ESC Heart Failure最新文献

{"title":"Immune cell dynamics in heart failure: implicated mechanisms and therapeutic targets.","authors":"Gen Li, Wu He, Dao Wen Wang","doi":"10.1002/ehf2.15238","DOIUrl":"https://doi.org/10.1002/ehf2.15238","url":null,"abstract":"<p><p>The relationship between heart failure (HF) and immune activation has garnered significant interest. Studies highlight the critical role of inflammation in HF, affecting cardiac structure and function. Despite promising anti-inflammatory therapies, clinical trials have faced challenges, indicating an incomplete understanding of immune mechanisms in HF. Immune cells, which are key cytokine sources, are pivotal in HF progression. In this review, the authors provide a comprehensive overview of the complex role of different types of immune cells and their cell subtypes in HF. In addition, the authors summarize the available targets and animal experimental evidence for targeting immune cells for the treatment of HF. Future research directions will focus on the roles of immune cells and their interrelationships at different stages of HF, aiming to develop more targeted therapeutic strategies that can achieve more precise interventions in the pathological process of HF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188740","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":"Response to the Nephrological perspectives on the underutilization of SGLT2i in heart failure and chronic kidney disease.","authors":"Umut Kocabas","doi":"10.1002/ehf2.15229","DOIUrl":"https://doi.org/10.1002/ehf2.15229","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187673","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 impact of gait speed, muscle strength and muscle mass in chronic heart failure-A prospective cohort study.","authors":"Vladimir Cejka, Hermann Riepl, Nora Schwegel, Ewald Kolesnik, David Zach, Viktoria Santner, Viktoria Höller, Natascha Schweighofer, Barbara Obermayer-Pietsch, Thomas Pieber, Caroline Morbach, Stefan Frantz, Andreas Zirlik, Dirk von Lewinski, Stefan Störk, Florian Posch, Klemens Ablasser, Nicolas Verheyen","doi":"10.1002/ehf2.15221","DOIUrl":"https://doi.org/10.1002/ehf2.15221","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) impairs skeletal muscle mass and function, which contributes to reduced physical performance. We investigated the prognostic impact of gait speed (GS), handgrip strength (HG) and appendicular skeletal muscle index (ASMI) on cardiovascular outcomes in a prospective HF cohort.</p><p><strong>Methods: </strong>This single-centre prospective cohort study included adults with stable chronic HF with a previous diagnosis of overtly reduced left ventricular ejection fraction (LVEF) <40% and LVEF < 50% at enrolment. GS was measured by the 4 m GS test, maximal HG was measured with a hydraulic dynamometer, and ASMI was measured by dual-energy X-ray absorptiometry. The primary combined outcome was cardiovascular death or worsening HF. Fine and Gray regression models were calculated, treating non-cardiovascular death as the competing event.</p><p><strong>Results: </strong>Two hundred five patients (78% male) were analysed. The median age was 66 (quartiles: 58-74) years, 31% had diabetes mellitus, and the median LVEF was 37 (30-43) %. Median GS was 1.0 (0.8-1.0) m/s, median HG was 32 (24-40) kg, and median ASMI was 8.0 (7.2-8.9) kg/m². During a median follow-up of 4.7 (4.0-5.3) years, the primary outcome was observed in 52 patients. In models adjusted for key clinical covariates, lower GS predicted a higher risk of cardiovascular death or worsening HF [subdistribution hazard ratio (SHR) per 0.1 m/s increase = 0.81, 95% confidence interval (CI) 0.68-0.95], whereas HG (SHR per 5 kg increase = 0.97, 95% CI 0.84-1.10) and ASMI (SHR per 1 kg/m² increase = 1.17, 95% CI 0.94-1.44) did not. In the analysis of effect modification, these associations were consistent across key clinical subgroups.</p><p><strong>Conclusions: </strong>Higher GS was independently associated with a lower risk of cardiovascular death or worsening HF, whereas HG and ASMI were not. We prospectively confirm GS as a physical performance measure with clear prognostic significance for patients with HF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188802","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":"Assessment of frailty in patients with heart failure: A new Heart Failure Frailty Score developed by Delphi consensus.","authors":"Cristiana Vitale, Emmanuelle Berthelot, Andrew J S Coats, Hill Loreena, Nancy M Albert, Michal Tkaczyszyn, Stamatis Adamopoulos, Lisa Anderson, Markus S Anker, Stefan D Anker, Derek Bell, Tuvia