1,721,319 research outputs found
Letter regarding the article “Hypocapnia is an independent predictor of in‐hospital mortality in acute heart failure”
Full text linkThe role of hypocapnia in acute heart failure (AHF) remains poorly understood. Tang and colleagues found that hypocapnia was associated with worse renal and cardiac function and a higher in-hospital, all-cause mortality in a cohort of patients with AHF
New Evidence for Structured Telephone Support in the Management of Patients with Heart Failure [Letter to Editor]
No full textLetter to the Editor of New England Journal of Medicine on behalf of the Cochrane Systematic Review team.\u
Iron deficiency and cardiovascular disease
Full text linkIron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease, and an even higher proportion of those with heart failure (HF) or pulmonary hypertension have ID; the evidence for cerebrovascular disease, aortic stenosis and atrial fibrillation is less robust. The prevalence of ID increases with the severity of cardiac and renal dysfunction and is probably more common amongst women. Insufficient dietary iron, reduced iron absorption due to increases in hepcidin secondary to the low-grade inflammation associated with atherosclerosis and congestion or reduced gastric acidity, and increased blood loss due to anti-thrombotic therapy or gastro-intestinal or renal disease may all cause ID. For older people in the general population and patients with HF with reduced ejection fraction (HFrEF), both anaemia and ID are associated with a poor prognosis; each may confer independent risk. There is growing evidence that ID is an important therapeutic target for patients with HFrEF, even if they do not have anaemia. Whether this is also true for other HF phenotypes or patients with cardiovascular disease in general is currently unknown. Randomized trials showed that intravenous ferric carboxymaltose improved symptoms, health-related quality of life and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF and mildly reduced ejection fraction (<50%). Since ID is easy to treat and is effective for patients with HFrEF, such patients should be investigated for possible ID. This recommendation may extend to other populations in the light of evidence from future trials
Risk stratification in patients with heart failure and in patients with implantable cardioverter-defibrillators
Full text linkHeart failure is a very common medical condition with significant mortality and morbidity. Patients hospitalised with heart failure are at high risk of death in the short term and patients with chronic heart failure in the community are also at a high risk of death in the medium to long term. It is difficult to accurately identify those at a higher risk of death as current methods of risk stratification lack both sensitivity and specificity. The available treatments for prevention of sudden death in patients with heart failure such as Implantable Cardioverter Defibrillators (ICD) are expensive and do not abolish the risk of sudden death completely. Hence it is necessary to improve risk stratification methods in patients with heart failure and identify factors predicting mortality in those patients with ICD protection. This thesis first describes a series of studies examining the clinical factors that predict increased risk of short-term mortality in patients with a recent hospitalisation for heart failure. These include examination of patient demographics, clinical history and examination, blood tests, electro-cardiographic and echo-cardiographic variables and medication. Based on these variables, I have formulated a simple scoring system to predict short term mortality in hospitalised patients with heart failure. This score was validated in a prospective study of contemporary heart failure population with a recent hospital admission. The relationship of cholesterol and risk of death in heart failure was examined in detail. Then, the utility of Holter monitoring and signal averaged electro cardiograms (SAECG) for risk stratification were examined based on the prognostic value of abnormalities found by these tests in patients with chronic heart failure. Finally patients with heart failure deemed at high risk of sudden death and had ICDs implanted were studied and factors predicting shocks and mortality were identified. Two separate studies were done, first in population who had ICDs mainly for secondary prevention and the second in patient population who had ICDs exclusively for primary prevention. From these studies, I have identified those clinical characteristics that are associated with high risk of death in patients with acute and chronic heart failure and those associated with death in patients with heart failure after ICD implantation
Risk stratification in patients with heart failure and in patients with implantable cardioverter-defibrillators
