ESC Heart Failure最新文献

{"title":"Multidisciplinary care: A missing solution to SGLT2 inhibitor underuse in heart failure","authors":"Wahab Khawar Siddiqui","doi":"10.1002/ehf2.15372","DOIUrl":"10.1002/ehf2.15372","url":null,"abstract":"<p>We commend the authors of the RED-HEART study for their valuable contribution detailing real-world use of sodium–glucose co-transporter 2 inhibitors (SGLT2is) in heart failure patients.<span>¹</span> Their identification of factors influencing SGLT2i prescription provides important clinical insights.</p><p>The authors rightly acknowledge as a limitation that their study included only patients managed in cardiology outpatient clinics. However, this limitation also represents a missed opportunity to explore how multidisciplinary care models might address the underuse of SGLT2is, particularly in patients with chronic kidney disease or diabetes. These populations often require co-management by nephrologists and endocrinologists, specialists with considerable experience prescribing SGLT2is.</p><p>Recent heart failure guidelines emphasize the importance of integrated, team-based approaches to optimize guideline-directed medical therapy. Multidisciplinary clinics and shared-care pathways have been shown to reduce therapeutic inertia and improve medication uptake in complex patients. The absence of analysis or discussion of multidisciplinary care as a potential enabler of higher SGLT2i use leaves a gap in interpreting the real-world barriers and solutions.</p><p>Future studies should evaluate how collaborative care models involving cardiology, nephrology and endocrinology influence the implementation of SGLT2 inhibitors in routine practice. Such research may help overcome barriers identified in RED-HEART and improve equitable access to these life-saving therapies.</p><p>Sincerely,</p><p>Dr. Wahab Khawar Siddiqui</p><p>Jinnah Sindh Medical University</p><p><span>[email protected]</span></p><p>None.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial clinical experience with dapagliflozin in addition to optimized medical therapy in paediatric heart failure patients","authors":"Lisa-Maria Rosenthal,&nbsp;Oliver Miera,&nbsp;Annemarie Krauss,&nbsp;Friederike Danne,&nbsp;Felix Berger,&nbsp;Peter Kramer","doi":"10.1002/ehf2.15386","DOIUrl":"10.1002/ehf2.15386","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has shown clinical benefits in adults with heart failure (HF), improving cardiac function, reducing HF-related hospitalizations and enhancing survival rates. While extensively studied in adult HF, data on its efficacy and safety in paediatric HF patients remain limited. We aimed to evaluate the use of dapagliflozin in addition to optimized therapy in paediatric HF patients regarding safety, clinical outcomes and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We conducted a single-centre retrospective analysis of 37 paediatric HF patients (median age 9.0 years, range 0.2–17.1 years) treated with dapagliflozin at our institution between April 2022 and February 2025. Clinical outcomes, left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), NT-proBNP levels and estimated glomerular filtration rate (eGFR) were analysed at baseline, 3–6 months and the latest follow-up. The most frequent diagnoses among paediatric HF patients treated with dapagliflozin were dilated cardiomyopathy (43.2%, 56% of those with acute myocarditis), heart transplant recipients (18.9%) and single ventricle heart defects (16.2%). The median duration of dapagliflozin treatment was 189 days (Q1, Q3: 381, 596). Dapagliflozin was well tolerated, with no severe adverse effects observed. During follow-up, four patients required ventricular assist device (VAD) implantation, five underwent heart transplantation and one patient died. In six patients, the VAD could be explanted due to myocardial recovery. Overall, LVEF significantly improved from 40% at baseline to 51% at 3–6 months and further to 57% at latest follow-up (<i>P</i> = 0.016). GLS significantly improved from −9.2% to −14.7% from baseline to latest follow-up (<i>P</i> = 0.023). Heart failure classification significantly improved from baseline to latest follow-up (<i>P</i> = 0.004). NT-proBNP levels decreased during follow-up, without reaching statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dapagliflozin in addition to optimized HF therapy was safe and well tolerated in paediatric HF patients, with improvements in functional class, left ventricular contractility and heart failure symptoms. The study's limitations, including its small sample size and retrospective design, highlight the need for larger, multicentre, prospective trials to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3494-3501"},"PeriodicalIF":3.