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Spironolactone and preserved heart failure

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https://www.readbyqxmd.com/read/28768320/effects-of-sodium-glucose-cotransporter-2-inhibitors-for-the-treatment-of-patients-with-heart-failure-proposal-of-a-novel-mechanism-of-action
#1
Milton Packer, Stefan D Anker, Javed Butler, Gerasimos Filippatos, Faiez Zannad
Importance: Only 1 class of glucose-lowering agents-sodium-glucose cotransporter 2 (SGLT2) inhibitors-has been reported to decrease the risk of cardiovascular events primarily by reducing the risk of the development or progression of heart failure. In a landmark trial called Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes [EMPA-REG Outcomes], long-term treatment with empagliflozin prevented fatal and nonfatal heart failure events but did not reduce the risk of myocardial infarction or stroke in diabetic patients...
September 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28647918/designing-future-clinical-trials-in-heart-failure-with-preserved-ejection-fraction-lessons-from-topcat
#2
REVIEW
Ravi B Patel, Sanjiv J Shah, Gregg C Fonarow, Javed Butler, Muthiah Vaduganathan
PURPOSE OF REVIEW: Spironolactone did not demonstrate benefit with respect to the primary composite endpoint in the global TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial in patients with chronic heart failure with preserved ejection fraction (HFpEF). We identify key lessons from the TOPCAT experience that can be applied to future HFpEF trials. RECENT FINDINGS: Subsequent analyses of TOPCAT have revealed marked regional heterogeneity in patient profiles, event rates, drug adherence, and treatment effects...
August 2017: Current Heart Failure Reports
https://www.readbyqxmd.com/read/28579091/characteristics-and-outcomes-of-heart-failure-hospitalization-before-implementation-of-a-heart-failure-clinic-the-precic-study
#3
Irene Marques, Sara Abreu, Manuela V Bertão, Betânia Ferreira, Raquel Lopes Ramos, Juliana Lopes, Sandra Nunes, Denisa Mendonça, Laetitia Teixeira
OBJECTIVE: This study aims to characterize patients hospitalized for acute heart failure (HF) in an internal medicine department and their one-year mortality and rate of rehospitalization for decompensated HF. METHODS: This retrospective observational study enrolled all patients discharged in 2012 after hospitalization for acute HF. Discharge summaries, clinical records and telephone interviews were analysed. The data reports to the year before implementation of a heart failure clinic...
June 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28542926/effect-of-spironolactone-on-exercise-tolerance-and-arterial-function-in-older-adults-with-heart-failure-with-preserved-ejection-fraction
#4
Bharathi Upadhya, William G Hundley, Peter H Brubaker, Timothy M Morgan, Kathryn P Stewart, Dalane W Kitzman
OBJECTIVES: To evaluate the effects of an aldosterone antagonist on exercise intolerance in older adults with heart failure and preserved ejection fraction (HFpEF). DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: Academic medical center, Winston-Salem, North Carolina. PARTICIPANTS: Older adults (N = 80, aged 71 ± 1; 80% female) with stable compensated HFpEF and controlled blood pressure (BP)...
May 19, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28460827/heart-failure
#5
REVIEW
Marco Metra, John R Teerlink
Heart failure is common in adults, accounting for substantial morbidity and mortality worldwide. Its prevalence is increasing because of ageing of the population and improved treatment of acute cardiovascular events, despite the efficacy of many therapies for patients with heart failure with reduced ejection fraction, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β blockers, and mineralocorticoid receptor antagonists, and advanced device therapies. Combined angiotensin receptor blocker neprilysin inhibitors (ARNIs) have been associated with improvements in hospital admissions and mortality from heart failure compared with enalapril, and guidelines now recommend substitution of ACE inhibitors or ARBs with ARNIs in appropriate patients...
April 28, 2017: Lancet
https://www.readbyqxmd.com/read/28451445/who-are-patients-classified-within-the-new-terminology-of-heart-failure-from-the-2016-esc-guidelines
#6
Benoit Delepaul, Guillaume Robin, Clément Delmas, Thomas Moine, Adrien Blanc, Pauline Fournier, Aénora Roger-Rollé, Guillaume Domain, Clémence Delon, Charles Uzan, Rabah Boudjellil, Didier Carrié, Jérôme Roncalli, Michel Galinier, Olivier Lairez
AIMS: The main terminology used to describe heart failure (HF) is based on measurement of the left ventricular ejection fraction (LVEF). LVEF in the range of 40-49% was recently defined as HF with mid-range EF (HFmrEF) by the 2016 European Society of Cardiology guidelines. The purpose of our study was to assess the clinical profile and prognosis of patients with HF according to this new classification. METHODS AND RESULTS: A total of 482 patients referred for HF were retrospectively included over a period of 1 year...
May 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/28401618/tailoring-mineralocorticoid-receptor-antagonist-therapy-in-heart-failure-patients-are-we-moving-towards-a-personalized-approach
#7
REVIEW
João Pedro Ferreira, Robert J Mentz, Anne Pizard, Bertram Pitt, Faiez Zannad
The aim of personalized medicine is to offer a tailored approach to each patient in order to provide the most effective therapy, while reducing risks and side effects. The use of mineralocorticoid receptor antagonists (MRAs) has demonstrated major benefits in heart failure with reduced ejection fraction (HFrEF), results with challenging inconsistencies in heart failure with preserved ejection fraction (HFpEF), and 'neutral' preliminary results in acute heart failure. Data derived from landmark trials are generally applied in a 'one size fits all' manner and the development and implementation of more personalized MRA management would offer the potential to improve outcomes and reduce side effects...
April 12, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28359411/interaction-between-spironolactone-and-natriuretic-peptides-in-patients-with-heart%C3%A2-failure-and-preserved-ejection%C3%A2-fraction-from-the-topcat-trial
#8
Inder S Anand, Brian Claggett, Jiankang Liu, Amil M Shah, Thomas S Rector, Sanjiv J Shah, Akshay S Desai, Eileen O'Meara, Jerome L Fleg, Marc A Pfeffer, Bertram Pitt, Scott D Solomon
OBJECTIVES: The aims of this study were to explore the relationship of baseline levels of natriuretic peptides (NPs) with outcomes and to test for an interaction between baseline levels of NPs and the effects spironolactone. BACKGROUND: Plasma NPs are considered to be helpful in the diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF), and elevated levels are associated with adverse outcomes. Levels of NPs higher than certain cutoffs are often used as inclusion criteria in clinical trials of HFpEF to increase the likelihood that patients have HF and to select patients at higher risk for events...
April 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28247180/registry-based-pragmatic-trials-in-heart-failure-current-experience-and-future-directions
#9
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
#10
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
#11
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
#12
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
#13
RANDOMIZED CONTROLLED TRIAL
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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