospitalization criterion since BNP levels were initially unavailable there...
April 2016: JACC. Basic to Translational Science
https://www.readbyqxmd.com/read/27707827/improved-exercise-tolerance-in-patients-with-preserved-ejection-fraction-by-spironolactone-on-myocardial-fibrosis-in-atrial-fibrillation-rationale-and-design-of-the-impress-af-randomised-controlled-trial
#8
Eduard Shantsila, Ronnie Haynes, Melanie Calvert, James Fisher, Paulus Kirchhof, Paramjit S Gill, Gregory Y H Lip
INTRODUCTION: Patients with atrial fibrillation frequently suffer from heart failure with preserved ejection fraction. At present there is no proven therapy to improve physical capacity and quality of life in participants with permanent atrial fibrillation with preserved left ventricular contractility. OBJECTIVE: The single-centre IMproved exercise tolerance In heart failure With PReserved Ejection fraction by Spironolactone On myocardial fibrosiS In Atrial Fibrillation (IMPRESS-AF) trial aims to establish whether treatment with spironolactone as compared with placebo improves exercise tolerance (cardiopulmonary exercise testing), quality of life and diastolic function in patients with permanent atrial fibrillation...
October 5, 2016: BMJ Open
https://www.readbyqxmd.com/read/27642919/js-ish-esh-4-what-do-clinical-trials-teach-us-about-selection-of-antihypertensive-drugs
#9
William C Cushman
Beginning with the Veterans Administration (VA) Cooperative Hypertension Study of the 1960 s, blood pressure (BP) lowering with antihypertensive medications has been shown to reduce major cardiovascular (CV) outcomes, including coronary heart disease, stroke, heart failure (HF) and CV and all-cause mortality in randomized controlled CV outcome trials. Multiple drugs were usually required in these trials to lower BP in treated participants. Medication regimens in the early trials, including the VA trial, included a thiazide-type diuretic (TTD) as initial therapy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27522631/rationale-and-design-of-the-athena-hf-trial-aldosterone-targeted-neurohormonal-combined-with-natriuresis-therapy-in-heart-failure
#10
REVIEW
Javed Butler, Adrian F Hernandez, Kevin J Anstrom, Andreas Kalogeropoulos, Margaret M Redfield, Marvin A Konstam, W H Wilson Tang, G Michael Felker, Monica R Shah, Eugene Braunwald
Although therapy with mineralocorticoid receptor antagonists (MRAs) is recommended for patients with chronic heart failure (HF) with reduced ejection fraction and in post-infarction HF, it has not been studied well in acute HF (AHF) despite being commonly used in this setting. At high doses, MRA therapy in AHF may relieve congestion through its natriuretic properties and mitigate the effects of adverse neurohormonal activation associated with intravenous loop diuretics. The ATHENA-HF (Aldosterone Targeted Neurohormonal Combined with Natriuresis Therapy in Heart Failure) trial is a randomized, double-blind, placebo-controlled study of the safety and efficacy of 100 mg/day spironolactone versus placebo (or continued low-dose spironolactone use in participants who are already receiving spironolactone at baseline) in 360 patients hospitalized for AHF...
September 2016: JACC. Heart Failure
https://www.readbyqxmd.com/read/27502863/clinical-and-echocardiographic-characteristics-and-outcomes-in-congestive-heart-failure-at-the-hospital-of-the-state-university-of-haiti
#11
Rodolphe Malebranche, Christian Tabou Moyo, Paul-Henry Morisset, Nernst-Atwood Raphael, James Robert Wilentz
BACKGROUND: This study aimed to evaluate the clinical and epidemiologic profile of congestive heart failure at the principal free-care hospital in Haiti. Cardiovascular disease represents the most prevalent cause of admissions to the medical service of the University Hospital of the State of Haiti. No previous study has examined the demographics of congestive heart failure in urban Haiti. METHODS: Two hundred forty-seven patients presented to the inpatient service between May 2011 and May 2013...
