JACC. Heart failure最新文献

{"title":"Prospective Validation and Implementation Pilot Study of an Emergency Department Heart Failure Risk Stratification Tool","authors":"Dana R. Sax MD, MPH ,&nbsp;Jie Huang PhD ,&nbsp;Dustin G. Mark MD ,&nbsp;Jamal S. Rana MD, PhD ,&nbsp;Mathew S. Solomon MD, PhD ,&nbsp;Robert P. Norris MD ,&nbsp;Mary E. Reed DrPH","doi":"10.1016/j.jchf.2025.01.018","DOIUrl":"10.1016/j.jchf.2025.01.018","url":null,"abstract":"<div><h3>Background</h3><div>The STRIDE-HF (Systematic Tool for Risk Identification and Decision-making in Emergency Heart Failure) emergency department (ED) risk tool was previously found to accurately predict the risk of a 30-day serious adverse event (SAE), including 30-day mortality, cardiopulmonary resuscitation, intra-aortic balloon pump insertion, intubation, new dialysis, myocardial infarction, or coronary revascularization.</div></div><div><h3>Objectives</h3><div>The aim of this study was to prospectively validate STRIDE-HF across 21 community EDs among patients in the ED with acute heart failure (AHF) from January 1, 2023, to December 31, 2023, and to assess the safety of the real-time use of risk estimates in a 2-ED pilot study.</div></div><div><h3>Methods</h3><div>Model area under the receiver operator curve (AUROC) and area under the precision recall curve (AUPRC), sensitivity, specificity, and positive and negative predictive values and likelihood ratios at key clinical thresholds are reported. In the clinical pilot, the rates of 30-day SAEs among patients who were at lower risk by STRIDE-HF and were discharged after ED or observation care were reported.</div></div><div><h3>Results</h3><div>There were 13,274 patients in the ED in the prospective validation; the median age was 76 years, 50.8% were female, and 44.5% were non-White; and 11.4%, 24.8%, 31.9%, and 31.9% of patients were at very low, low, moderate, and high risk, respectively. The 30-day SAE rates among very–low-risk and low-risk patients were 3.4% and 6.7%, respectively, and the 30-day mortality rates were &lt;1% and &lt;2%, respectively. STRIDE-HF was highly sensitive among low-risk patients (97.6%; 95% CI: 96.8%-98.2%); AUROC was 0.75 (95% CI: 0.74-0.76), and AUPRC was 0.43 (95% CI: 0.39-0.44). There were 845 patients in the pilot study; among patients classified by STRIDE-HF criteria as being at very low risk who were discharged, none experienced a 30-day SAE.</div></div><div><h3>Conclusions</h3><div>STRIDE-HF maintained high predictive accuracy for 30-day SAE in prospective validation in this large, diverse, multicenter cohort; the use of risk estimates in real time safely identified low-risk patients appropriate for discharge.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 958-969"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Stratification in Acute Heart Failure","authors":"Chang (Nancy) Wang MD, MSc ,&nbsp;Douglas S. Lee MD, PhD","doi":"10.1016/j.jchf.2025.02.013","DOIUrl":"10.1016/j.jchf.2025.02.013","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 970-972"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Searching for Volume in All the Wrong Places","authors":"Sean P. Pinney MD","doi":"10.1016/j.jchf.2025.04.005","DOIUrl":"10.1016/j.jchf.2025.04.005","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 1011-1013"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of the Precision Event Monitoring for Patients With Heart Failure Using HeartLogic Study (PREEMPT-HF)","authors":"Andrew J. Sauer MD ,&nbsp;Craig M. Stolen PhD ,&nbsp;Jonathan B. Shute PhD ,&nbsp;Brian Kwan MS ,&nbsp;Ramesh Wariar PhD ,&nbsp;Stephen B. Ruble PhD ,&nbsp;Roy S. Gardner MD ,&nbsp;John P. Boehmer MD","doi":"10.1016/j.jchf.2025.01.028","DOIUrl":"10.1016/j.jchf.2025.01.028","url":null,"abstract":"<div><h3>Background</h3><div>Improved patient monitoring and management after heart failure (HF) hospitalizations are needed to reduce readmissions significantly.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate the association between monitoring data and readmissions.