[New Treatment Strategies in Patients with Heart Failure with Reduced Ejection Fraction: Beyond Neurohormonal Inhibition].

Patients affected by heart failure (HF) with reduced ejection fraction (HFrEF) are prone to experience episodes of worsening symptoms and signs despite continued therapy, termed "worsening heart failure" (WHF). Although guideline-directed medical therapy is well established, worsening of chronic heart failure accounts for almost 50% of all hospital admissions for HF with consequent higher risk of death and hospitalization than patients with "stable" HF. New drugs are emerging as cornerstones to reduce residual risk of both cardiovascular mortality and readmission for heart failure. The following review will debate about emerging definition of WHF in light of the recent clinical consensus released by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the new therapeutic strategies in cardiorenal patients.

[Seroconversion and immune response after anti-HBV vaccination in patients on chronic hemodialysis: comparison of two vaccines]. / Sieroconversione e risposta immunitaria dopo vaccinazione anti-HBV in pazienti sottoposti a trattamento emodialitico cronico: confronto tra due diversi protocolli di vaccinazione.

ESRD patients on hemodialysis (HD) have a high risk of HBV infections. Primary prevention through vaccination is a first choice to reduce the morbidity from HBV. Prevention can be accomplished by two types of vaccines. The aim of this study was to evaluate the serological response to HBV vaccination in a population of HD patients who were randomized to Fendrix or Engerix B according to common administration protocols. Ninety-two HD patients were randomized to Fendrix or Engerix B immunization protocols. Patients in the Fendrix arm received four intramuscular administrations of 20 micron g, while patients in the Engerix arm received three intramuscular administrations of 40 micron g with an optional booster dose at two months from the last administration in nonresponders. The seroconversion rates were higher in the Fendrix group than the Engerix group, with faster responses, higher titers and longer duration of immune memory. Fendrix seems to be more effective than the older vaccine, Engerix, especially in patients at high infection risk like those making up our study population. Other crucial factors for good outcomes in patient immunization were biological and dialysis age. This underlines the importance of early immunization protocols such as already discussed by many nephrologists.