August 2016: American Heart Journal
https://www.readbyqxmd.com/read/27372043/association-between-long-term-prescription-of-aldosterone-antagonist-and-the-progression-of-heart-failure-with-preserved-ejection-fraction-in-hypertensive-patients
#12
Jun Gu, Yu-Qi Fan, Zhi-Hua Han, Li Fan, Ling Bian, Hui-Li Zhang, Zuo-Jun Xu, Zhao-Fang Yin, Yu-Shui Xie, Jun-Feng Zhang, Chang-Qian Wang
BACKGROUND: Hypertension complicated with left ventricular hypertrophy (LVH) and diastolic dysfunction is independently related to increasing risk of subsequent incident heart failure with preserved ejection fraction (HFpEF). This study was designed to evaluate the influences of long-term aldosterone antagonist prescription in these patients. METHODS: Using a propensity score matching of 1:2 ratio, this retrospective claims database study compared spironolactone prescription (n=65) and non-spironolactone therapy (n=130) in hypertensive patients with LVH [left ventricular mass index (LVMI)>125g/m(2) for men and >110g/m(2) for women] and suspected diastolic dysfunction (E/E' ratio between 8 and 15) and without clinical signs or symptoms of heart failure...
October 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27358439/phenotype-specific-treatment-of-heart-failure-with-preserved-ejection-fraction-a-multiorgan-roadmap
#13
REVIEW
Sanjiv J Shah, Dalane W Kitzman, Barry A Borlaug, Loek van Heerebeek, Michael R Zile, David A Kass, Walter J Paulus
Heart failure (HF) with preserved ejection fraction (EF; HFpEF) accounts for 50% of HF cases, and its prevalence relative to HF with reduced EF continues to rise. In contrast to HF with reduced EF, large trials testing neurohumoral inhibition in HFpEF failed to reach a positive outcome. This failure was recently attributed to distinct systemic and myocardial signaling in HFpEF and to diversity of HFpEF phenotypes. In this review, an HFpEF treatment strategy is proposed that addresses HFpEF-specific signaling and phenotypic diversity...
July 5, 2016: Circulation
https://www.readbyqxmd.com/read/27075872/after-topcat-what-to-do-now-in-heart-failure-with-preserved-ejection-fraction
#14
REVIEW
Akshay S Desai, Pardeep S Jhund
Although patients with heart failure and preserved ejection fraction (HF-PEF) represent nearly half of the population with chronic heart failure, few evidence-based medical therapies are available. The neutral overall results of the TOPCAT trial of spironolactone in HF-PEF leave clinicians who treat heart failure with an ongoing clinical dilemma. In this review, we outline an approach to the clinical management of the patient with HF-PEF synthesizing data from available clinical trials and expert consensus.
November 1, 2016: European Heart Journal
https://www.readbyqxmd.com/read/27039126/qrs-duration-is-a-predictor-of-adverse%C3%A2-outcomes-in-heart-failure-with%C3%A2-preserved-ejection-fraction
#15
Jacob Joseph, Brian C Claggett, Inder S Anand, Jerome L Fleg, Thao Huynh, Akshay S Desai, Scott D Solomon, Eileen O'Meara, Sonja Mckinlay, Bertram Pitt, Marc A Pfeffer, Eldrin F Lewis
OBJECTIVES: This study examined the relationship between baseline QRS duration and clinical outcomes in subjects enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. BACKGROUND: Heart failure with preserved ejection fraction (HFPEF) is a heterogeneous clinical syndrome. Whether QRS duration identifies HFPEF subjects at an increased risk of adverse outcomes has not been well studied. METHODS: QRS duration was analyzed as a dichotomous variable (≥120 ms or <120 ms) and as a continuous variable to determine its relation to the primary outcome (composite of cardiovascular death, aborted cardiac arrest, or HF hospitalization [HFH]) and to each component of the primary outcome...
