ESC Heart Failure最新文献

{"title":"BUN-to-ALB ratio as an effective predictor of 30 day mortality in ADHF patients in eastern China.","authors":"Xin Huang, Chao Wang, Shiming He, Guoan Jian, Kun Jiang, Zihao Lu, Guotai Sheng, Yang Zou, Guobo Xie","doi":"10.1002/ehf2.15289","DOIUrl":"https://doi.org/10.1002/ehf2.15289","url":null,"abstract":"<p><strong>Aims: </strong>The blood urea nitrogen-to-albumin ratio (BAR) is considered a potential indicator for assessing the poor prognosis of heart failure (HF). However, its prognostic value for Chinese patients with acute decompensated HF (ADHF) remains unclear.</p><p><strong>Methods: </strong>This study included ADHF patients who met the study criteria and were admitted to Jiangxi Provincial People's Hospital from 2019 to 2022. We first employed univariate and multivariate Cox regression models to determine the role of BAR in evaluating the short-term prognosis of ADHF patients. Subsequently, we used restricted cubic spline regression to explore the nonlinear relationship and potential threshold between BAR and prognosis. Receiver operating characteristic (ROC) curve analysis was performed to calculate the predictive accuracy of BAR for 30 day mortality and identify relevant threshold points.</p><p><strong>Results: </strong>A total of 1421 patients were included in the analysis, and the population was divided into two groups based on the optimal threshold for BAR (0.33) determined by ROC curve analysis. During the median 30 day follow-up period, the mortality rates in the high-BAR and low-BAR groups were 12.46% and 1.26%, respectively. Multivariable Cox regression analysis indicated that a high BAR was associated with an increased 30 day mortality risk in ADHF patients [hazard ratio (HR): 3.25, 95% confidence interval (CI): 1.28-8.30], particularly among those with concomitant cerebral infarction (HR: 19.12, 95% CI: 2.67-136.67). The five sensitivity analyses completed were consistent with the results of the main analysis. Furthermore, restricted cubic spline analysis revealed a nonlinear association between BAR and short-term mortality in ADHF patients (P for nonlinearity: <0.001), with a potential threshold effect observed when BAR was between 0.3 and 0.5. ROC curve analysis determined that the predictive efficiency of BAR for short-term mortality in ADHF patients was ~84%, with an area under the ROC curve (AUC) of 0.84.</p><p><strong>Conclusions: </strong>This study found that BAR can serve as an effective predictor of short-term prognosis in ADHF patients based on clinical data from the Jiangxi population, with an optimal predictive threshold calculated at 0.33.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis.","authors":"M Cobo Marcos, R de la Espriella, I Zegri-Reiriz, P Llacer, J Rubio Gracia, J Comín-Colet, J L Morales-Rull, P Diez-Villanueva, J de Juan Bagudá, S Jiménez-Marrero, C Ortiz Cortés, M A Restrepo-Córdoba, J M García-Pinilla, E Barrios, S Del Prado Díaz, J Núñez","doi":"10.1002/ehf2.15275","DOIUrl":"https://doi.org/10.1002/ehf2.15275","url":null,"abstract":"<p><strong>Aims: </strong>Early diuresis and natriuresis are commonly used to assess the efficacy of decongestive therapy following an acute heart failure episode. There is limited knowledge regarding which parameter better predicts adverse clinical outcomes, especially in the outpatient setting. This study investigated the prognostic value of both metrics in predicting 30-day adverse clinical events in an ambulatory worsening heart failure (WHF) scenario.</p><p><strong>Methods and results: </strong>This is a post-hoc analysis of the SALT-HF trial involving 167 patients with ambulatory WHF randomized to receive intravenous furosemide with or without hypertonic saline solution. Early diuretic response was assessed through 3-h urine output and 3-h urinary sodium (uNa⁺) levels following intravenous (IV) diuretic infusion. We analysed their association with 30-day adverse events (defined as death, heart failure hospitalization, or the need for outpatient IV diuretics) using logistic regression analysis. Both exposures were examined along the continuum and dichotomized in their median. The discriminative ability between the exposures and endpoints was assessed by receiver operating characteristic curves (AUC-ROC).