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1.
J Med Case Rep ; 15(1): 143, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33741059

RESUMEN

BACKGROUND: There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. CASE PRESENTATION: In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. CONCLUSIONS: The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.


Asunto(s)
/diagnóstico , Cardiomiopatías/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Trastornos Puerperales/diagnóstico , Edema Pulmonar/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Azitromicina/uso terapéutico , /terapia , Cardiomiopatías/tratamiento farmacológico , Cardiomiopatías/fisiopatología , Cesárea , Tos/fisiopatología , Diagnóstico Diferencial , Diuréticos/uso terapéutico , Disnea/fisiopatología , Ecocardiografía , Electrocardiografía , Femenino , Furosemida/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Interferón beta/uso terapéutico , Pulmón/diagnóstico por imagen , Preeclampsia , Embarazo , Trastornos Puerperales/tratamiento farmacológico , Trastornos Puerperales/fisiopatología , Edema Pulmonar/tratamiento farmacológico , Edema Pulmonar/fisiopatología , Volumen Sistólico , Tomografía Computarizada por Rayos X
2.
PLoS One ; 16(3): e0249043, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33755715

RESUMEN

BACKGROUND: We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. METHODS: Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. RESULTS: Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group. CONCLUSIONS: HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.


Asunto(s)
/patología , Enfermedades Cardiovasculares/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Hospitalización/estadística & datos numéricos , Adulto , Anciano , Instituciones de Atención Ambulatoria , Enfermedades Cardiovasculares/mortalidad , Bases de Datos Factuales , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Trasplante de Corazón , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia
3.
Circ Heart Fail ; 14(3): e007048, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33663235

RESUMEN

BACKGROUND: Empagliflozin reduces the risk of hospitalization for heart failure in patients with type 2 diabetes and cardiovascular disease. We sought to elucidate the effect of empagliflozin as an add-on therapy on decongestion and renal function in patients with type 2 diabetes admitted for acute decompensated heart failure. METHODS: The study was terminated early due to COVID-19 pandemic. We enrolled 59 consecutive patients with type 2 diabetes admitted for acute decompensated heart failure. Patients were randomly assigned to receive either empagliflozin add-on (n=30) or conventional glucose-lowering therapy (n=29). We performed laboratory tests at baseline and 1, 2, 3, and 7 days after randomization. Percent change in plasma volume between admission and subsequent time points was calculated using the Strauss formula. RESULTS: There were no significant baseline differences in left ventricular ejection fraction and serum NT-proBNP (N-terminal pro-B-type natriuretic peptide), hematocrit, or serum creatinine levels between the 2 groups. Seven days after randomization, NT-proBNP level was significantly lower in the empagliflozin group than in the conventional group (P=0.040), and hemoconcentration (≥3% absolute increase in hematocrit) was more frequently observed in the empagliflozin group than in the conventional group (P=0.020). The decrease in percent change in plasma volume between baseline and subsequent time points was significantly larger in the empagliflozin group than in the conventional group 7 days after randomization (P=0.017). The incidence of worsening renal function (an increase in serum creatinine ≥0.3 mg/dL) did not significantly differ between the 2 groups. CONCLUSIONS: In this exploratory analysis, empagliflozin achieved effective decongestion without an increased risk of worsening renal function as an add-on therapy in patients with type 2 diabetes with acute decompensated heart failure. Registration: URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000026315.


Asunto(s)
Compuestos de Bencidrilo/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización , Riñón/efectos de los fármacos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Compuestos de Bencidrilo/efectos adversos , Biomarcadores/sangre , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Creatinina/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Terminación Anticipada de los Ensayos Clínicos , Femenino , Glucósidos/efectos adversos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Japón , Riñón/fisiopatología , Masculino , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Estudios Prospectivos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
4.
Ther Adv Cardiovasc Dis ; 15: 17539447211002678, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33779401

