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Indications for cardiac resynchronization therapy. AF, atrial fibrillation; CLBBB, complete left bundle branch block; CRT, cardiac resynchronization therapy; Fc, functional class; HFrEF, heart failure with reduced ejection fraction; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; QRSd, QRS duration; RVP, right ventricular pacing.
Source publication
Heart failure is a growing epidemic, especially in Taiwan because of the aging population. The 2016 Taiwan Society of Cardiology - Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed that the guideline-recommended therapies were prescribed suboptimally both at the time of hospital discharge and during follow-up. We, therefore,...
Contexts in source publication
Context 1
... Of the improvements in quality-adjusted life years with CRT among patients with moderate to severe HF, two-thirds may be attributed to improved quality of life and one-third to increased longevity. 99 The indications are listed in Figure 4. ...
Citations
... Heart failure (HF), the final common stage of ASCVD, is associated with high morbidity and mortality. 2 ASCVD and HF share common risk factors, including hypertension, dyslipidemia, diabetes, obesity, smoking, and an unhealthy lifestyle. Thus, modifying these risk factors is crucial for both primary and secondary prevention of ASCVD. ...
... Thus, modifying these risk factors is crucial for both primary and secondary prevention of ASCVD. [1][2][3] Several risk prediction models have been developed to assess an individual's risk of ASCVD. The Framingham risk score (FRS) is the most well-known tool, and it has been widely used to predict the risk of CHD in middleaged patients since 1998. ...
... Heart failure (HF) is a highly prevalent major global public health issue. 1 Symptoms of deteriorating HF include reduced urine output, lower limb edema, weight gain, fatigue, loss of appetite, and cold extremities. 2 In Taiwan, the 6-month readmission and mortality rates of patients with HF are as high as 31.9% and 15.9%, respectively. ...
... This program is expected to reduce HF readmission rates, avoid disability and improve the quality of life of HF patients by integrating multidisciplinary team care. 1,5 To the best of our knowledge, most previous articles on HF-PAC programs have assessed readmission and mortality. However, our results demonstrated good efficacy in improving the patients' functional capacity, nutritional status, LVEF and quality of life after completing the HF-PAC program. ...
... In addition, all therapy processes must conform to the most recent European Society of Cardiology, ACC/AHA, and Taiwan Society of Cardiology (TSOC) guidelines. 1,24,25 According to the 2016 TSOC HF registry, the ratio of discharged patients with HF who received GDMT was approximately 60%. 10 After the TSOC promoted the advantages of GDMT to cardiologists, 95% of the patients receiving the HF-PAC program were on ACEIs/ARBs/ARNIs or b-blockers/I f channel inhibitors, and 78% were on MRAs. SGLT2is are new GDMT for HF, and they can reduce HF readmission and mortality rates. ...
Background:
The National Health Insurance Administration in Taiwan has promoted the heart failure post-acute care (HF-PAC) program as a means to provide proactive integrated care within the optimal treatment timeframe to enhance functional recovery after acute decompensated heart failure (HF).
Objectives:
The aim of this program was to reduce HF readmission rates, improved medication prescription rates, and improve the quality of life in HF patients.
Methods:
Patients who had a reduced left ventricular ejection fraction (LVEF) of ≤ 40% were included and followed up for 6 months after discharge. They underwent cardiac rehabilitation and physiological, and nutritional status evaluations. The main clinical outcomes of the HF-PAC program were guideline-directed medical therapy prescription rate and 6-month readmission rate.
Results:
A total of 122 patients were recruited from June 2018 to December 2020 at a medical center in southern Taiwan. The patients' activities of daily living, nutritional status, quality of life and LVEF were significantly improved during the HF-PAC program. More than 95% of the patients received guideline-directed medical prescriptions at the end of the HF-PAC program. The cardiovascular-related 6-month re-admission rate after the HF-PAC program ended was 27.7%, and it could be predicted by the New York Health Association functional class [hazard ratio (HR) 95% confidence interval (95% CI) = 4.12 (1.36-12.46)], value of the Mini Nutritional Assessment - Short Form [HR (95% CI) = 0.46 (0.31-0.68)] and LVEF [HR (95% CI) = 0.95 (0.91-0.99)].
Conclusions:
By incorporating multidisciplinary healthcare teams, the HF-PAC program improves the guideline- directed medical therapy prescription rate, thus improving patients' cardiac function, physical activity recovery, the quality of life, and also reduces their readmission rate.