</p><p><strong>Results: </strong>The median age of participants was 81 years, predominantly male (69.5%). Patients with lower 3-h urinary sodium and diuresis were older and exhibited reduced kidney function and haemoglobin levels. At 30 days, 50 (29.9%) of the sample experienced the composite endpoint. Multivariate analyses revealed that lower 3-h uNa⁺ was associated with a higher risk of 30-day adverse events (P = 0.008). Conversely, 3-h diuresis did not significantly predict 30-day adverse outcomes (P = 0.424). There was a trend towards a higher AUC-ROC for the inverse of 3-h natriuresis compared with 3-h diuresis: 0.680 versus 0.601, P = 0.092.</p><p><strong>Conclusions: </strong>In patients with ambulatory WHF treated with IV furosemide, 3-h urinary sodium predicted 30-day outcomes whereas 3-h diuresis did not.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding the article \"Prevalence and prognostic value of different iron deficiency definitions in light chain cardiac amyloidosis patients\".","authors":"Shaotao Zhang, Jinglun Li","doi":"10.1002/ehf2.15288","DOIUrl":"https://doi.org/10.1002/ehf2.15288","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of tricuspid regurgitation predicts risk of recurrence of atrial fibrillation after pulmonary vein isolation.","authors":"Jan Wintrich, Dimitrios Bismpos, Anika Teusch, Valerie Pavlicek, Patrick Fischer, Felix Mahfoud, Michael Böhm, Christian Ukena","doi":"10.1002/ehf2.15197","DOIUrl":"https://doi.org/10.1002/ehf2.15197","url":null,"abstract":"<p><strong>Aims: </strong>Tricuspid regurgitation (TR) results in right atrial remodelling, thus promoting the formation of a substrate for atrial fibrillation (AF). In turn, AF may cause TR by annulus dilatation. We investigated whether the presence of TR affects the efficacy of pulmonary vein isolation (PVI) for AF.</p><p><strong>Methods and results: </strong>In patients undergoing PVI, we compared the severity of TR before and 6 months after the procedure. Moderate to severe TR was defined as advanced. Moreover, we investigated whether the severity of TR, at baseline and 6 months after PVI, predicted the recurrence of AF. Out of 320 patients, advanced TR at baseline was documented in 13.1%. Six months after PVI, the proportion of patients with advanced TR (13.1% to 7.2%; P < 0.001) decreased significantly. Compared with patients with post-interventional improvement of advanced TR, right atrial (RA) dilatation at baseline was more pronounced in patients without TR improvement (RA area 20.2 ± 4.4 vs. 26.6 ± 8.3 cm). The presence of advanced TR, particularly without improvement during the follow-up, increased the risk of AF recurrences compared with patients without advanced TR. Even after propensity-score matching, TR at baseline remained an independent risk predictor regarding recurrent AF [hazard ratio 2.2 (95% confidence interval, 1.1-4.9); P = 0.045]. Advanced MR was not associated with increased risk of AF.</p><p><strong>Conclusions: </strong>In AF patients undergoing PVI, the presence of advanced TR, particularly without improvement 6 months after the procedure, was associated with an increased risk of AF recurrences.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical profile, short and long-term outcomes of non-ischaemic cardiogenic shock: A FRENSHOCK sub-analysis.","authors":"Miloud Cherbi, François Roubille, Edouard Gerbaud, Eric Bonnefoy, Nicolas Lamblin, Laurent Bonello, Bruno Levy, Pascal Lim, Hamid Merdji, Meyer Elbaz, Hadi Khachab, Jeremy Bourenne, Marie-France Seronde, Guillaume Schurtz, Brahim Harbaoui, Gerald Vanzetto, Nicolas Combaret, Benoit Lattuca, Guillaume Leurent, Etienne Puymirat, Clément Delmas","doi":"10.1002/ehf2.15046","DOIUrl":"https://doi.org/10.1002/ehf2.15046","url":null,"abstract":"<p><strong>Aims: </strong>Although predominant in routine practice, non-ischaemic cardiogenic shock (NICS) remains underrepresented in past studies, mainly focused on ischaemic cardiogenic shock (CS). This study aims to describe the current NICS picture and define its independent correlates of short- and long-term outcomes.</p><p><strong>Methods and results: </strong>FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. One-year mortality was the primary outcome. One-month mortality and the composite of 1-year mortality, heart transplantation (HTx), or ventricular assistance device (VAD) were secondary outcomes. Within 772 patients included, 492 (63.7%) were NICS. One-month and 1-year mortality rates were 25.6% and 45.7%, with a combined endpoint of 1-year mortality, HTx, or VAD of 53.9%. Multivariate analysis showed five independent factors for 1-year mortality: age (per year: aHR 1.03 [1.01-1.05], P < 0.01), chronic kidney disease (CKD) (aHR 1.87 [1.25-2.80], P < 0.01), norepinephrine use (aHR 1.52 [1.02-2.26], P = 0.04), active cancer (aHR 1.91 [1.07-3.42], P = 0.03) and acute renal replacement therapy (aHR 1.57 [1.01-2.46], P = 0.049). Age, CKD and norepinephrine were also predictive of 1-month mortality and 1-year mortality and/or HTx and/or VAD. Additionally, 1-month mortality was associated with septic triggers, and 1-year mortality and/or HTx and/or VAD with acute mechanical circulatory support, NYHA stage ≥ 3 and fluid administration.