RESUMEN

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are a relatively new class of antihyperglycemic drug with salutary effects on glucose control, body weight, and blood pressure. Emerging evidence now indicates that these drugs may have a beneficial effect on outcomes in heart failure with reduced ejection fraction (HFrEF). Post-approval cardiovascular outcomes data for three of these agents (canagliflozin, empagliflozin, and dapagliflozin) showed an unexpected improvement in cardiovascular endpoints, including heart failure hospitalization and mortality, among patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease or risk factors. These studies were followed by a placebo controlled trial of dapagliflozin in patients with HFrEF both with and without T2DM, showing a reduction in all-cause mortality comparable to current guideline-directed HFrEF medical therapies such as angiotensin-converting enzyme inhibitors and beta-blockers. In this review, we discuss the current landscape of evidence, safety and adverse effects, and proposed mechanisms of action for use of these agents for patients with HFrEF. The United States (US) and European guidelines are reviewed, as are the current US federally approved indications for each SGLT2 inhibitor. Use of these agents in clinical practice may be limited by an uncertain insurance environment, especially in patients without T2DM. Finally, we discuss practical considerations for the cardiovascular clinician, including within-class differences of the SGLT2 inhibitors currently available on the US market (217/300).


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Biomarcadores/sangre , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Progresión de la Enfermedad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Hospitalización , Humanos , Recuperación de la Función , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Resultado del Tratamiento
5.
Int Heart J ; 62(2): 437-440, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731532

RESUMEN

A 61-year-old woman suffered chest pain and was admitted to a nearby hospital emergency department. She was diagnosed with acute myocardial infarction probably due to thromboembolism in the left anterior descending coronary artery and aspiration thrombectomy was performed. Afterwards, she developed refractory heart failure with severe global left ventricular dysfunction and was transferred to our hospital. An 18F-FDG-PET/CT scan revealed abnormal 18F-FDG uptake in non-infarcted regions of the left ventricle. Non-caseating granulomas were detected by biopsy from a skin eruption. She was diagnosed with cardiac sarcoidosis. In cases of refractory heart failure which cannot be explained only by myocardial infarction, evaluation of other undiagnosed cardiomyopathies is important for optimal management.


Asunto(s)
Cardiomiopatías/complicaciones , Trombosis Coronaria/complicaciones , Insuficiencia Cardíaca/etiología , Infarto del Miocardio/etiología , Sarcoidosis/complicaciones , Cardiomiopatías/diagnóstico , Trombosis Coronaria/diagnóstico , Diagnóstico Diferencial , Electrocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Tomografía Computarizada por Tomografía de Emisión de Positrones , Sarcoidosis/diagnóstico
6.
Acute Med ; 20(1): 68-73, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33749695

RESUMEN

A 30-year-old female patient with a past medical history of pernicious anaemia presented with pleuritic chest pain, palpitations, fatigue, coryzal symptoms and a high temperature. She was hypoxic and tachycardic and was extensively investigated as well as aggressively treated. A type 1 'gut feeling' assessment by the admitting medical registrar made the diagnosis possible as thyroid function tests were grossly deranged and pointed to Graves' disease causing heart failure, complicated by pneumonia. The patient was discharged on carbimazole, antibiotics and beta blockers. Due to a resultant thrombocytopaenia, she has now been swapped onto propylthiouracil and is under active follow up.


Asunto(s)
Enfermedad de Graves , Insuficiencia Cardíaca , Tirotoxicosis , Adulto , Antitiroideos/uso terapéutico , Femenino , Enfermedad de Graves/complicaciones , Enfermedad de Graves/diagnóstico , Enfermedad de Graves/tratamiento farmacológico , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , Propiltiouracilo , Tirotoxicosis/complicaciones , Tirotoxicosis/diagnóstico , Tirotoxicosis/tratamiento farmacológico
7.
Heart Fail Clin ; 17(2): 167-177, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673942

RESUMEN

Stage A heart failure (HF) patients do not show HF symptoms or any structural heart disease but are at risk of HF development. Cardiovascular risk factors (hypertension, diabetes, metabolic syndrome, sedentary lifestyle, poor diet, and exposure to cardiotoxic agents) characterize subjects affected by stage A HF. It is essential to identify these subjects early and ensure that, despite being asymptomatic, they grasp the importance of undertaking correct lifestyle and therapeutic interventions. A careful stratification of asymptomatic subject's risk profile is needed to adopt proper preventive strategies and to set individualized therapeutic targets that avoid progression to advanced stages of HF.


