JACC. Heart failure最新文献

{"title":"Rapid Uptitration of Guideline-Directed Medical Therapies in Acute Heart Failure With and Without Atrial Fibrillation","authors":"Dimitrios Farmakis MD ,&nbsp;Beth Davison PhD ,&nbsp;Katerina Fountoulaki MD ,&nbsp;Sotiria Liori MD ,&nbsp;Ovidiu Chioncel MD ,&nbsp;Marco Metra MD ,&nbsp;Jelena Celutkiene MD ,&nbsp;Alain Cohen-Solal MD ,&nbsp;Albertino Damasceno MD ,&nbsp;Rafael Diaz MD ,&nbsp;Christopher Edwards MD ,&nbsp;Etienne Gayat MD ,&nbsp;Maria Novosadova MD ,&nbsp;Vasiliki Bistola MD ,&nbsp;Peter S. Pang MD ,&nbsp;Piotr Ponikowski MD ,&nbsp;Hadiza Saidu MD ,&nbsp;Karen Sliwa MD ,&nbsp;Koji Takagi MD ,&nbsp;Adriaan A. Voors MD ,&nbsp;Gerasimos Filippatos MD","doi":"10.1016/j.jchf.2024.06.010","DOIUrl":"10.1016/j.jchf.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Rapid uptitration of guideline-directed medical therapy (GDMT) before and after discharge in hospitalized heart failure (HF) patients is feasible, is safe, and improves outcomes; whether this is also true in patients with coexistent atrial fibrillation/flutter (AF/AFL) is not known.</div></div><div><h3>Objectives</h3><div>This study sought to investigate whether rapid GDMT uptitration before and after discharge for HF is feasible, safe and beneficial in patients with and without AF/AFL.</div></div><div><h3>Methods</h3><div>In this secondary analysis of the STRONG-HF (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) trial, GDMT uptitration and patient outcomes were analyzed by AF/AFL status and type (permanent, persistent, paroxysmal).</div></div><div><h3>Results</h3><div>Among 1,078 patients enrolled in STRONG-HF, 496 (46%) had a history of AF, including 238 assigned to high-intensity care (HIC) and 258 to usual care (UC), and 581 did not have a history of AF/AFL, including 304 assigned to HIC and 277 to UC. By day 90, the average percent optimal dose of neurohormonal inhibitors achieved in the HIC arm was similar in patients with and without AF/AFL, reaching approximately 80% of the optimal dose (average absolute difference between AF/AFL and non-AF/AFL groups: −0.81%; 95% CI: −3.51 to 1.89). All-cause death or HF readmission by day 180 occurred less frequently in the HIC than the UC arm, both in patients with and without AF (adjusted HR: 0.75 [95% CI: 0.48-1.19] in AF vs adjusted HR: 0.50 [95% CI: 0.31-0.79] in non-AF/AFL patients; <em>P</em> for interaction = 0.2107). Adverse event rates were similar in patients with and without AF/AFL. AF/AFL type did not affect either uptitration or patient outcomes.</div></div><div><h3>Conclusions</h3><div>Nearly half of acute HF patients have AF/AFL history. Rapid GDMT uptitration before and early after discharge is feasible, is safe, and may improve outcomes regardless of AF presence or type. (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies [STRONG-HF]; <span><span>NCT03412201</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1845-1858"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995752","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":"Dapagliflozin in Heart Failure, Type 2 Diabetes, and Neuropathy","authors":"Jawad H. Butt MD ,&nbsp;Li Shen MD, PhD ,&nbsp;Silvio E. Inzucchi MD ,&nbsp;Kieran F. Docherty MBChB, PhD ,&nbsp;Pardeep S. Jhund MBChB, MSc, PhD ,&nbsp;Felipe A. Martinez MD ,&nbsp;Marc S. Sabatine MD, MPH ,&nbsp;Muthiah Vaduganathan MD, MPH ,&nbsp;Scott D. Solomon MD ,&nbsp;John J.V. McMurray MD ,&nbsp;DAPA-HF and DELIVER Committees and Investigators","doi":"10.1016/j.jchf.2024.07.017","DOIUrl":"10.1016/j.jchf.2024.07.017","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1946-1948"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264103","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":"Redefining Boundaries