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and design of the randomized ‘early ventricular assist device’—Trial (VAD-DZHK3)","authors":"Christoph Knosalla,&nbsp;Gloria Färber,&nbsp;Andreas J. Rieth,&nbsp;Rolf Wachter,&nbsp;Marius Placzek,&nbsp;Wolfgang Albert,&nbsp;Gerd Hasenfuß,&nbsp;Volkmar Falk,&nbsp;Tim Friede,&nbsp;for the VAD-DZHK3 Investigators","doi":"10.1002/ehf2.15376","DOIUrl":"10.1002/ehf2.15376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Bridge to transplantation (BTT) with durable, continuous-flow left ventricular assist devices (LVAD) of patients is a well-established treatment concept in patients awaiting heart transplantation (HTx). However, the role of elective LVAD implantation in patients with less advanced HF, but increased risk of decompensation remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>The VAD-DZHK3 trial is an investigator-initiated, randomized controlled trial designed to assess whether an early strategy of elective LVAD implantation improves outcomes compared with a conventional approach involving optimal medical therapy and delayed device implantation only after clinical deterioration. Eligible patients are those with end-stage HF listed for cardiac transplantation. This is an event-driven study, that is, the study is completed once 120 events of the primary composite endpoint have been observed and all patients have at least 1 year of follow-up unless they died earlier. Patients meeting inclusion criteria who decline randomization are enrolled in a parallel observational registry reflecting standard care. The primary efficacy endpoint is survival free from high urgent cardiac transplantation, disabling stroke and HF hospitalizations (including emergency room HF visits &gt;6 h).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The VAD-DZHK3 trial will provide guidance on the optimal timing and patient selection for LVAD implantation in heart transplant candidates, potentially redefining current standards of care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3731-3740"},"PeriodicalIF":3.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanistic gaps and statistical considerations in pulmonary heart disease: Insights from PAH combination therapy studies","authors":"Youtao Zhang","doi":"10.1002/ehf2.15385","DOIUrl":"10.1002/ehf2.15385","url":null,"abstract":"&lt;p&gt;Skowasch et al. present an insightful analysis comparing mono and combination therapies in patients with pulmonary arterial hypertension (PAH), as documented in their recent study.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Their work offers significant contributions to optimizing therapeutic strategies in PAH, a field characterized by complex treatment paradigms and evolving evidence bases. Nonetheless, there are several aspects within the study that warrant further discussion.&lt;/p&gt;&lt;p&gt;First, the COMPERA studies have identified short-term benefits and long-term failures in PAH treatments, yet they have not sufficiently elucidated the underlying mechanisms. Specifically, the study only focused on downstream factor changes such as BNP/NT-proBNP and ignored upstream pathways (e.g., endothelin or inflammatory signalling),&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; limiting clinical translation. To address this gap, I suggest that the authors consider conducting organoid experiments to mimic PAH and co-morbid environments. Specifically, patient-derived pulmonary arterial organoids could be used to investigate how dual endothelin-receptor blockade affects SMAD-dependent signalling, providing a clearer link between the clinical results and the biological mechanisms.