June 2016: JACC. Heart Failure
https://www.readbyqxmd.com/read/26962133/impact-of-spironolactone-on-longitudinal-changes-in-health-related-quality-of-life-in-the-treatment-of-preserved-cardiac-function-heart-failure-with-an-aldosterone-antagonist-trial
#16
RANDOMIZED CONTROLLED TRIAL
Eldrin F Lewis, Hae-Young Kim, Brian Claggett, John Spertus, John F Heitner, Susan F Assmann, Christopher T Kenwood, Scott D Solomon, Akshay S Desai, James C Fang, Sonia A McKinlay, Bertram A Pitt, Marc A Pfeffer
BACKGROUND: Heart failure (HF) with preserved ejection fraction patients have equally impaired health-related quality of life (HRQL) compared with those with HF with reduced ejection fraction, but limited studies have evaluated the impact of therapies on changes in HRQL. METHODS AND RESULTS: Patients ≥50 years of age, with symptomatic HF and left ventricular ejection fraction ≥45%, were enrolled in Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) and randomized to spironolactone or placebo...
March 2016: Circulation. Heart Failure
https://www.readbyqxmd.com/read/26840036/reduction-of-diuretics-and-analysis-of-water-and-muscle-volumes-to-prevent-falls-and-fall-related-fractures-in-older-adults
#17
Kosuke Okada, Masahiro Okada, Nanao Kamada, Yumiko Yamaguchi, Masayuki Kakehashi, Hidemi Sasaki, Shigeko Katoh, Katsuya Morita
AIM: In an attempt to decrease the incidence of falls and fall-related fractures at a special geriatric nursing home, we endeavored to reduce diuretic doses, and examined the relationship between the effectiveness of this approach with the body compositions and activities of daily living of the study cohort. METHODS: We enrolled 93 participants living in the community, 60 residents of an intermediate geriatric nursing home and 50 residents of the 100-bed Kandayama Yasuragien special geriatric nursing home...
February 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/26475142/prognostic-importance-of-changes-in-cardiac-structure-and-function-in-heart-failure-with-preserved-ejection-fraction-and-the-impact-of-spironolactone
#18
RANDOMIZED CONTROLLED TRIAL
Amil M Shah, Brian Claggett, Nancy K Sweitzer, Sanjiv J Shah, Anita Deswal, Inder S Anand, Jerome L Fleg, Bertram Pitt, Marc A Pfeffer, Scott D Solomon
BACKGROUND: Limited data exist regarding the impact of aldosterone antagonist therapy on cardiac structure and function in heart failure with preserved ejection fraction and on the prognostic relevance of changes in cardiac structure and function in heart failure with preserved ejection fraction. METHODS AND RESULTS: Cardiac structure and function were assessed by quantitative echocardiography at baseline and at 12- to 18-month follow-up in 239 patients with heart failure with preserved ejection fraction (left ventricular [LV] ejection fraction [LVEF] ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial...
November 2015: Circulation. Heart Failure
https://www.readbyqxmd.com/read/26408016/spironolactone-for-management-of-heart-failure-with-preserved-ejection-fraction-whither-to-after-topcat
#19
REVIEW
Sumeet S Mitter, Sanjiv J Shah
Mineralocorticoid receptor antagonists (MRAs) represent an attractive class of drugs for the treatment of heart failure with preserved ejection fraction (HFpEF) because of the deleterious cardiovascular effects of aldosterone and because MRAs combat myocardial fibrosis and improve cardiac structure/function and vascular health. Recently, the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study, a randomized, double-blind clinical trial of spironolactone versus placebo, was conducted in 3445 patients with symptomatic HFpEF...
November 2015: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/26374849/influence-of-ejection-fraction-on-outcomes-and-efficacy-of-spironolactone-in-patients-with-heart-failure-with-preserved-ejection-fraction
#20
RANDOMIZED CONTROLLED TRIAL
Scott D Solomon, Brian Claggett, Eldrin F Lewis, Akshay Desai, Inder Anand, Nancy K Sweitzer, Eileen O'Meara, Sanjiv J Shah, Sonja McKinlay, Jerome L Fleg, George Sopko, Bertram Pitt, Marc A Pfeffer
AIMS: While mineralocorticoid receptor antagonists (MRAs) have been shown to benefit patients with reduced left ventricular ejection fraction (LVEF), spironolactone did not reduce the primary endpoint of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT trial, which enrolled patients with LVEF of 45% or greater. We utilized data from TOPCAT to assess the relationship between LVEF as well as outcomes and efficacy of spironolactone...
February 1, 2016: European Heart Journal
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