in Heart Failure Care","authors":"Jeroen Dauw MD, PhD, MMed ,&nbsp;Wilfried Mullens MD, PhD","doi":"10.1016/j.jchf.2024.08.014","DOIUrl":"10.1016/j.jchf.2024.08.014","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1842-1844"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465736","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":"Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide 1 Receptor Agonists","authors":"Josephine Harrington MD ,&nbsp;Darren K. McGuire MD, MHS ,&nbsp;Silvio E. Inzucchi MD","doi":"10.1016/j.jchf.2024.08.013","DOIUrl":"10.1016/j.jchf.2024.08.013","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1827-1829"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465737","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":"Dynamic Risk Estimation of Adverse Events in Ambulatory LVAD Patients","authors":"Palak Shah MD, MS ,&nbsp;Gabriel Sayer MD ,&nbsp;Shashank S. Sinha MD, MSc ,&nbsp;Manreet K. Kanwar MD ,&nbsp;Jennifer A. Cowger MD, MS ,&nbsp;Francis D. Pagani MD, PhD ,&nbsp;Aditi Nayak MD ,&nbsp;Mandeep R. Mehra MD ,&nbsp;Joseph C. Cleveland Jr. MD ,&nbsp;Mitchell A. Psotka MD, PhD ,&nbsp;Ramesh Singh MD ,&nbsp;Shashank S. Desai MD ,&nbsp;Qianhui Lu MS ,&nbsp;Yajing Hu PhD ,&nbsp;Allison Connolly PhD ,&nbsp;Robert L. Kormos MD ,&nbsp;Nir Uriel MD","doi":"10.1016/j.jchf.2024.05.018","DOIUrl":"10.1016/j.jchf.2024.05.018","url":null,"abstract":"<div><h3>Background</h3><div>Hemocompatibility-related adverse events affect patients after left ventricular assist device (LVAD) implantation but are hard to predict.</div></div><div><h3>Objectives</h3><div>Dynamic risk modeling with a multistate model can predict risk of gastrointestinal bleeding (GIB), stroke, or death in ambulatory patients.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) trial. HeartMate 3 LVAD recipients who survived to hospital discharge and were followed for up to 2 years. A total of 145 variables were included in the multistate model with multivariate logistic regression. Model performance was assessed with the area under the curve in a holdout validation cohort. A risk stratification tool was created by dividing patients into categories of predicted risk using the final model variables and associated OR.</div></div><div><h3>Results</h3><div>Among 2,056 LVAD patients, the median age was 59.4 years (20.4% women, 28.6% Black). At 2 years, the incidence of GIB, stroke, and death was 25.6%, 6.0%, and 12.3%, respectively. The multistate model included 39 total variables to predict risk of GIB (16 variables), stroke (10 variables), and death (19 variables). When ambulatory patients were classified according to their risk category, the 30-day observed event rate in the highest risk group for GIB, stroke, or death was 26.9%, 1.8%, and 4.8%, respectively. The multistate model predicted GIB, stroke, and death at any 30-day period with an area under the curve of 0.70, 0.69, and 0.86, respectively.</div></div><div><h3>Conclusions</h3><div>The multistate model informs 30-day risk in ambulatory LVAD recipients and allows recalculation of risk as new patient-specific data become available. The model allows for accurate risk stratification that predicts impending adverse events and may guide clinical decision making. (MOMENTUM 3 IDE Clinical Study Protocol; <span><span>NCT02224755</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1898-1912"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787996","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":"Cardiac Resynchronization Therapy in Ischemic Versus Nonischemic Cardiomyopathy","authors":"Saurabh Sudesh MD, MS ,&nbsp;William T. Abraham MD ,&nbsp;John G.F. Cleland MD, PhD ,&nbsp;Anne B. Curtis MD ,&nbsp;Daniel J. Friedman MD ,&nbsp;Michael R. Gold MD, PhD ,&nbsp;Valentina Kutyifa MD, PhD ,&nbsp;Cecilia Linde MD, PhD ,&nbsp;Anthony S. Tang MD ,&nbsp;Antonio Olivas-Martinez MD ,&nbsp;Lurdes Y.T. Inoue PhD ,&nbsp;Gillian D. Sanders PhD ,&nbsp;Sana M. Al-Khatib MD, MHS","doi":"10.1016/j.jchf.2024.08.010","DOIUrl":"10.1016/j.jchf.