Ben-Gal, Vasiliki Bistola, Biykem Bozkurt, Poppy Brooks, Miguel Camafort, Juan Jesus Carrero, Ovidiu Chioncel, Dong-Ju Choi, Wook-Jin Chung, Wolfram Doehner, Daniel Fernández-Bergés, Roberto Ferrari, Mona Fiuzat, Juan Esteban Gomez-Mesa, Finn Gustafsson, Ewa Jankowska, Seok-Min Kang, Koichiro Kinugawa, Kamlesh Khunti, F D Richard Hobbs, Christopher Lee, Yuri Lopatin, Matthew Maddocks, Giuseppe Maltese, Elena Marques-Sule, Yuya Matsue, Òscar Miró, Brenda Moura, Massimo Piepoli, Piotr Ponikowski, Giovanni Pulignano, Amina Rakisheva, Robin Ray, Angela Sciacqua, Petar Seferovic, Trinidad Sentandreu-Mañó, Shirley Sze, Alan Sinclair, Anna Strömberg, Olga Theou, Hiroyuki Tsutsui, Izabella Uchmanowicz, Maria Teresa Vidan, Maurizio Volterrani, Stephan von Haehling, Byungsu Yoo, Jian Zhang, Yuhui Zhang, Marco Metra, Giuseppe Massimo Claudio Rosano","doi":"10.1002/ehf2.15187","DOIUrl":"https://doi.org/10.1002/ehf2.15187","url":null,"abstract":"<p><strong>Aims: </strong>The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF.</p><p><strong>Methods and results: </strong>The HFFS was developed through a Delphi consensus process involving 54 international experts. This approach involved iterative rounds of questionnaires and interviews, where a panel of experts provided their opinions on specific questions prepared by the Steering Committee. The experts were invited to vote and share their views anonymously, using a 5-point Likert scale over iterative rounds. An 80% threshold was set for agreement or disagreement for each statement. Twenty-two variables from four domains (clinical, functional, psycho-cognitive and social) have been selected for inclusion in the HFFS after the third round of the Delphi process. A shorter version (S-HFFS), including 10 variables, has also been developed for daily clinical use.</p><p><strong>Conclusions: </strong>The HFFS is a new multidimensional tool for the identification of frailty in patients with HF. It should also enables healthcare providers to identify potential 'red flags' for frailty in order to develop personalized care plans. The next step will be to validate the new score in patients with HF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188708","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":"Smartwatches in the assessment of heart failure patients in epidemiology and pathophysiology studies: A scoping review.","authors":"Solenn Fabien, Sandra Waechter, Gbenga A Kayode, Berno Müller, Marietta Roth, Friedrich Koehler","doi":"10.1002/ehf2.15226","DOIUrl":"https://doi.org/10.1002/ehf2.15226","url":null,"abstract":"<p><p>A limited number of studies with smartwatches (SWs) investigated their potential in the field of heart failure (HF). The aim of this scoping review is to understand the extent of current literature on SWs in the HF population and the device's potential to improve disease management. The literature search was performed on PubMed and Embase in March 2024. Inclusion criteria included the use of commercialized SWs, HF diagnosis and peer-reviewed publications. Articles were excluded if the SW was not the study intervention or was part of a broader intervention programme. Reviews, case reports and study protocols were excluded. Of 1200 identified articles, 13 were included in the scoping review, encompassing 1171 patients with HF, and findings were presented in a descriptive summary table. Validity of several SW-collected physiological metrics was assessed against established technologies. Heart rate and step count measures were deemed moderately accurate in the HF population with Fitbit trackers (n = 5 patients, r = 0.54) and Garmin watches [n = 15 patients (mean age: 65.5 ± 12.6 years), concordance correlation coefficient (CCC) = 0.89 for Vivofit 1 and CCC = 0.92 for Vivofit 3], respectively, while calorimetry was the least reliable measurement [n = 19 patients (mean age: 65.1 ± 6.6 years), mean difference to indirect calorimeter: P = 0.01 for Fitbit Charge 2, P = 0.02 for Mio Slice]. Wrist-worn activity trackers were positively received by patients with HF [91.3% of adherence in research setting (n = 70 patients, median age (IQR): 79 years (76-82)), and 64% in real-world environment (n = 14 patients)] and their health-care providers (six cardiologists out of six acknowledged the data's usefulness), although device ownership ranged from 10 to 50% among the HF population. Physical activity information collected from SWs was found to be valuable in assisting cardiologists with their New York Heart Association (NYHA) functional class assessment, which is known for its limited objectivity and reproducibility. Multiple studies found