1,721,296 research outputs found
Reply: Benefits of statins in healthy elderly subjects: What is the number needed to treat?
No full textTolerability and efficacy of sodium-glucose co-transporter 2 inhibitors in patients with cardiac amyloidosis: a meta-analysis of observational studies
No full textAims The role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in patients with cardiac amyloidosis (CA) is controversial. However, they have shown encouraging results in several clinical settings, including heart failure, myocardial infarction, chronic kidney disease, and various forms of restrictive cardiomyopathy. The current study aims to evaluate the tolerability and efficacy of SGLT2i in patients with CA. Methods and results PubMed, Scopus, Cochrane Library, and Embase were scanned for eligible articles up to 28th of March 2025. Safety endpoints included the cumulative prevalence of adverse events (AEs) and drug discontinuation (DD) in the SGLT2i-group. Efficacy endpoints were the pooled risk ratio (RR) of all-cause death (ACD) and hospitalization due to worsening heart failure (WHF) between treatment- and control-groups, as well as the difference between mean change of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in both treatment- and control-groups. Thirteen observational studies, encompassing 19 227 patients, were included in the meta-analysis. Sodium-glucose co-transporter 2 inhibitors use in patients with CA resulted to be tolerable, as demonstrated by a low absolute cumulative prevalence of both AEs [8%; 95% confidence interval (CI) 2-17, nine studies, 603 patients] and DD (4%; 95% CI: 1-7, nine studies, 603 patients). Furthermore, its use was associated with a reduction in the risk of ACD (RR 0.59; 95% CI: 0.48-0.72) and NT-proBNP levels (median difference: -525.54; 95% CI: -718.09 to -332.98), despite no significant association with WHF was noted. Conclusion The administration of SGLT2i proved to be well tolerated in patients with CA. Randomized controlled trials are urgently needed to confirm the prognostic improvement associated with their use in this clinical setting
Safety and efficacy of early initiation of sodium-glucose cotransporter-2 inhibitors after an acute coronary syndrome event: a meta-analysis of randomized controlled trials
No full textEvidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction
Full text linkOlder patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results in the real world and leading to weaker evidence supporting the use and titration of guideline-directed medical therapy (GDMT) in older patients with HF with reduced ejection fraction. This, in combination with other factors limiting the application of guideline recommendations, including a fear of poor tolerability or adverse effects, the heavy burden of comorbidities and the need for multiple therapies, classically leads to lower adherence to GDMT in older patients. Although there are no data supporting the under-use and under-dosing of HF medications in older patients, large registry-based studies have confirmed age as one of the major obstacles to treatment optimisation. In this review, the authors provide an overview of the contemporary state of implementation of GDMT in older groups and the reasons for the lower use of treatments, and discuss some measures that may help improve adherence to evidence-based recommendations in older age groups
Combining New Classes of Drugs for HFrEF: from Trials to Clinical Practice
No full textPharmacological approach to heart failure with reduced ejection fraction (HFrEF) is evolving, as recently published large randomized clinical trials have implemented the disposal of HFrEF treatments with four new classes of drugs, namely angiotensin receptor/neprilysin inhibitor , sodium-glucose co-transporters 2 inhibitors , soluble guanylate cyclase modulators and myosin activators, which have proved to further improve patients' quality of life and long-term outcomes. As these novel drugs target additional pathways not already intercepted by the guideline-directed medical therapy, integration of them in the management of HFrEF is desirable. This review paper aims to provide an overview of the current evolving concepts of HFrEF therapy joining the most recent evidences and to furnish practical suggestions for the use of these new classes of drugs in clinical practice
From mid-range to mildly reduced ejection fraction heart failure: A call to treat
No full textThe historical classification of heart failure (HF) has considered two distinct subgroups, HF with reduced ejection fraction (HFrEF), generally classified as EF below 40%, and HF with preserved ejection fraction (HFpEF) variably classified as EF above 40%, 45% or 50%. One of the principal reasons behind this distinction was related to presence of effective therapy in HFrEF, but not in HFpEF. Recently the expanding knowledge in the specific subgroup of patient with a LVEF between 41% and 49% and the potential benefit of new therapies and of those used in patients with LVEF below 40%, has led to rename this group as HF with mildly reduced EF (HFmrEF). In this review we discuss the reasons behind this modification, we summarize the main characteristics of HFmrEF the similarities and differences with the two other EF categories, and finally we provide a comprehensive overview of the current available evidence supporting the treatment of patients with HFmrEF
principle ‘do no harm’?
No full textAlthough approaches to optimize volume status, such as modifying
fluid and salt intake, are important,1 use of loop diuretics
remains the mainstay of treatment for congestion in patients with
both acute (AHF) and chronic heart failure (CHF), regardless of
the underlying left ventricular ejection fraction.2 Characteristically,
more than 80% of patients with CHF receive regular treatment
with some kind of oral loop diuretic.3,4 The 2016 European guidelines
on heart failure (HF) recommend the use of diuretics for
patients with signs and symptoms of congestion (recommendation
class I, level of evidence B).5 However, loop diuretics may exert a
range of adverse effects including electrolyte depletion, which predispose
to life-threatening ventricular arrhythmias, hyperglycaemia,
hyperuricaemia, orthostatic hypotension, vestibular symptoms and
renal function deterioration.2 Furthermore, they seem to activate
the neurohormonal system and hamper the up-titration of
guideline-recommended HF treatment.6,7 Thus, current guidelines
recommend use of diuretics at the lowest dose needed to achieve
and maintain euvolaemia, meaning that reduced loop diuretic dose
may often be indicated in stable CHF patients.5 Recently, the Heart
Failure Association (HFA) of the European Society of Cardiology
(ESC) put together a comprehensive consensus document on the
use of diuretics in HF,1 providing, among others, guidance on the
challenging task of assessing HF patients’ fluid status.
Herein we summarize the existing literature on loop diuretic
dose changes in CHF and call for randomized trials. Loop diuretic
strategies in AHF are not addressed
- …