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Transcriptomics combined with CRISPR editing can further identify key pathways (e.g., TGF-β). Specifically, metabolomics studies could be employed to identify specific metabolic markers, such as elevated levels of long-chain acylcarnitines like palmitoylcarnitine (C16) and stearoylcarnitine (C18), which have been associated with adverse outcomes in PAH.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Additionally, host–microbe interaction studies could explore whether specific alterations in the gut microbiome, such as increased abundance of pro-inflammatory bacterial taxa, are linked to treatment response heterogeneity in PAH patients.&lt;/p&gt;&lt;p&gt;The statistical analysis of this study raises concerns that multiple hypothesis testing may lead to higher type I error rates. The original article was scrutinized in order to determine whether Skowasch et al. presupposed endpoints. The authors noted that their analysis was exploratory and did not presuppose an endpoint. Given this exploratory nature, it is important to recognize the possibility of inflated type I errors when interpreting the results.&lt;/p&gt;&lt;p&gt;The study tested four primary endpoints (WHO functional class, 6-min walk distance, NT-proBNP level and risk profile). In the study, 43 (24.9%) patients in the monotherapy group and 67 (37.0%) patients in the combination therapy group showed improvement in WHO functional class, with &lt;i&gt;P&lt;/i&gt;-value of 0.0299. Additionally, the relative change in NT-proBNP/BNP from baseline to first follow-up was −28.3% [−72.3%, 66.9%] for monotherapy and −57.0% [−83.9%, −6.8%] for combination therapy, with a &lt;i&gt;P&lt;/i&gt;-value of &lt;0.0001. The change in risk status showed that 71 (39.2%) patients in the monotherapy group and 100 (52.6%) patients in th","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3761-3762"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory anaemia in a patient with end-stage heart failure secondary to aortic stenosis","authors":"Jiayu Liang,&nbsp;Suxin Luo,&nbsp;Bi Huang","doi":"10.1002/ehf2.15388","DOIUrl":"10.1002/ehf2.15388","url":null,"abstract":"&lt;p&gt;Anaemia is common in patients with cardiovascular disease, particularly in those with heart failure (HF). Approximately one third of these patients present with anaemia, which has been associated with increased all-cause and cardiovascular mortality.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Iron deficiency anaemia is the most common type, accounting for about half of all anaemia cases.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The pathogenesis of anaemia in HF is multifactorial, involving iron deficiency, abnormalities in erythropoietin synthesis and responsiveness, chronic inflammation leading to bone marrow dysfunction, gastrointestinal bleeding, and the adverse effects of various medications, among other factors.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; As a result, anaemia in HF patients is often regarded as an explainable phenomenon. However, in some cases, the cause of anaemia may be unexpected and complex. Here, we report a patient with HF who presented with refractory anaemia and was ultimately treated successfully. This case may provide insights into potential underlying causes of anaemia in patients with HF.&lt;/p&gt;&lt;p&gt;A 78-year-old woman admitted due to worsened dyspnoea. She was diagnosed with rheumatic heart disease (RHD) complicated by mitral stenosis 32 years ago. Surgical mechanical mitral valve replacement (MVR) was performed and the symptoms improved post-operation. She has been taking warfarin ever since with international normalized ratio ranging between 1.8 and 2.2. During follow-up period, the complete blood count (CBC) indicated haemoglobin (Hb) was around 110 g/L.&lt;/p&gt;&lt;p&gt;Twenty years after MVR, when she had routine checkup, the echocardiography showed a mild aortic valve stenosis (AS); however, she had no symptoms. Five years later, the patient began to feel dyspnoea again and CBC indicated a decreased Hb of 65 g/L. The patient reported she had intermittent black stool, and therefore received gastrointestinal endoscopy examination; however, there were no obvious ulcer, cancers, or vascular malformation. Besides, bone marrow aspiration showed an active erythroid hyperplasia with iron deficiency and serum iron was also significantly reduced. Therefore, she was prescribed with oral iron supplementation, but anaemia still worsened gradually and a transfusion was needed every 2–4 weeks to maintain the Hb around 80 g/L.