</p><p><strong>Conclusions: </strong>In this large study, NICS accounted for almost two-thirds of all CS cases, with substantial rates of short- and long-term mortality. Future studies should evaluate interventions to improve early stratification and management. NCT02703038.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart failure, dementia is associated with increased stroke severity, in-hospital mortality and complications.","authors":"Lijun Zuo, YanHong Dong, Yang Hu, Zixiao Li, Hongqiu Gu, Xingquan Zhao, Yongjun Wang","doi":"10.1002/ehf2.15216","DOIUrl":"https://doi.org/10.1002/ehf2.15216","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a risk factor for ischemic stroke. Cognitive impairment is very common in HF and stroke patients. Patients with HF have higher risk of developing dementia. However, there are limited studies investigating the characteristics, in-hospital mortality and complications of stroke patients with both HF and dementia.</p><p><strong>Methods and results: </strong>Patients in this study were from the China Stroke Center Alliance database. We divided patients into four groups: (A) stroke patients with dementia but no HF; (B) stroke patients with HF but no dementia; (C) stroke patients with both dementia and HF; (D) stroke patients without HF or dementia. We analysed the in-hospital mortality, and complications among the 4 groups. Outcomes include in-hospital mortality and in-hospital complications, including pneumonia, decubitus ulcer, pulmonary embolism, myocardial infarction, gastrointestinal bleeding and deep vein thrombosis (DVT). Multivariable logistic regression was performed to validate the association between HF, dementia, stroke and functional outcomes. Stroke patients with dementia and HF were older, and had a higher proportion of individuals with a history of strokeperipheral vascular disease and dyslipidaemia, and had a higher level of homocysteine, glycosylated hemoglobin and so on. Compared with group D (stroke patients without HF or dementia), all the other three groups have significantly higher proportion of in-hospital mortality and complications, such as pneumonia, decubitus ulcer, pulmonary embolism, myocardial infarction, DVT, gastrointestinal bleeding and poor swallow function. When compared with group B (stroke patients with HF but no dementia), the in-hospital mortality was higher in group C (stroke patients with HF and dementia), but the difference was not statistically significant; the prevalence of decubitus ulcer, gastrointestinal bleeding and poor wallow function were significantly higher in group C. In the logistic regression, the stroke patients with dementia and HF showed significant higher in-hospital mortality (adjusted OR, 2.875; 95% CI, 1.539-5.371; P = 0.001) and higher proportion of pneumonia (adjusted OR 2.596, 95% CI, 2.027-3.325, P < 0.001), decubitus ulcer (adjusted OR, 6.473, 95% CI, 3.999-10.477, P < 0.001) and pulmonary embolism (adjusted OR, 2.876, 95% CI, 1.054-7.850, P = 0.039).</p><p><strong>Conclusions: </strong>Stroke patients with dementia and HF have an increased risk of in-hospital mortality and complications. Future studies should strengthen the risk factor control among individuals with both dementia and HF for stroke prevention.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation.","authors":"Christophe Tribouilloy, Yohann Bohbot, Benjamin Essayagh, Giovanni Benfari, Jeroen J Bax, Thierry Le Tourneau, Yan Topilsky, Clemence Antoine, Dan Rusinaru, Francesco Grigioni, Nina Ajmone Marsan, Aniek van Wijngaarden, Aviram Hochstadt, Jean Christian Roussel, Prabin Thapa, Michelena Hector, Maurice Enriquez-Sarano","doi":"10.1002/ehf2.15278","DOIUrl":"https://doi.org/10.1002/ehf2.15278","url":null,"abstract":"<p><strong>Aims: </strong>Functional tricuspid regurgitation (FTR) associated with degenerative mitral regurgitation (DMR) accentuates the severity of heart failure and is a marker of poor prognosis. Little is known about FTR associated with asymptomatic DMR.