</div></div><div><h3>Methods</h3><div>PREEMPT-HF (PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic) was a global, observational, single-arm study enrolling adult HF patients remotely monitored with HeartLogic-capable implantable cardioverter-defibrillator and cardiac resynchronization therapy devices. Patients and clinicians were blinded to the index and alerts. Participants were followed for 12 months for site reporting of events.</div></div><div><h3>Results</h3><div>A total of 2,155 patients were enrolled at 103 sites and were monitored remotely (39% implantable cardioverter-defibrillators and 61% cardiac resynchronization therapy-defibrillators). There were 243 hospitalizations for HF, of which 156 (64%) were index hospitalizations. There were 25 (28%) unplanned all-cause readmissions in the 30 days after discharge and 45 (46%) all-cause readmissions within 90 days. Alert sensitivity for outpatient visits and hospitalizations for HF was 78.3%, and the false-positive rate was 1.18/year. The HeartLogic index was higher before index hospitalizations for HF when followed by HF or readmission for all causes. Index hospitalizations for HF were also more likely to be followed by readmission for HF in 90 days if the patient was in an alert state (vs out-of-alert state) 1 or 2 weeks before or 2 weeks after the index admission.</div></div><div><h3>Conclusions</h3><div>HeartLogic index trends were significantly different for patients who were readmitted for HF. These trends suggest that individuals at risk for readmission have had a more sustained worsening and/or insufficient intervention during the initial hospitalization for HF. (PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic [PREEMPT-HF]; <span><span>NCT03579641</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 973-983"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tricuspid Regurgitation in Left Ventricular Assist Device","authors":"Boaz Elad MD ,&nbsp;Emily Tat MD ,&nbsp;Gabriel Sayer MD ,&nbsp;Koji Takeda MD ,&nbsp;Michael I. Brener MD ,&nbsp;Dor Lotan MD ,&nbsp;Daniel Burkhoff MD, PhD ,&nbsp;Susheel Kodali MD ,&nbsp;Rebecca Hahn MD ,&nbsp;Martin B. Leon MD ,&nbsp;Nir Uriel MD, MSc","doi":"10.1016/j.jchf.2025.03.031","DOIUrl":"10.1016/j.jchf.2025.03.031","url":null,"abstract":"<div><div>The presence of tricuspid regurgitation (TR) in patients with heart failure is associated with poor outcomes. Similarly, TR in patients with durable left ventricular assist device (LVAD) support is associated with increased morbidity and mortality. The role of tricuspid valve (TV) intervention to correct TR at the time of LVAD implantation remains uncertain because multiple studies thus far have shown conflicting results on clinical outcomes. This review discusses the mechanism of TR in LVAD recipients, the hemodynamic effects of TR after LVAD implantation, and the significance of corrected and uncorrected TR in the context of LVAD support. It also examines predictors of TR following LVAD implantation and highlights the discrepancies and gaps in the existing published reports. Finally, the review evaluates the potential role of novel transcatheter tricuspid therapies in these patients.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 901-911"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Acute Phase Intensive Exercise Training in Patients With Acute Decompensated Heart Failure","authors":"Kentaro Kamiya PT, PhD ,&nbsp;Shinya Tanaka PT, PhD ,&nbsp;Hiroshi Saito PT, PhD ,&nbsp;Masashi Yamashita PT, PhD ,&nbsp;Ryusuke Yonezawa PT, PhD ,&nbsp;Nobuaki Hamazaki PT, PhD ,&nbsp;Ryota Matsuzawa PT, PhD ,&nbsp;Kohei Nozaki PT, PhD ,&nbsp;Yoshiko Endo PT ,&nbsp;Kazuki Wakaume PT, MSc ,&nbsp;Shota Uchida PT, PhD ,&nbsp;Emi Maekawa MD, PhD ,&nbsp;Yuya Matsue MD, PhD ,&nbsp;Makoto Suzuki MD, PhD ,&nbsp;Takayuki Inomata MD, PhD ,&nbsp;Junya Ako MD, PhD","doi":"10.1016/j.jchf.2024.11.006","DOIUrl":"10.1016/j.jchf.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Acute decompensated heart failure (ADHF) leads to hospitalizations and functional decline in older adults. Although cardiac rehabilitation (CR) is effective for stable heart failure, its impact on ADHF patients, particularly those without frailty, is unclear.