Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC.

Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.

Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology.

Episodes of worsening symptoms and signs characterize the clinical course of patients with chronic heart failure (HF). These events are associated with poorer quality of life, increased risks of hospitalization and death and are a major burden on healthcare resources. They usually require diuretic therapy, either administered intravenously or by escalation of oral doses or with combinations of different diuretic classes. Additional treatments may also have a major role, including initiation of guideline-recommended medical therapy (GRMT). Hospital admission is often necessary but treatment in the emergency service or in outpatient clinics or by primary care physicians has become increasingly used. Prevention of first and recurring episodes of worsening HF is an essential component of HF treatment and this may be achieved through early and rapid administration of GRMT. The aim of the present clinical consensus statement by the Heart Failure Association of the European Society of Cardiology is to provide an update on the definition, clinical characteristics, management and prevention of worsening HF in clinical practice.

Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs.

Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population. Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective. Study Design: Cross-sectional cost of disease study. Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non-pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism. Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage. Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.

A Year in the Life of the EU-CardioRNA COST Action: CA17129 Catalysing Transcriptomics Research in Cardiovascular Disease.

The EU-CardioRNA Cooperation in Science and Technology (COST) Action is a European-wide consortium established in 2018 with 31 European country members and four associate member countries to build bridges between translational researchers from academia and industry who conduct research on non-coding RNAs, cardiovascular diseases and similar research areas. EU-CardioRNA comprises four core working groups (WG1-4). In the first year since its launch, EU-CardioRNA met biannually to exchange and discuss recent findings in related fields of scientific research, with scientific sessions broadly divided up according to WG. These meetings are also an opportunity to establish interdisciplinary discussion groups, brainstorm ideas and make plans to apply for joint research grants and conduct other scientific activities, including knowledge transfer. Following its launch in Brussels in 2018, three WG meetings have taken place. The first of these in Lisbon, Portugal, the second in Istanbul, Turkey, and the most recent in Maastricht, The Netherlands. Each meeting includes a scientific session from each WG. This meeting report briefly describes the highlights and key take-home messages from each WG session in this first successful year of the EU-CardioRNA COST Action.

Cost of heart failure management in Turkey: results of a Delphi Panel.

OBJECTIVE: To analyze health-related cost of heart failure (HF) and to evaluate health-related source utilization aiming to provide data on the economic burden of HF in actual clinical practice in Turkey. METHODS: The study used the Delphi process of seeking expert consensus of opinion including 11 cardiologists who are experienced in HF. The standardized questionnaire comprised items to reflect the opinion of the expert panelists on the distribution of the HF patients in terms of demographic and clinical characteristics and background disease states. Costs related to out-patient follow-up, in-patient follow-up, medications, and other therapies were also evaluated. RESULTS: 34.1% of the HF patients were in the age range of 60-69 years, and 62.3% were males. Coronary heart disease was the leading cause of HF (59.6%); 63.6% of the HF patients had reduced ejection fraction (rEF) and 42.3% were in New York Heart Association (NYHA)-II class. Approximately 75 % of the patients were followed up by a cardiology unit. The total annual visit number was estimated as 3.41. Approximately 32% of HF patients were hospitalized 1.64 times a year, for an average of 6.77 days each time. The total annual costs of all HF patients and HF-rEF patients were estimated as 1.537 TL and as 2.141 TL, respectively. CONCLUSION: The analysis demonstrating the magnitude of the economic impact of HF management on Turkey's healthcare system may help facilitate health and social policy interventions to improve the prevention and treatment of HF.

Diagnosis and management of acute heart failure.

Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an 'aged' population.As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department,intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge.

Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease limiting patients' survival. The prognosis of COPD worsens with the addition of right ventricular (RV) failure. Red cell distribution width (RDW) is a measure of variability in the size of circulating erythrocytes, and is a powerful predictor of outcomes in patients with both chronic and acute left heart failure. Here we attempted to test whether RDW could provide an early marker of RV failure in patients with COPD. METHODS: Thirty-nine consecutive patients with COPD were enrolled in the study. All patients had at least 10 years' history of COPD, and all were treated appropriately. Thirty-nine age-matched and sex-matched individuals were enrolled for comparison. Red cell distribution width was obtained in all patients before transthoracic echocardiography. Right ventricular parameters were evaluated, and RV failure was identified via lateral tricuspid annulus longitudinal motion and systolic-tissue Doppler velocity, using transthoracic echocardiography. RESULTS: Patients with COPD had significantly higher RDW values compared with control subjects (patients with COPD, mean ± SD, 16.1 ± 2.5; range, 12.3 to 23.3; control subjects, mean ± SD, 13.6 ± 1.3; range, 11.7 to 18.3; P < .001). In multivariable logistic regression, the presence of high RDW was the only parameter independently predicting RV failure in patients with COPD (odds ratio, 2.098; P = .017). Levels of RDW, obtained before echocardiography, predicted the presence of RV failure with a sensitivity of 70% and specificity of 93.1%, with a cutoff value of >17.7. CONCLUSION: Red cell distribution width may be used to identify COPD patients with RV failure.

The assessment of adherence of hypertensive individuals to treatment and lifestyle change recommendations.

OBJECTIVE: Most of studies about adherence in hypertension highlight the adherence to the medical treatment but do not include the adherence to the other recommendations, such as lifestyle modifications. The factors effective on adherence to each type of recommendation may differ. Accordingly, we aimed in this study to show that nonadherence to each recommendation should be assessed individually. METHODS: The study, which was designed as cross-sectional and descriptive, included 150 patients who were followed by the outpatient clinics for at least one year. A data collecting form with 44 questions was prepared by the investigators, and the patient adherence was assessed in five categories: medicine-related adherence, diet-related adherence, exercise-related adherence, measurement-related adherence and smoking related adherence. The face-to-face interview method was used to collect data. Statistical analysis was accomplished by Chi-square test and logistic regression analysis. RESULTS: Of 150 subjects included in the study, 94 (63%) were female and mean age was 56+/- 12 (20-81) years. Mean duration of drug use was 6.5+/- 6.5 years and the mean number of drugs used was 1.6+/- 0.8. The adherence to recommendations of medication, diet, exercise, home-blood measurement and smoking were 72%, 65%, 31% , 63% and 83%, respectively. Each patient was adherent to at least one recommendation, while 11% of patients were adherent to one recommendation, 23% - to two, 29% - to three, 24% - to four and 13% - to five. According to the regression analysis, factors effective on each type of adherence were found to be different from others. The presence of three or more types of adherence was related to income level (OR= 0.297; 95%CI - 0.132-0.666; <0.001) and presence of any other chronic disease (OR=2.329; 95% CI - 1.114-4.859; p=0.002). CONCLUSION: The rates of adherence to medicine and life-style changes were generally found to be low in hypertension. The cause of nonadherence is different according to the type of adherence. Each recommendation should be assessed individually in terms of adherence.