Asunto(s)
Guías como Asunto , Insuficiencia Cardíaca/prevención & control , Progresión de la Enfermedad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Factores de Riesgo
8.
Heart Fail Clin ; 17(2): 187-194, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673944

RESUMEN

During the past decade, coronary computed tomography angiography has emerged as the primary modality to noninvasively detect and rule out coronary artery disease. Therefore, this technique could play an important role in identifying patients at high risk of heart failure, considering the high prevalence of coronary artery disease in these patients. The latest technologies have also increased diagnostic accuracy, helping to close the gap with the other functional imaging modalities.


Asunto(s)
Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/complicaciones , Insuficiencia Cardíaca/prevención & control , Tomografía Computarizada por Rayos X/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , Valor Predictivo de las Pruebas
9.
Heart Fail Clin ; 17(2): 207-221, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673946

RESUMEN

This review describes the current role and potential future applications of cardiac magnetic resonance (CMR) for the management of heart failure (HF). CMR allows noninvasive morphologic and functional assessment, tissue characterization, blood flow, and perfusion evaluation. CMR overcomes echocardiography limitations (geometric assumptions, interobserver variability and poor acoustic window) and provides incremental information in relation to cause, prognosis, and treatment monitoring of patients with HF.


Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Imagen por Resonancia Cinemagnética/métodos , Humanos , Pronóstico
10.
Heart Fail Clin ; 17(2): 245-254, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673948

RESUMEN

The heart and the arterial system are anatomically and functionally linked together. Noninvasive assessment of ventricular-arterial coupling (VAC) can be done using different methods that are promising tools to assess individual hemodynamics and tailor treatment in patients with heart failure (HF). Moreover, different methods available can be appropriately used in different settings such as acute and chronic HF. VAC parameters also can add incremental value over the conventional risk factors in predicting cardiac outcome.


Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Medición de Riesgo/métodos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Pronóstico
11.
Sensors (Basel) ; 21(4)2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33671930

RESUMEN

Heart failure (HF) hospitalisations due to decompensation are associated with shorter life expectancy and lower quality of life. These hospitalisations pose a significant burden on the patients, doctors and healthcare resources. Early detection of an upcoming episode of decompensation may facilitate timely optimisation of the ambulatory medical treatment and thereby prevent heart-failure-related hospitalisations. The HeartLogicTM algorithm combines data from five sensors of cardiac implantable electronic devices into a cumulative index value. It has been developed for early detection of fluid retention in heart failure patients. This review aims to provide an overview of the current literature and experience with the HeartLogicTM algorithm, illustrate how the index can be implemented in daily clinical practice and discuss ongoing studies and potential future developments of interest.


Asunto(s)
Desfibriladores Implantables , Insuficiencia Cardíaca , Algoritmos , Insuficiencia Cardíaca/diagnóstico , Humanos , Hidrodinámica , Masculino , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Volumen Sistólico , Función Ventricular Izquierda
16.
Circ Heart Fail ; 14(3): e007767, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33724883

RESUMEN

BACKGROUND: The expense of clinical trials mandates new strategies to efficiently generate evidence and test novel therapies. In this context, we designed a decentralized, patient-centered randomized clinical trial leveraging mobile technologies, rather than in-person site visits, to test the efficacy of 12 weeks of canagliflozin for the treatment of heart failure, regardless of ejection fraction or diabetes status, on the reduction of heart failure symptoms. METHODS: One thousand nine hundred patients will be enrolled with a medical record-confirmed diagnosis of heart failure, stratified by reduced (≤40%) or preserved (>40%) ejection fraction and randomized 1:1 to 100 mg daily of canagliflozin or matching placebo. The primary outcome will be the 12-week change in the total symptom score of the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes will be daily step count and other scales of the Kansas City Cardiomyopathy Questionnaire. RESULTS: The trial is currently enrolling, even in the era of the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) is deploying a novel model of conducting a decentralized, patient-centered, randomized clinical trial for a new indication for canagliflozin to improve the symptoms of patients with heart failure. It can model a new method for more cost-effectively testing the efficacy of treatments using mobile technologies with patient-reported outcomes as the primary clinical end point of the trial. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04252287.