No full textHeart failure is a very common medical condition with significant mortality and morbidity. Patients hospitalised with heart failure are at high risk of death in the short term and patients with chronic heart failure in the community are also at a high risk of death in the medium to long term. It is difficult to accurately identify those at a higher risk of death as current methods of risk stratification lack both sensitivity and specificity. The available treatments for prevention of sudden death in patients with heart failure such as Implantable Cardioverter Defibrillators (ICD) are expensive and do not abolish the risk of sudden death completely. Hence it is necessary to improve risk stratification methods in patients with heart failure and identify factors predicting mortality in those patients with ICD protection. This thesis first describes a series of studies examining the clinical factors that predict increased risk of short-term mortality in patients with a recent hospitalisation for heart failure. These include examination of patient demographics, clinical history and examination, blood tests, electro-cardiographic and echo-cardiographic variables and medication. Based on these variables, I have formulated a simple scoring system to predict short term mortality in hospitalised patients with heart failure. This score was validated in a prospective study of contemporary heart failure population with a recent hospital admission. The relationship of cholesterol and risk of death in heart failure was examined in detail. Then, the utility of Holter monitoring and signal averaged electro cardiograms (SAECG) for risk stratification were examined based on the prognostic value of abnormalities found by these tests in patients with chronic heart failure. Finally patients with heart failure deemed at high risk of sudden death and had ICDs implanted were studied and factors predicting shocks and mortality were identified. Two separate studies were done, first in population who had ICDs mainly for secondary prevention and the second in patient population who had ICDs exclusively for primary prevention. From these studies, I have identified those clinical characteristics that are associated with high risk of death in patients with acute and chronic heart failure and those associated with death in patients with heart failure after ICD implantation
The role of stress echocardiography and colour doppler myocardial imaging in the evaluation of patients with suspected heart failure
Full text linkMuscle wasting as an independent predictor of survival in patients with chronic heart failure
Full text linkBackground:
Skeletal muscle wasting is an extremely common feature in patients with heart failure, affecting approximately 20% of ambulatory patients with even higher values during acute decompensation. Its occurrence is associated with reduced exercise capacity, muscle strength, and quality of life. We sought to investigate if the presence of muscle wasting carries prognostic information.
Methods:
Two hundred sixty‐eight ambulatory patients with heart failure (age 67.1 ± 10.9 years, New York Heart Association class 2.3 ± 0.6, left ventricular ejection fraction 39 ± 13.3%, and 21% female) were prospectively enrolled as part of the Studies Investigating Co‐morbidities Aggravating Heart Failure. Muscle wasting as assessed using dual‐energy X‐ray absorptiometry was present in 47 patients (17.5%).
Results
During a mean follow‐up of 67.2 ± 28.02 months, 95 patients (35.4%) died from any cause. After adjusting for age, New York Heart Association class, left ventricular ejection fraction, creatinine, N‐terminal pro‐B‐type natriuretic peptide, and iron deficiency, muscle wasting remained an independent predictor of death (hazard ratio 1.80, 95% confidence interval 1.01–3.19, P = 0.04). This effect was more pronounced in patients with heart failure with reduced than in heart failure with preserved ejection fraction.
Conclusions:
Muscle wasting is an independent predictor of death in ambulatory patients with heart failure. Clinical trials are needed to identify treatment approaches to this co‐morbidity
Intravenous iron in patients with heart failure and iron deficiency: an updated meta-analysis
Full text linkBackground
For patients with heart failure (HF) and iron deficiency (ID), randomised trials suggest that intravenous (IV) iron reduces heart failure hospitalisations, but uncertainty exists about the effects in subgroups and the impact on mortality. We conducted a meta-analysis of randomised trials investigating the effect of IV iron on clinical outcomes in patients with HF.
Methods
We identified randomised trials published between January 1st 2000 and November 5th 2022 investigating the effect of IV iron vs standard care/placebo in patients with HF and ID in any clinical setting, regardless of HF phenotype. Trials of oral iron or not in English were not included. The main outcomes of interest were a composite of hospitalisations for heart failure (HHF) and cardiovascular death (CVD), on HHF alone and on cardiovascular and all-cause mortality.
Results
Ten trials were identified with 3,373 participants, of whom 1,759 were assigned to IV iron. IV iron reduced the composite of recurrent HHF and CVD [RR 0.75 (0.61-0.93), p<0.01] and first HHF or CVD [OR 0.72 (0.53-0.99), p=0.04]. Effects on cardiovascular [OR 0.86 (0.70-1.05), p=0.14] and all-cause mortality [OR 0.93 (0.78-1.12), p=0.47] were inconclusive. Results were similar in analyses confined to the first year of follow-up, which was less disrupted by the COVID-19 pandemic. Subgroup analyses found little evidence of heterogeneity for the effect on the primary endpoint, although patients with transferrin saturation <20% [OR 0.67 (0.49-0.92)] may have benefited more than those with values ≥20% [OR 0.99 (0.74-1.30)] (heterogeneity p = 0.07).
Conclusion
In patients with HF and ID, this meta-analysis suggests that IV iron reduces the risk of HHF but whether this is associated with a reduction in cardiovascular or all-cause mortality remains inconclusive
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