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Data on whether cardiac resynchronization therapy (CRT) results in better clinical and echocardiographic outcomes in patients with nonischemic cardiomyopathy (NICM) vs ischemic cardiomyopathy (ICM) are conflicting.</div></div><div><h3>Objectives</h3><div>The authors conducted this meta-analysis of 7 clinical trials of CRT to determine the association between etiology of cardiomyopathy and clinical and echocardiographic outcomes.</div></div><div><h3>Methods</h3><div>The authors analyzed patient-level data using Bayesian Hierarchical Weibull survival regression modeling to determine the association between etiology of cardiomyopathy and time to all-cause death or heart failure hospitalization (HFH). Linear regression was used to assess the association between etiology of cardiomyopathy and echocardiographic measurements.</div></div><div><h3>Results</h3><div>Of 6,252 patients included, 4,717 (75%) were men, median age was 66 years (IQR: 58-73 years), 3,704 (59%) had ICM, and 3,778 (60%) received CRT. CRT increased the time to HFH or all-cause death (HR: 0.67; 95% credible interval [CrI]: 0.56-0.82; <em>P &lt;</em> 0.001) with no difference by etiology of cardiomyopathy (HR ratio: 1.06 [95% CrI: 0.87-1.29]; <em>P =</em> 0.57). Likewise, CRT increased the time to all-cause death (HR: 0.71 [95% CrI: 0.55-0.93]; <em>P =</em> 0.019) with no difference by etiology of cardiomyopathy (HR ratio: 1.06 [95% CrI: 0.80-1.43]; <em>P =</em> 0.70). Echocardiographic data that were available for 2,430 (39%) patients showed that CRT improvements in left ventricular ejection fraction, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter were larger for patients with NICM.</div></div><div><h3>Conclusions</h3><div>Although CRT led to greater increases in left ventricular ejection fraction and reductions in ventricular dimensions for patients with NICM compared with those with ICM, CRT significantly increased the time to HFH or all-cause death independently of the etiology of cardiomyopathy. Further studies on improving patient selection for CRT are needed.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1915-1924"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465730","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":"Full Issue PDF","authors":"","doi":"10.1016/S2213-1779(24)00683-8","DOIUrl":"10.1016/S2213-1779(24)00683-8","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages I-CLXIV"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578381","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":"Heart Failure Drug Development Over the Eras","authors":"Vanessa Blumer MD ,&nbsp;James L. Januzzi Jr. MD ,&nbsp;JoAnn Lindenfeld MD ,&nbsp;Scott D. Solomon MD ,&nbsp;Mitchell A. Psotka MD, PhD ,&nbsp;Peter E. Carson MD ,&nbsp;Michael R. Bristow MD, PhD ,&nbsp;William T. Abraham MD ,&nbsp;Charu Gandotra MD ,&nbsp;Benjamin R. Saville PhD ,&nbsp;Christopher O’Connor MD ,&nbsp;Mona Fiuzat PharmD ,&nbsp;Heart Failure Collaboratory","doi":"10.1016/j.jchf.2024.03.021","DOIUrl":"10.1016/j.jchf.2024.03.021","url":null,"abstract":"<div><div>Over the past decade, the field of heart failure (HF) has witnessed remarkable progress in drug development, resulting in the approval of numerous groundbreaking drugs by the U.S. Food and Drug Administration. To address some of these challenges, the U.S. Food and Drug Administration has issued guidance documents that have been critical in contemporary HF