</p><p><strong>Methods and results: </strong>The study included 1249 asymptomatic patients with moderate or severe DMR from the Mitral Regurgitation International Database-Quantitative (MIDA-Q) registry (mean age 64 ± 15 years, 25% female). Despite the asymptomatic status, absent/trivial FTR was noted in only 42%, mild in 34.5%, moderate in 11%, and severe FTR in 12.5%. Patients with higher FTR grades were older and more often female and had higher EuroScore II, larger left atrial volumes, and more atrial fibrillation (all P < 0.05). Patients with moderate or severe FTR had comparable 5-year survival (64 ± 4% and 65 ± 4%) and lower than patients with no/trivial FTR(96 ± 1%, P < 0.001). After adjustment for key prognostic factors, including age, left ventricular dilatation and dysfunction, DMR severity, left atrial dilatation, and pulmonary hypertension, ≥moderate FTR remained a strong predictor of mortality (HR = 2.08 [1.17-3.72], P = 0.013). Sensitivity analysis showed stable impact of ≥moderate FTR among patients with/without pulmonary hypertension, in women and men and for any other subset. For patients who underwent mitral valve surgery, post-operative survival rates were similar between those with no/trivial FTR and those with ≥moderate or severe FTR (P = 0.76), suggesting that surgery could reduce the excess mortality related to preoperative FTR.</p><p><strong>Conclusions: </strong>Among asymptomatic patients with significant DMR, ≥moderate FTR is frequent and independently associated with higher mortality, independently of traditional guideline-based risk factors. These findings suggest that ≥moderate FTR should lead to consideration of early mitral surgery to improve outcomes.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early occurrence of heart failure hospitalization or ventricular arrhythmia re-define the long-term prognosis after CRT.","authors":"Anna Zsofia Toth, Laszlo Nagy, Krisztina Maria Szabo, Vivien Racz, Alexandra Kiss, Gabor Sandorfi, Attila Borbely, Tibor Laszlo Nagy, Zoltan Csanadi","doi":"10.1002/ehf2.15274","DOIUrl":"https://doi.org/10.1002/ehf2.15274","url":null,"abstract":"<p><strong>Aims: </strong>Classifying patients as responders or non-responders to cardiac resynchronization therapy (CRT) has been recently challenged, suggesting that preventing heart failure (HF) progression may also provide survival benefits. We assessed a novel classification based on echocardiographic left ventricular (LV) reverse remodelling and the occurrence of acute HF hospitalization (HHF) or sustained ventricular arrhythmia (VA) within 1-year post-CRT.</p><p><strong>Methods and results: </strong>Patients implanted with a CRT defibrillator (CRT-D) at our department between 2010 and 2020 were classified based on the change in LV ejection fraction (LVEF) within 1 year as responders (increase ≥ 10%), non-progressors (increase <10%) or progressors (decline). Patients in each category were further divided based on the occurrence or absence of an HHF/VA event within 1-year post-implantation. Long-term survival free of heart transplantation or LV assist device implantation was calculated for all six subgroups. Cohorts demonstrating no significant between-group differences were grouped together and reclassified as improved, stabilized or worsened. One hundred nineteen responders, 79 non-progressors and 69 progressors were identified based on the echocardiographic response. Long-term event-free survival was higher for responders as compared with non-progressors (hazard ratio [HR] 0.51, P = 0.002) or progressors (HR 0.34, P < 0.0001). Furthermore, non-progressors had better outcome than progressors (HR 0.63, P = 0.03). Long-term prognosis in patients was superior with versus without an HHF/VA event within each group of responders (HR 0.47, P = 0.03), non-progressors (HR 0.31, P = 0.0001) or progressors (HR 0.38, P = 0.0004). No survival difference was found between responders and non-progressors with no event (HR 0.69, P = 0.09), who were recategorized as improved. Long-term prognosis was also similar in responders with any event and in progressors with no event (HR 0.98, P = 0.88; stabilized), as well as in non-progressors and progressors with any event (HR 0.87, P = 0.63; worsened). Median survival rates demonstrated significant differences between the improved, stabilized and worsened groups (102.3, 62.0 and 24.4 months; HR 0.53, P = 0.006 between improved and stabilized; HR 0.41, P < 0.0001 between stabilized and worsened; HR 0.21, P < 0.0001 between improved and worsened cohorts, respectively).