that SWs, especially Fitbit devices, successfully identified a pattern where the degree of exercise intolerance increased with higher NYHA classes. These findings suggested that activity trackers can objectively evaluate the severity of physical activity limitations. As the functional classification of patients influences treatment strategies, SWs could serve as a valuable tool to facilitate and optimize outpatient disease management. SWs could be used as a complement to standard monitoring in HF. With continuous technological advances, it will be valuable to follow the deployment of SWs and to investigate their contribution to increased patient safety and consequently to health care cost reductions.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188152","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":"Cardiac magnetic resonance left atrioventricular coupling index as a prognostic tool in hypertrophic cardiomyopathy.","authors":"Jinyang Wen, Junhao Tu, Xinwei Tao, Yuanyuan Tang, Zhaoxia Yang, Ziyi Pan, Yi Luo, Chunlin Xiang, Dazhong Tang, Lu Huang, Liming Xia","doi":"10.1002/ehf2.15237","DOIUrl":"https://doi.org/10.1002/ehf2.15237","url":null,"abstract":"<p><strong>Aims: </strong>A novel marker left atrioventricular coupling index (LACI) has been proved to be associated with cardiovascular events in patients without history of cardiovascular disease. However, the studies on cardiac magnetic resonance-derived LACI in hypertrophic cardiomyopathy (HCM) patients are limited, and the prognostic value of LACI has still not been studied thoroughly, so we aimed to explore the association between LACI and adverse clinical outcomes in HCM patients.</p><p><strong>Methods: </strong>A total of 206 HCM patients underwent cardiac magnetic resonance examination were retrospectively enrolled. LACI is defined by the ratio between the left atrial (LA) volume and the left ventricular (LV) volume in LV end-diastolic phase. The composite endpoint was categorized into death-related, heart failure-related, and arrhythmia-related events, reflecting mortality risk, heart failure progression, and arrhythmia burden, respectively. Receiver operating characteristics curve analysis was used to determine the optimal cut-off value for LACI to distinguish HCM patients at high risk of adverse clinical outcome. Multivariable Cox regression models were built including significant clinical variables, LA ejection fraction (LAEF), LA volume index (LAVI), late gadolinium enhancement (LGE) extent and LACI. The improvement of discrimination by adding LACI to a clinical model was assessed using C-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).</p><p><strong>Results: </strong>Thirty-four HCM patients reached the endpoint during a median follow-up time of 60 [interquartile range (50-68)] months. In the multivariate Cox regression analysis, LACI [hazard ratio 1.054, 95% confidence interval (CI): 1.037, 1.071; P < 0.001] was an independent predictor of the composite events after adjustment for age and atrial fibrillation. Then 40.09% was identified as an optimal cut-off for LACI in the risk stratification. Integrating LACI to the clinical model yielded higher C-statistic 0.892 with 95% CI (0.861, 0.922) compared with LA diameter, LAEF, LAVI and LGE extent, providing an improvement in prediction of high-risk patients (NRI = 0.627, 95% CI: 0.112-0.934; IDI = 0.295, 95% CI: 0.016-0.709).</p><p><strong>Conclusions: </strong>LACI is an independent risk factor for clinical adverse outcome and is superior to conventional LA parameters and LGE extent for the identification of high-risk HCM patients.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188720","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":"Growth differentiation factor-15 and N-terminal pro-BNP in acute heart failure with preserved ejection fraction.","authors":"Yoichiro Otaki, Tetsu Watanabe, Mari Shimizu, Shingo Tachibana, Junya Sato, Yuta Kobayashi, Harutoshi Tamura, Shigehiko Kato, Satoshi Nishiyama, Hiroki Takahashi, Takanori Arimoto, Masafumi Watanabe","doi":"10.1002/ehf2.15068","DOIUrl":"https://doi.org/10.1002/ehf2.15068","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure with preserved ejection fraction (HFpEF) continues to be an increasingly common health problem associated with a high mortality rate. Elevated levels of Growth differentiation factor-15 (GDF15) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are reportedly associated with poor clinical outcomes in a broad range of cardiovascular diseases. The aim of the present study was to examine the effect of the combined assessment of these markers on clinical outcomes in patients with HFpEF.