&lt;/p&gt;&lt;p&gt;Meanwhile, her exercise tolerance was progressively reduced. When she was 74 years old, echocardiography revealed a moderate to severe AS with orifice area 0.8 cm&lt;sup&gt;2&lt;/sup&gt; and 2 years later it progressed to severe AS with orifice area 0.5 cm&lt;sup&gt;2&lt;/sup&gt;. The patient's exercise tolerance continued to worsen despite aggressive therapy, including daily administration of 40–80 mg of furosemide to maintain a dry weight status, as well as beta-blockers to control the heart rate within the range of 70–80 b.p.m. Meanwhile, the Hb decreased to 60 g/L, and it needed transfusing 200–400 mL red blood cell every other day to maintain the Hb around 80 g/L despite the u","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3766-3770"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients report increased control and decreased impact of heart failure during pulmonary pressure-guided management","authors":"Lisa D. Rathman,&nbsp;Samuel F. Sears,&nbsp;Marie-Elena Brett,&nbsp;John D. Henderson,&nbsp;Natalie R. Castillo,&nbsp;Philip B. Adamson,&nbsp;Lynne W. Stevenson","doi":"10.1002/ehf2.15364","DOIUrl":"10.1002/ehf2.15364","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study investigated Class III heart failure patient experience with pulmonary artery pressure (PAP) monitoring over 24 months including (1) changes in reported quality of life (QoL), (2) changes in HF illness perception and sense of control (control), (3) patient evaluation of PAP-guided therapy as a modality and (4) behavioural adherence to remote monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A 272 patient subgroup from the <i>N</i> = 1200 patient CardioMEMS™ Post-Approval Study completed 3 questionnaires including HF-related QoL, illness perception and control, and PAP therapy evaluation. Patient measurement frequency was also collected as a behavioural adherence index. Patient perception of illness was assessed via a general linear mixed model to account for all data available at all time points (<i>n</i> = 272). A paired analysis of patients with 24-month questionnaires (<i>n</i> = 135) was performed to further evaluate patients who completed follow-up. Patients reported significant improvement in overall QoL scores from baseline (44.5 ± 24.0) to 6 months (58.8 ± 25.2) which was maintained through 2 years (all <i>P</i> &lt; 0.0001). Patients described their sense of control as strong (4.3 ± 0.9, 5 is <i>strongly agree</i>), positively evaluated PAP-guided therapy (4.1 ± 1.0, 5 is <i>strongly agree</i>), and 90% actively transmitted device data weekly with a significant reduction in patient perceived illness throughout 2 years of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Two-year follow up of the patient experience of PAP-guided therapy indicated that patients reported increased QoL, perceptions of control, device acceptability and continued remote monitoring over the 24 month follow-up. These results suggest that knowledge of PA pressures is associated with positive patient experience and engagement in HF care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3381-3387"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of supine and sitting pulmonary pressures in ambulatory heart failure patients using the novel Cordella pulmonary pressure system","authors":"Husam M. Salah,&nbsp;Tamas Alexy,&nbsp;Ryan J. Tedford,&nbsp;Nicholas J. Hiivala,&nbsp;Max M. Owens,&nbsp;Liviu Klein,&nbsp;Marat Fudim","doi":"10.1002/ehf2.15374","DOIUrl":"10.1002/ehf2.15374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study is to examine the relationship between supine and seated pulmonary artery pressure (PAP) measurements using the CordellaTM HF management system (Cordella) in patients with heart failure (HF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method and results</h3>\u0000 \u0000 <p>Paired supine and seated PAP readings from the SIRONA 2 and PROACTIVE-HF trials were included. A total of 504 NYHA class III HF patients contributed 40 115 paired measurements. Mean supine mean PAP (mPAP) was 29.1 ± 11.6 mmHg compared with