drug development; however, there are still many challenges in need of investigation. This paper leverages efforts of the Heart Failure Collaboratory and the scientific community to discuss the critical need for innovative trial designs, important concepts in clinical trials in the modern era, and the utilization of big data to accelerate HF drug development. At this inflection point in HF drug development, it is imperative that, as a global scientific community, we foster increased collaboration among researchers, clinicians, patients, and regulatory bodies. Only through such unified efforts can we navigate the complexities of HF, accelerate the development process, and ultimately deliver effective therapies that transform patient outcomes.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1803-1813"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Medical Therapy and Outcomes Among Patients With Chronic Heart Failure With Reduced Ejection Fraction","authors":"Vishal N. Rao MD, MPH ,&nbsp;Anne S. Hellkamp MS ,&nbsp;Laine E. Thomas PhD ,&nbsp;Gregg C. Fonarow MD ,&nbsp;Mona Fiuzat PharmD ,&nbsp;Christopher M. O’Connor MD ,&nbsp;John A. Spertus MD, MPH ,&nbsp;Akshay S. Desai MD, MPH ,&nbsp;Nancy M. Albert PhD ,&nbsp;Javed Butler MD, MPH, MBA ,&nbsp;Adrian F. Hernandez MD, MHS ,&nbsp;Adam D. DeVore MD, MHS","doi":"10.1016/j.jchf.2024.05.026","DOIUrl":"10.1016/j.jchf.2024.05.026","url":null,"abstract":"<div><h3>Background</h3><div>Optimal medical therapy (OMT) scoring may stratify clinical risk in real-world chronic heart failure with reduced ejection fraction (HFrEF) by integrating use and dosing of guideline-directed medical therapy (GDMT) for HFrEF.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to characterize patients and associated long-term clinical outcomes by OMT score-derived treatment groups.</div></div><div><h3>Methods</h3><div>CHAMP-HF (Change the Management of Patients with Heart Failure) included U.S. outpatients with chronic HFrEF receiving ≥1 GDMT. OMT subgroups were defined as suboptimal (score &lt;3), acceptable (score = 3), and optimal (score ≥4) by baseline use and dose of GDMT, as proposed by the HF Collaboratory consortium. Cox proportional hazard analyses were used to assess for all-cause and cardiovascular death across subgroups, after adjusting for demographic and clinical covariates.</div></div><div><h3>Results</h3><div>The authors studied 4,582 participants enrolled in CHAMP-HF with available 2-year follow-up. Median age was 68 years, 1,327 (29%) were women, and 2,842 (62%) were White, non-Hispanic. Median OMT score across the population was 4 (Q1-Q3: 2-5), and 1,628 (35%) had suboptimal, 665 (14%) had acceptable, and 2,289 (50%) had optimal therapy. Participants with optimal treatment were younger, had higher annual household income, and were enrolled from practices with dedicated HF clinics (all <em>P &lt;</em> 0.001) than participants with acceptable or suboptimal treatment. Participants with optimal treatment had lower all-cause death (adjusted HR: 0.77; 95% CI: 0.64-0.92) and cardiovascular death (adjusted HR: 0.79; 95% CI: 0.65-0.96) than those with suboptimal treatment.</div></div><div><h3>Conclusions</h3><div>Across a large cohort of chronic ambulatory HFrEF, OMT scores stratified risk of all-cause and cardiovascular death.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1862-1875"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STRONG-HF","authors":"Lisa J. Anderson MD","doi":"10.1016/j.jchf.2024.07.009","DOIUrl":"10.1016/j.jchf.2024.07.009","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 11","pages":"Pages 1859-1861"},"PeriodicalIF":10.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145667","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}