</p><p><strong>Conclusions: </strong>Long-term survival can be predicted based on the change in LVEF and on the occurrence of an HHF/VA event within 1-year after CRT-D implantation. Stabilized patients have significantly better prognosis as compared with the worsened group. Patients with strikingly poor prognosis can be identified using this assessment method.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DanGer Shock-like profile predicts the outcome in ST-elevation myocardial infarction-related cardiogenic shock.","authors":"Norman Mangner, Johannes Mierke, Dominik Baron, Felix J Woitek, Stephan Haussig, Thomas Nowack, Ephraim B Winzer, Julia Fischer, Robert Höllriegel, Stefanie Jellinghaus, Axel Linke","doi":"10.1002/ehf2.15269","DOIUrl":"https://doi.org/10.1002/ehf2.15269","url":null,"abstract":"<p><strong>Aims: </strong>The DanGer Shock (DGS) trial demonstrated that the routine use of a microaxial flow pump (mAFP) with standard care to treat STEMI-related cardiogenic shock (STEMI-CS) led to a lower risk of all-cause death at 180 days than standard care alone. We investigated the impact of patient eligibility for DGS in an all-comers cardiogenic shock registry of patients receiving a mAFP.</p><p><strong>Methods and results: </strong>Prospective single-centre mAFP registry including 478 CS-patients with 225 patients having STEMI-CS. DGS-like was defined as STEMI-CS, lactate ≥2.5 mmol/L, left ventricular ejection fraction < 45%, no mechanical complications, and no comatose out-of-hospital cardiac arrest but in-hospital cardiac arrest with a maximum of 10 min to return of spontaneous circulation as a surrogate for medically witnessed cardiac arrest was included. The comparison group consisted of STEMI-CS patients who did not fulfil the aforementioned criteria (DGS-unlike). The primary outcome was 180-day mortality. Out of 225 STEMI-CS, 64 (28.4%) patients were considered DGS-like. Those patients were younger, had less often received CPR before mAFP implantation, and mAFP-support was longer. Comorbidities, baseline lactate, coronary artery disease characteristics/treatment, inotropes/vasopressors, and escalation to other mechanical circulatory support devices were not different. All-cause mortality at 180 days was significantly lower in the DGS-like compared to the DGS-unlike cohort (62.5% vs. 72.0%, P = 0.014) as was 30-day all-cause mortality (48.4% vs. 70.2%, P < 0.001). DGS-like remained an independent predictor of both 180-day (HR 0.57, 95% CI 0.39, 0.83) and 30-day mortality (HR 0.48, 95% CI 0.32, 0.72) in a multivariable analysis.</p><p><strong>Conclusions: </strong>A DGS-like profile was associated with a lower 180-day mortality compared with a DGS-unlike profile in a STEMI-CS cohort treated by mAFP.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elements of effective palliative care interventions in advanced heart failure: A narrative review.","authors":"Peter Allcroft, Carmine G De Pasquale, David Lim, Ingrid Amgarth-Duff, Meera R Agar","doi":"10.1002/ehf2.15243","DOIUrl":"https://doi.org/10.1002/ehf2.15243","url":null,"abstract":"<p><p>People with advanced heart failure experience significant biopsychosocial needs and have a poor prognosis. International guidelines have called for integrating palliative care in heart failure management. This review explores the elements of effective palliative care interventions in advanced heart failure. PubMed, Embase, CINAHL and Cochrane Reviews were searched following an a priori review protocol for clinical trials of advanced heart failure and palliative care. The risk of bias was assessed using Risk of Bias 2 (RoB2). A qualitative, emergent approach was used to synthesize context + mechanism = outcome. Twenty-one papers from 18 studies were the data source. The efficacy of palliative care in advanced heart failure was mixed. Five studies reported significant improvement in health outcomes compared with the usual care control group. Timing may be necessary in accounting for improvement in quality of life (occurring on or about 3 months) and functional and symptomatic improvements (occurring on or about 6 months or longer). Effective models of secondary palliative care in advanced heart failure include interdisciplinary teams comprising primary care, cardiology and palliative care, routine check-ins, personalized care plans that explore goals, evidence-based symptom management and counselling. Integrating palliative care with heart failure management could improve patient outcomes. Future research and policy development may wish to consider when, how and what palliative care modalities are to be incorporated into the care of patients with advanced heart failure.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}