... 5 Evidence-based medical (EBM) therapy, e.g., treatment with an angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blocker, or mineralocorticoid receptor antagonist (MRA), is the most effective strategy and the cornerstone treatment for HF with reduced ejection fraction (HFrEF). 6,7 Sacubitril/valsartan, an angiotensin receptor antag-onist and neprilysin inhibitor (ARNI), was recently shown to be superior to ACEI in reducing the risks of cardiovascular death and HF hospitalization (HFH) in The Prospective Comparison of Angiotensin Receptor Antagonist and Neprilysin Inhibitor with Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial (PARADIGM-HF). 8 Thus, most guidelines currently recommend ARNI as an EBM therapy for ambulatory patients with HFrEF. ...
... 8 Thus, most guidelines currently recommend ARNI as an EBM therapy for ambulatory patients with HFrEF. 6,7,9 However, whether different ARNI prescription timings are associated with different HF outcomes is uncertain. The PIONEER-HF study first demonstrated the feasibility of ARNI in patients in stable condition after acute decompensated HF (ADHF). ...
Background:
Angiotensin receptor neprilysin inhibition (ARNI) is superior to enalapril in reducing the risk of cardiovascular death and heart failure hospitalization (HFH). However, whether prescription pattern is associated with heart failure outcome is unknown.
Methods:
This is a retrospective study of 153 patients who received ARNI in a tertiary medical center in Taiwan. We analyzed the impact of dose up-titration and prescription timing including during initial admission, within 3 months after initial HFH discharge, and at outpatient clinics without prior HFH. The primary endpoint was the composite of cardiovascular death and HFH.
Results:
After a mean follow-up period of 287 ± 197 days, the primary endpoint occurred in 43 (28.1%) subjects. Patients without and with a primary endpoint significantly differed in terms of history of valvular heart disease (VHD, p = 0.006), ventricular tachyarrhythmia (VT, p = 0.043), percutaneous coronary intervention (p = 0.007), coronary artery bypass grafting (p = 0.002), chronic kidney disease (p = 0.002), age (p = 0.002), diastolic blood pressure (p = 0.025), and prescription timing (p = 0.002). Kaplan-Meier analysis showed ARNI up-titration and prescription timing had a significant association with primary endpoint-free survival (Breslow test; p = 0.032, and log-rank test; p = 0.001, respectively). Cox regression analysis showed that independent predictors for the primary endpoint were ARNI up-titration [hazard ratio (HR): 0.41, p = 0.024], non-hospital ARNI versus hospital ARNI (HR: 0.41, p = 0.009), VHD (HR: 2.71, p = 0.013), VT (HR: 3.09, p = 0.02), and age (HR: 1.03, p = 0.033).
Conclusions:
The prescription pattern of ARNI could be associated with heart failure events.
... Although cancer therapy-induced cardiac dysfunction (CTRCD), including heart failure, is well known, efficient therapy is still lacking (Kim et al. 2021;Wang et al. 2019). Therefore, early detection of minor myocardial dysfunction is important for its prevention (Bonsignore et al. 2021;Wang et al. 2019). ...
... Although cancer therapy-induced cardiac dysfunction (CTRCD), including heart failure, is well known, efficient therapy is still lacking (Kim et al. 2021;Wang et al. 2019). Therefore, early detection of minor myocardial dysfunction is important for its prevention (Bonsignore et al. 2021;Wang et al. 2019). However, facing an increasing number of cancer patients, physicians encounter difficulties in screening each individual sequentially (Bonsignore et al. 2021). ...
... CTRCD has detrimental effects on treatment outcomes in cancer survivors (Caro-Codon et al. 2020;Chang et al. 2020Chang et al. , 2022Wang et al. 2019). In contrast to the rescue strategy for cancer therapy-related myocardial damage, risk stratification of cancer patients before treatment provides potential solutions to improve their quality of life (Kim et al. 2021;Yang et al. 2019). ...