Asunto(s)
Canagliflozina/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Telemedicina , Actigrafía/instrumentación , Canagliflozina/efectos adversos , Método Doble Ciego , Tolerancia al Ejercicio/efectos de los fármacos , Monitores de Ejercicio , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Aplicaciones Móviles , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Volumen Sistólico/efectos de los fármacos , Telemedicina/instrumentación , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Función Ventricular Izquierda/efectos de los fármacos
17.
Vasc Health Risk Manag ; 17: 49-58, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33623387

RESUMEN

Background: Heart failure is the third most fatal disease in Germany and generates considerable treatment costs. The multimodal program of inpatient rehabilitation can improve the symptoms and prognosis of these patients. At the present time, however, only few data are available on the effectiveness of rehabilitation for heart failure patients. Methods: After receiving study approval from the ethics committee of the Saxony-Anhalt Medical Association, 200 patients with a primary or secondary diagnosis of heart failure were prospectively included in the study at Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany. Baseline parameters such as age, gender, and BMI were documented. Outcome variables included NYHA classifications, quality of life, and mortality. For follow-up, the patients were contacted again by mail or phone after three and 12 months and, data on symptoms and serious events were recorded. Results: The proportion of patients with a highly reduced ejection fraction (HFrEF) was 13.5%, with a midrange reduced ejection fraction (HFmrEF) 33%, and with preserved ejection fraction (HFpEF) 53.5%. The mean age was 64 ± 11.9 years, the proportion of women 24.1%. The effects of rehabilitation were documented by low overall mortality (no patient died during the stay, only 4% of the patients died in the 12-month follow-up) and an improvement in NYHA classification during and after the inpatient rehabilitation. Conclusion: This monocentric study showed effects both for symptoms (improvement in NYHA classifications) and prognosis (overall mortality) after rehabilitation. These data reflect the effectiveness of multimodal rehabilitation and underscore the need for rehabilitation in patients diagnosed with heart failure after an acute event and hospital stay or who present with chronic deterioration.


Asunto(s)
Rehabilitación Cardiaca , Servicio de Cardiología en Hospital , Insuficiencia Cardíaca/rehabilitación , Pacientes Internos , Anciano , Rehabilitación Cardiaca/efectos adversos , Rehabilitación Cardiaca/mortalidad , Femenino , Alemania , Estado de Salud , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Recuperación de la Función , Volumen Sistólico , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular Izquierda
18.
Nutr Metab Cardiovasc Dis ; 31(3): 886-893, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33549461

RESUMEN

BACKGROUND AND AIMS: Until now, there are lack of established clinical factors allowing management of chronic heart failure (CHF) patients being at risk of cardiac cachexia (CC). The changes in soluble protein ST2 (sST2) concentrations suggest a valuable and prognostic usefulness of this biomarker in monitoring patients with CHF, especially those who potentially are prompt to develop CC. The aim of this study was to assess the potential role of sST2 in male patients with CHF under cachexia condition. METHODS AND RESULT: 91 male patients were selected to the study group and underwent meticulous screening according to recent clinical guidelines in order to CHF and CC detection. Additionally all patients underwent assessment of body composition and sST2 testing. Patients were followed-up for 60 months. Plasma sST2 concentration was significantly increased in cachectic compared with non-cachectic patients (median: 27.40 ng/mL and 20.62 ng/mL; p < 0.001), however, in this group the EF% was reduced (mean: 34 ± 13.5% and 41 ± 14.5%; p = 0.029). Correlations between sST2 and CRP (R = 0.524; p < 0.001) and phase angle (PA) (R = -0.513; p < 0.001) were observed. CHF patients in whose the PA value ranged in Q1 (<3.06°) and sST2 concentration ranged in Q3 (>33.15 ng/mL) had higher risk of death (HR = 9.62 and 8.60, respectively). The death rate was the highest in cachectic group with the simultaneous presence of sST2-Q3 and PA-Q1 (87.5% of this group). They had almost 7-fold higher risk of death during follow-up period (HR = 6.89, p < 0.001). CONCLUSIONS: sST2 demonstrates potential utility in male patients with CHF under cachexia condition in prediction death rate.