</p><p><strong>Methods: </strong>This study is the prospective observational study. We measured the serum levels of GDF15 and NT-proBNP in 643 patients (mean age 73 ± 12, 42% females). All patients were prospectively followed up for a median period of 1998 days. Total 132 HF-related events and 88 all-cause deaths occurred during the follow-up period.</p><p><strong>Results: </strong>Multivariate Cox proportional hazards regression analysis demonstrated that both serum GDF15 and NT-proBNP levels were independently associated with HF-related events after adjustment for confounding risk factors (GDF15: hazard ratio, 1.72; 95% confidence interval, 1.35-2.19; P < 0.0001 and NT-proBNP: hazard ratio, 1.63; 95% confidence interval, 1.25-2.13; P = 0.0003). Serum GDF15 levels improved the prediction capacity for HF-related events (0.7405 vs. 0.7190; P = 0.0422), with a significant net reclassification index (0.2724) and integrated discrimination improvement (0.0246). The C indices of GDF15 for HF-related events and all-cause deaths were significantly larger than those of NT-proBNP in men (HF-related events: 0.7389 vs. 0.6721; P = 0.0393, and all-cause deaths: 0.6922 vs.0.6109; P = 0.0262) but not in women. The combination of GDF15 and NT-proBNP levels stratified patients with HFpEF, identifying those at a high risk for HF-related events and all-cause deaths.</p><p><strong>Conclusions: </strong>Serum GDF15 could be an additional prognostic information to NT-proBNP in patients with HFpEF. The prognostic abilities of serum GDF15 and NT-proBNP differed according to sex. These markers were the feasible markers for patients with HFpEF, identifying those at a high risk for HF-related events and all-cause deaths.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122596","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":"Validation of a biomarker-based mortality score for cardiogenic shock patients: Comparison with a clinical risk score.","authors":"Elina Hynninen, Heli Tolppanen, Mercedes Rivas-Lasarte, Tuukka Tarvasmäki, Veli-Pekka Harjola, Benjamin Deniau, Mari Hongisto, Ewa A Jankowska, Raija Jurkko, Toni Jäntti, Anu Kataja, Alexandre Mebazaa, Tuija Sabell, Alessandro Sionis, Johan Lassus","doi":"10.1002/ehf2.15234","DOIUrl":"https://doi.org/10.1002/ehf2.15234","url":null,"abstract":"<p><strong>Aims: </strong>Cardiogenic shock (CS) is the deadliest manifestation of acute heart failure, with persistently high mortality rates and a lack of recent therapeutic breakthroughs. Accurate risk prediction is crucial in clinical decision-making and the design of future clinical trials. We aimed to validate the CLIP score, a biomarker-based risk score comprising cystatin C, lactate, interleukin-6 and NT-proBNP, for predicting mortality in acute coronary syndrome (ACS) related CS, and to compare its predictive value with the previously published CardShock risk score.</p><p><strong>Methods and results: </strong>The study is a post hoc analysis of the CardShock Study, a prospective, observational European multicentre study on CS. The CLIP score was calculated 12 h after hospital admission, and its ability to predict 90-day mortality was assessed using are under the curve (AUC) of the receiver-operating characteristics (ROC) curve analysis. The discriminative ability of the CLIP score was compared with the CardShock risk score by comparing the AUC's. The cohort was dichotomized into low and high risk groups by the optimal cut-off value derived from the ROC analysis of the CLIP score. Kaplan-Meier curves were constructed to evaluate risk stratification when combining the CLIP and CardShock risk scores. The cohort (n = 121) comprised 77% (n = 93) men and the median age was 67 years (IQR 61-76). A total of 21% (n = 25) of the patients had non-ACS related CS. The CLIP score demonstrated appropriate predictive accuracy for 90-day mortality (AUC 0.84, 95% CI 0.77-0.91), comparable with the CardShock risk score (AUC 0.77 [95% CI 0.69-0.85]; P = 0.064 for comparison). A CLIP score cut-off of 0.28 stratified patients into high risk (65% mortality) and low risk (16% mortality) groups. In addition, incorporating the CLIP score enhanced risk stratification in all CardShock risk score categories.</p><p><strong>Conclusions: </strong>The CLIP score, calculated within 12 h of hospital admission, accurately predicted 90-day mortality in CS and complemented the CardShock risk score. The biomarker-based score has potential utility in dynamic mortality risk assessment and could inform clinical management and trial design.