</div></div><div><h3>Objectives</h3><div>The goal of this study was to evaluate the efficacy and safety of early in-hospital CR for patients hospitalized with ADHF who are not frail.</div></div><div><h3>Methods</h3><div>In this multicenter trial (ACTIVE-ADHF [Effects of Acute Phase Intensive Exercise Training in Patients with Acute Decompensated Heart Failure]), ADHF patients without physical frailty were randomized 2:1 to undergo either exercise-based CR or standard care. The intervention included early mobilization and structured exercise training. The primary outcome was the change in 6-minute walk distance (6MWD) from baseline to discharge. Secondary outcomes assessed physical and cognitive function, quality of life, and safety.</div></div><div><h3>Results</h3><div>A total of 91 patients were randomized to treatment, with 59 allocated to the intervention group and 32 to the control group. The primary outcome, 6MWD, improved significantly more in the intervention group, with a mean increase of 75.0 ± 7.8 m vs 44.1 ± 10.2 m in the control group, with an effect size of 30.9 ± 13.1 m (95% CI: 4.8-57.0; <em>P =</em> 0.021). The intervention group showed favorable results in secondary efficacy outcomes, including physical and cognitive function, physical activity, and quality of life. Safety outcomes were similar between groups, except for a greater reduction in B-type natriuretic peptide levels at 90 days’ postdischarge in the intervention group.</div></div><div><h3>Conclusions</h3><div>In patients with ADHF without physical frailty, in-hospital exercise-based CR led to significant improvements in 6MWD at 2 weeks after randomization without compromising safety. (ACTIVE-ADHF [Effects of Acute Phase Intensive Exercise Training in Patients with Acute Decompensated Heart Failure]; <span><span>UMIN000020919</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 912-922"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Composition and Survival in Patients With Heart Failure","authors":"Dayana D. Mendonça MSc, PhD ,&nbsp;William V.R. da Silva MD ,&nbsp;Gabriela C. Souza MSc, PhD ,&nbsp;Dimitris V. Rados MD, MSc, PhD ,&nbsp;Andreia Biolo MD, MSc, PhD","doi":"10.1016/j.jchf.2025.01.016","DOIUrl":"10.1016/j.jchf.2025.01.016","url":null,"abstract":"<div><h3>Background</h3><div>Body composition is increasingly recognized as an important factor in the prognosis of patients with heart failure (HF). Variations in muscle mass, fat-free mass, and fat mass may influence survival outcomes, but the extent of these associations remains unclear.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate the impact of body composition parameters on survival in patients with HF.</div></div><div><h3>Methods</h3><div>Five databases were searched through January 2024. Eligible papers reported associations between body composition parameters and survival in HF patients. All-cause mortality was the primary outcome. Risk of bias was evaluated using the Newcastle-Ottawa scale. A random-effects model was used to calculate the 95% CI and HR, with heterogeneity assessed using Cochran’s Q and <em>I</em>² tests.</div></div><div><h3>Results</h3><div>The analysis included 39 cohort studies involving 36,176 HF patients, with 21 studies included in the quantitative analysis. Low muscle mass (HR: 1.73 [95% CI: 1.32-2.26]; <em>I</em>² = 47%) (7 studies) was significantly associated with increased all-cause mortality risk. The prognostic significance of low muscle mass remained consistent across sensitivity and subgroup analysis. Elevated fat mass was not associated with a risk of death (pooled adjusted HR: 0.75 [95% CI: 0.26-2.12]; <em>I</em>² = 77%). Higher abdominal fat showed no significant mortality association.