a mean seated mPAP of 22.1 ± 12.2 mmHg (supine-seated difference 7.1 ± 6.5 mmHg, correlation = 0.85; <i>P</i> &lt; 0.001); mean supine sPAP was 44.4 ± 16.6 mmHg compared to a mean seated sPAP 35.4 ± 17.8 mmHg (supine-seated difference 9.0 ± 8.5 mmHg, correlation = 0.88; <i>P</i> &lt; 0.001); and mean supine dPAP was 19.1 ± 9.5 mmHg compared to a mean seated dPAP of 13.9 ± 9.5 mmHg (supine-seated difference 5.2 ± 5.6 mmHg, correlation = 0.82; <i>P</i> &lt; 0.001). Quartile analysis demonstrated that supine-seated differences were larger at lower mPAP levels and narrowed at higher pressures (<i>P</i> &lt; 0.001). Seated mPAP trends showed modest increases prior to heart failure hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study presents the largest paired comparison of supine and sitting PAP and demonstrates a high degree of correlation between seated and supine measures of PAP. Supine-seated differences may reflect venous capacitance and preload reserve, providing novel physiologic insights into HF phenotyping. Seated PAP measurements are a valid and reliable alternative to supine measurements for HF patients with PAP sensors. Given patient preference for seated measurements and their closer reflection of daily physiologic status, incorporating seated PAP into routine monitoring may enhance adherence and optimize remote HF management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3399-3404"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15374","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic determinants of vaccination against pneumococcus in 763 945 patients with heart failure","authors":"F. Roubille,&nbsp;B. Wyplosz,&nbsp;J. Fernandes,&nbsp;B. Grenier,&nbsp;F. Raguideau,&nbsp;E. Blanc,&nbsp;G. Goussiaume","doi":"10.1002/ehf2.15381","DOIUrl":"10.1002/ehf2.15381","url":null,"abstract":"<p>Respiratory infections are the leading cause of acute decompensation, hospitalization and higher mortality in heart failure (HF) patients. Despite recommendations, vaccination coverage against pneumococcus and influenza remains alarmingly low (3% and 50% in 2018, respectively). This study aimed to identify factors associated with vaccination among HF patients using data from the Nationwide Health Claims Database for 2020, in France. The patients were followed during the entire year 2020. At least one dose of PCV13 was considered as a proxy for vaccination. The model used was a multivarable logistic regression.</p><p>Among 763 945 HF patients (mean age 76.7 years, 54.2% male), the mean annual visits were 7.0 with a general practitioner, 1.68 with a specialist and 70.0 with a nurse. Despite frequent healthcare contacts, vaccination coverage was only 12.6% for pneumococcus (PCV13) and 63.1% for influenza.</p><p>In multivariable analyses, at least one dose of the PCV13 was less often received when patients were (1) older (odd ratio (OR): 0.71 [0.67; 0.74], <i>P</i> &lt; 0.0001 and 0.48 [0.46; 0.51], <i>P</i> &lt; 0.0001) in patients 76–85 and older than 85 years old, respectively, (2) women (OR: 0.916 [0.903; 0.929], <i>P</i> &lt; 0.0001) or 3/when they presented social deprivation (for the quintile Q5 of deprivation index, OR was 0.893 [0.872; 0.914], <i>P</i> &lt; 0.0001). Pneumoccocus vaccination was associated with influenza vaccination or with better access to health services.</p><p>We need to consider factors, such as age, sex and social deprivation, to adapt public health initiatives supporting a significantly and sustainably increase pneumococcal vaccination coverage in frail HF patients.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3750-3754"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pulmonary artery pulsatility index in patients with severe aortic stenosis undergoing valve replacement","authors":"Laura A. Rechsteiner,&nbsp;Lukas Weber,&nbsp;Philipp K. Haager,&nbsp;Johannes Rigger,&nbsp;Joannis Chronis,&nbsp;Peter Ammann,&nbsp;Roman Brenner,&nbsp;Martin O. Schmiady,&nbsp;Hans Rickli,&nbsp;Micha T. Maeder","doi":"10.1002/ehf2.15378","DOIUrl":"10.1002/ehf2.15378","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>The pulmonary artery pulsatility index (PAPi), that is, the pulmonary artery pulse pressure (PAPP) divided by the mean right atrial pressure (mRAP), is an increasingly used invasive