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079077","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":"Randomized trial to assess worsening renal function by adding dapagliflozin for acute decompensated heart failure.","authors":"Shodai Kawanami, Yasuyuki Egami, Masaru Abe, Mizuki Osuga, Hiroaki Nohara, Kohei Ukita, Akito Kawamura, Koji Yasumoto, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masamichi Yano, Masami Nishino","doi":"10.1002/ehf2.15212","DOIUrl":"https://doi.org/10.1002/ehf2.15212","url":null,"abstract":"<p><strong>Aims: </strong>Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 inhibitor, has been shown to reduce cardiovascular mortality among patients with chronic heart failure. We aimed to evaluate the impact on a worsening renal function (WRF) by adding DAPA as compared to standard decongestive therapy with loop diuretics alone.</p><p><strong>Methods and results: </strong>We enrolled 114 consecutive acute decompensated heart failure (ADHF) patients with a left ventricular ejection fraction (LVEF) of less than 50%. The patients were prospectively randomized to be assigned either to DAPA group who received DAPA at a dose of 10 mg once daily within 24 h after admission or conventional therapy group (CON group) who received loop diuretics alone. All patients were adjusted by increasing or decreasing the loop diuretic by 10 mg to maintain a 1-2 mL/kg/h urine output. The primary endpoint was the incidence of WRF, which was defined as an increase in the serum creatinine of ≥0.3 mg/dL from baseline. The median age of the patients was 77 [interquartile range (IQR): 64, 85] years, 35% were female and the median LVEF was 33 [IQR: 28, 38] %. There was no significant difference in the incidence of WRF between the two groups (16.1%, n = 9 vs. 12.1%, n = 7, P value = 0.54). The total dose of loop diuretics through day 7 was lower in the DAPA group than CON group (184 ± 79.5 mg vs. 214 ± 66.5 mg, P value = 0.03).</p><p><strong>Conclusions: </strong>This randomized prospective trial revealed the addition of DAPA within 24 h after admission reduced the diuretic dose without WRF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064442","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":"Real-world comparative effectiveness of sacubitril/valsartan versus RAS inhibition alone in patients with de novo heart failure.","authors":"Ankeet S Bhatt, Muthiah Vaduganathan, Barada P Jena, Sylwia Suminska, Carlos Eid, Heike Schwende, Michele Senni","doi":"10.1002/ehf2.15183","DOIUrl":"https://doi.org/10.1002/ehf2.15183","url":null,"abstract":"<p><strong>Aims: </strong>Large-scale, real-world data on early initiation of sacubitril/valsartan in patients newly diagnosed (de novo) with HF with reduced ejection fraction (HFrEF) are limited. We examined the effectiveness of sacubitril/valsartan versus angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) on all-cause and cause-specific hospitalizations among patients with de novo HFrEF from the Optum® dataset in the United States.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with de novo HFrEF (diagnosed ≤30 days) with left ventricular ejection fraction (LVEF) ≤40% who were first prescribed with sacubitril/valsartan or ACEi/ARB from 1 January 2016 to 31 March 2020. The primary endpoint (all-cause hospitalization) and secondary endpoints were analysed in propensity score-matched cohorts.</p><p><strong>Results: </strong>A cohort of 3290 patients with de novo HFrEF who were prescribed with sacubitril/valsartan and a propensity-matched cohort of 6580 patients who were prescribed with ACEi/ARB were analysed. Overall, the mean (SD) age of patients was 63 (14) years, 34% were women, and baseline characteristics were balanced across treatment groups. Hypertension (67%), diabetes (33%) and chronic kidney disease (28%) were highly prevalent comorbidities. Patients in the sacubitril/valsartan cohort when compared with the ACEi/ARB cohort had lower annual rates of all-cause hospitalizations [incidence rate ratio (IRR): 0.81, 95% confidence interval (CI): 0.75-0.89, P < 0.001], cardiovascular (CV) hospitalizations (IRR: 0.80, 95% CI: 0.73-0.87, P < 0.001) and HF hospitalizations (IRR: 0.86, 95% CI: 0.78-0.95, P = 0.002).</p><p><strong>Conclusions: </strong>Among patients with de novo HFrEF, sacubitril/valsartan (compared with that of ACEi/ARB) was associated with fewer all-cause, CV and HF hospitalizations. These findings are consistent with clinical trial evidence suggesting potential benefits of early initiation of sacubitril/valsartan in patients with HFrEF, including those soon after diagnosis.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064478","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}