</div></div><div><h3>Conclusions</h3><div>The authors found a strong association between body composition parameters and all-cause mortality. Muscular wasting, measured by low muscle mass, was associated with increased mortality, strengthening the role of muscle mass in HF prognosis. In contrast, higher fat mass and abdominal adiposity showed no association. These findings underscore the importance of comprehensive body composition evaluation in HF prognosis. (Association of Body Composition with Overall Survival in Patients with Heart Failure: A Systematic Review and Meta-Analysis; <span><span>CRD42023488040</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 943-954"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-in-Human Implantable Inferior Vena Cava Sensor for Remote Care in Heart Failure","authors":"Paul R. Kalra MA, MB BChir, MD ,&nbsp;Irakli Gogorishvili MD ,&nbsp;George Khabeishvili MD ,&nbsp;Filip Málek MD, PhD, MBA ,&nbsp;Ondřej Toman PhD, MHA ,&nbsp;Chris Critoph BM, MD ,&nbsp;Andrew S. Flett MBBS, MD, CCDS ,&nbsp;Peter J. Cowburn MD ,&nbsp;Mandeep R. Mehra MD, MSc ,&nbsp;William S. Sheridan PhD ,&nbsp;John R. Britton PhD, MBA ,&nbsp;Teresa Buxo MSc ,&nbsp;Robyn M. Kealy MSc ,&nbsp;Annette Kent PhD ,&nbsp;Barry R. Greene PhD ,&nbsp;Kaushik Guha MD ,&nbsp;Roy S. Gardner MBChB, MD ,&nbsp;Ian Loke MBChB, MD ,&nbsp;Ali Vazir PhD, MBBS ,&nbsp;Jasper J. Brugts MD, PhD, MSc ,&nbsp;Kevin Damman MD, PhD","doi":"10.1016/j.jchf.2025.01.019","DOIUrl":"10.1016/j.jchf.2025.01.019","url":null,"abstract":"<div><h3>Background</h3><div>Variations of inferior vena cava (IVC) area and collapsibility serve as early markers of congestion and predict risk for heart failure (HF) events.</div></div><div><h3>Objectives</h3><div>The aim of this first-in-human study (FUTURE-HF [First in Human Clinical Investigation of the FIRE1 System in Heart Failure Patients]) was to evaluate the safety and feasibility of a novel implantable IVC sensor for remote management in patients with HF. This paper is the final report on primary (3-month) and exploratory (6-month) endpoints.</div></div><div><h3>Methods</h3><div>Patients with HF hospitalizations within the previous year, with elevated natriuretic peptide levels, and on optimal HF treatment were included. The primary safety endpoints were procedural success without device- or procedure-related complications at 3 months. The primary technical endpoint was signal acquisition following implantation and at a clinic visit within 3 months. Sensor-derived IVC area was compared with computed tomography (CT)–based IVC dimensions. Patient adherence to daily readings and exploratory clinical findings at 6 months were assessed.</div></div><div><h3>Results</h3><div>Fifty patients underwent successful implantation (mean age 65 ± 9 years, 14% women, 72% in NYHA functional class III), with 49 contributing to the primary safety and technical endpoints at 3 months. Sensor-derived IVC area demonstrated excellent agreement with CT measurement (mean absolute error 13.53 mm² [3.55%] <em>R</em>² = 0.98). Median adherence was 96% at 6-month follow-up. Exploratory analyses of clinical outcomes suggested improvements in N-terminal pro–B-type natriuretic peptide, NYHA functional class, and quality of life and reduced HF events.</div></div><div><h3>Conclusions</h3><div>This first-in-human experience demonstrated that the implantation of an IVC sensor was safe and feasible. Sensor-derived IVC area demonstrated excellent correlation with CT-derived IVC area, and exploratory clinical outcomes suggest that this may serve as a novel tool for ambulatory management of congestion to facilitate remote care in HF. (First in Human Clinical Investigation of the FIRE1 System in Heart Failure Patients [FUTURE-HF]; <span><span>NCT04203576</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 6","pages":"Pages 1000-1010"},"PeriodicalIF":10.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Heart Failure Etiology","authors":"Jane E. Wilcox MD, MSc ,&nbsp;G. Michael Felker MD","doi":"10.1016/j.jchf.2025.03.029","DOIUrl":"10.1016/j.jchf.2025.03.029","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102471"},"PeriodicalIF":10.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GDF-15 in Cardiovascular Disease: Are We at the Heart of the Energy Balance?","authors":"Angelo Di Vincenzo, Federico Capone, Marco Rossato","doi":"10.1016/j.jchf.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.03.034","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":"102488"},"PeriodicalIF":10.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}