Asunto(s)
Caquexia/sangre , Insuficiencia Cardíaca/sangre , Proteína 1 Similar al Receptor de Interleucina-1/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Composición Corporal , Caquexia/diagnóstico , Caquexia/mortalidad , Caquexia/fisiopatología , Enfermedad Crónica , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo
19.
Adv Clin Exp Med ; 30(1): 67-75, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33529509

RESUMEN

BACKGROUND: Despite the progress in the treatment of heart failure with reduced ejection fraction (HFrEF), the prognosis remains unfavorable. OBJECTIVES: To evaluate the effectiveness, tolerance and safety after one-year follow-up of Polish patients with stable chronic HFrEF treated with sacubitril/valsartan. MATERIAL AND METHODS: This was an observational multicenter study conducted in 3 centers (Kraków, Lódz and Warszawa) specializing in heart failure (HF). We enrolled 89 HFrEF patients (aged 59.3 ±13.5 years, 82% males) in NYHA class II-IV (ambulatory). Clinical, laboratory and echocardiographic parameters were evaluated at baseline and after a one-year follow-up. The composite endpoint was defined as death or urgent HF hospitalization. RESULTS: After 1 year, 80% of patients used 50% or more of the target dose of sacubitril/valsartan. After a year of treatment, there were significant improvements of HF symptoms, N-terminal prohormone B-type natriuretic peptide (NT proBNP), ejection fraction (EF), and distance in six-minute walk test (6MWP) (all p < 0.001). Patients treated with the highest dose of sacubitril/valsartan exhibited the greatest benefits. The safety profile was favorable and consistent with that previously reported; however, therapy discontinuation due to side effects occurred in 11% of patients. The independent predictors for composite endpoint (n = 24, 26.9%) were history of HF hospitalization, tricuspid annular plane systolic excursion (TAPSE) and angiotensin-converting-enzyme inhibitor (ACEI)-naive patients. CONCLUSIONS: Treatment of chronic HFrEF patients with sacubitril/valsartan is safe and is associated with significant clinical and objective improvement. The non-survivors had more advanced HF, so the initiation and uptitration of sacubitril/valsartan should be done early.


Asunto(s)
Aminobutiratos/uso terapéutico , Insuficiencia Cardíaca , Tetrazoles/uso terapéutico , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Combinación de Medicamentos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Polonia , Volumen Sistólico , Valsartán
20.
Sensors (Basel) ; 21(3)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33525556

RESUMEN

Heart failure (HF) is a major health care issue, and the incidence of HF is only expected to grow further. Due to the frequent hospitalizations, HF places a major burden on the available hospital and healthcare resources. In the future, HF care should not only be organized solely at the clinical ward and outpatient clinics, but remote monitoring strategies are urgently needed to guide, monitor, and treat chronic HF patients remotely from their homes as well. The intuitiveness and relatively low costs of non-invasive remote monitoring tools make them an appealing and emerging concept for developing new medical apps and devices. The recent COVID-19 pandemic and the associated transition of patient care outside the hospital will boost the development of remote monitoring tools, and many strategies will be reinvented with modern tools. However, it is important to look carefully at the inconsistencies that have been reported in non-invasive remote monitoring effectiveness. With this review, we provide an up-to-date overview of the available evidence on non-invasive remote monitoring in chronic HF patients and provide future perspectives that may significantly benefit the broader group of HF patients.


Asunto(s)
Continuidad de la Atención al Paciente/tendencias , Insuficiencia Cardíaca/terapia , Monitoreo Fisiológico/métodos , Telemedicina/tendencias , Insuficiencia Cardíaca/diagnóstico , Humanos , Pandemias , Telemetría , Teleenfermería
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