index of right ventricular function. We sought to assess the prognostic impact of the PAPi in unselected patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied consecutive patients with severe AS (<i>n</i> = 487, 74 ± 10 years, 58% males) undergoing right heart catheterization prior to AVR with post-AVR follow-up of several years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean PAPi was 4.7 ± 3.3, and the mean values in the four PAPi quartiles were 2.1 ± 0.5, 3.2 ± 0.3, 4.5 ± 0.5 and 8.9 ± 4.2. Patients in the lowest PAPi quartile had similar AS severity, symptoms, B-type natriuretic peptide and surgical risk compared with patients in higher quartiles. The lowest PAPi quartile had the lowest PAPP and the highest mRAP and only a slightly reduced stroke volume index (SVI) but the highest pulmonary artery capacitance (PAC). After a median post-AVR follow-up of 45 months mortality did not differ across PAPi quartiles (log rank <i>P</i> = 0.50), which was independent of the AVR mode. However, all contributors of the PAPi equation, that is, higher PAPP, lower PAC (i.e., stroke volume divided by PAPP), lower SVI and higher mRAP were associated with increased mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In unselected patients with severe AS, the PAPi did not predict post-AVR mortality. This may be explained by the fact that the low PAPP in those with low PAPi was mainly a reflection of a high PAC rather than a low SVI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3483-3493"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of ambulatory intravenous diuresis for chronic heart failure patients: Insights from the DEA-HF trial","authors":"Amit Gruber,&nbsp;Aharon (Ronnie) Abbo,&nbsp;Ina Volis,&nbsp;Doron Aronson,&nbsp;Nicolas Girerd,&nbsp;Søren Lund Kristensen,&nbsp;Robert Zukermann,&nbsp;Natalia Alberkant,&nbsp;Elena Sitnitsky,&nbsp;Anton Kruger,&nbsp;Polina Khasis,&nbsp;Evgeny Bravo,&nbsp;Boaz Elad,&nbsp;Ludmila Helmer Levin,&nbsp;Oren Caspi","doi":"10.1002/ehf2.15358","DOIUrl":"10.1002/ehf2.15358","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Oral diuretic treatment has limited efficacy in managing chronic heart failure (HF) patients. Novel strategies are needed to manage patients with refractory congestion despite optimal HF therapy and high-dose oral diuretic treatment. In the present study, we prospectively quantified the efficacy and safety of an ambulatory, weekly, high-dose parenteral diuresis strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Data from the prospective, randomized, cross-over controlled study for comparisons of diuresis efficacy in HF patients (DEA-HF) were analysed. Chronic HF patients with congestion despite guideline-directed medical therapy were enrolled to receive three high-intensity diuretic regimens, once a week, in a randomized order: intravenous (IV) furosemide 250 mg; IV furosemide 250 mg + oral metolazone 5 mg; and IV furosemide 250 mg + IV acetazolamide 500 mg. The primary outcome compared the total sodium excretion following each diuretic regimen. Here, all regimens were pooled to assess the effect of weekly intensive diuresis approach on congestion parameters. The study population included 42 patients, 40% females, with a mean age of 72 ± 9 years. Following three consecutive weekly treatments, the mean body weight was decreased from 85.5 kg [95% confidence interval (CI): 79.7–91.2] to 83.1 kg (95% CI: 77.4–88.9. <i>P</i> = 0.0005), accompanied by a significant decrease in congestion score, N-terminal-pro-brain natriuretic peptide levels and lung ultrasound B-line count. Serum creatinine mildly but significantly increased from 1.81 mg/dL (95% CI: 1.62–2.01) to 2.01 mg/dL (95% CI: 1.81–2.21. <i>P</i> &lt; 0.001), and no hospitalizations due to acute kidney injury occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with congestion-refractory HF, an ambulatory strategy utilizing high-intensity weekly IV diuretic therapy achieved effective decongestion without major safety concerns. This escalated strategy may improve clinical outcomes and prevent hospitalizations of chronic HF patients who require diuresis intensification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3285-3295"},"PeriodicalIF":3.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}