Although anti-cancer therapy-induced cardiotoxicity is known, until now it lacks a reliable risk predictive model of the subsequent cardiotoxicity in breast cancer patients receiving anthracycline therapy. An artificial intelligence (AI) with a machine learning approach has yet to be applied in cardio-oncology. Herein, we aimed to establish a predictive model for differentiating patients at a high risk of developing cardiotoxicity, including cancer therapy-related cardiac dysfunction (CTRCD) and symptomatic heart failure with reduced ejection fraction. This prospective single-center study enrolled patients with newly diagnosed breast cancer who were preparing for anthracycline therapy from 2014 to 2018. We randomized the patients into a 70%/30% split group for ML model training and testing. We used 15 variables, including clinical, chemotherapy, and echocardiographic parameters, to construct a random forest model to predict CTRCD and heart failure with a reduced ejection fraction (HFrEF) during the 3-year follow-up period (median, 30 months). Comparisons of the predictive accuracies among the random forest, logistic regression, support-vector clustering (SVC), LightGBM, K-nearest neighbor (KNN), and multilayer perceptron (MLP) models were also performed. Notably, predicting CTRCD using the MLP model showed the best accuracy compared with the logistic regression, random forest, SVC, LightGBM, and KNN models. The areas under the curves (AUC) of MLP achieved 0.66 with the sensitivity and specificity as 0.86 and 0.53, respectively. Notably, among the features, the use of trastuzumab, hypertension, and anthracycline dose were the major determinants for the development of CTRCD in the logistic regression. Similarly, MLP, logistic regression, and SVM also showed higher AUCs for predicting the development of HFrEF. We also validated the AI prediction model with an additional set of patients developing HFrEF, and MLP presented an AUC of 0.81. Collectively, an AI prediction model is promising for facilitating physicians to predict CTRCD and HFrEF in breast cancer patients receiving anthracycline therapy. Further studies are warranted to evaluate its impact in clinical practice.
... 9,10 Evidence-based HF guidelines recommend increasing ACEIs to a target dose unless there is a tolerability problem. 1,2,11 Concerning the tolerability of ACEIs, renal function, serum potassium, signs and symptoms of cough and angioedema should be measured within 1-2 weeks from the start of treatment. 1,11,12 ACEIs are generally well tolerated and high dose can be reached and maintained in the majority of patients with HF if increased properly, but some side effects such as hyperkalemia and hypotension might occur while using high dose of ACEIs. ...
... 1,2,11 Concerning the tolerability of ACEIs, renal function, serum potassium, signs and symptoms of cough and angioedema should be measured within 1-2 weeks from the start of treatment. 1,11,12 ACEIs are generally well tolerated and high dose can be reached and maintained in the majority of patients with HF if increased properly, but some side effects such as hyperkalemia and hypotension might occur while using high dose of ACEIs. 13,14 However, a study conducted in Sweden reported that 77% of patients practiced angioedema within the first 3 weeks of starting treatment. ...
... 42 Even though there is an improvement in patients' symptoms of congestion, the dose of loop diuretics is not reduced which causes poor up-titration of ACEIs. 11,41 Mainly, the dose of furosemide needs to be optimized to allow titration of ACEIs to the target dose. So, clinicians should prescribe a dose of diuretics with careful attention taken for their negative effect of furosemide on the up-titration of ACEIs. ...
Introduction
Angiotensin-converting enzyme inhibitors dose optimizations (ACEIs) are essential to boost the treatment outcome in heart failure patients (HF) with reduced ejection fraction. Therefore, the main purpose of this study was to evaluate dose optimization and associated factors of ACEIs among HF patients.
Method
An institutional-based retrospective study was conducted on 256 study participants from May 20 to August 30, 2020 in ambulatory care clinic at Felege Hiwot Comprehensive Specialized Hospital. A systematic random sampling method was carried out to select study participants. Data were collected from the patient interview and the review of medical records. Epidata and SPSS version 22 were used for data entry and analysis. A bivariate logistic regression analysis was done to determine the association of independent variables with a dose optimization of ACEIs.
Results
The mean age of the subjects in the study was 53.82 years with a standard deviation (SD) of 17.067 and more than half of (60.9%) the patients were unable to read and write. Among participants who were receiving ACEIs, only 30.6% were taking an optimal dose. Age ≥65 years (AOR 5.04 (2.81–12.56)) and a dose of furosemide ≥40 mg (AOR, 2.62 (1.28–16.74)) were significantly associated with the suboptimal dose of ACEIs.
Conclusion
Only one-third of patients received the optimum dose of ACEIs. Older age and dose of furosemide greater >40 mg were significantly associated with suboptimal dosing of ACEIs. Therefore, more attention must be given to older patients with HF in order to optimize the dose of ACEIs administered.
... Chronic heart failure (CHF) is the final common pathway of various cardiac diseases and is characterized by high morbidity and mortality (7). While morbidity due to CHF is high in many parts of the world, the etiologies are different. ...
Background
Heart failure (HF) is a major health problem that affects patients and healthcare systems worldwide. It is the leading cause of morbidity and death and negatively impacts the quality of life, healthcare costs, and longevity. However, the causes of death were not well defined. This study aimed to identify the determinants of death among patients with HF in the Amhara Region, Northwest Ethiopia.
Methods
A multicenter retrospective cohort study was conducted on 285 patients in the age group 15 years or older under follow-up from 1 January 2015 to 31 December 2019. Descriptive analyses were summarized using the Kaplan–Meier survival curve and the log-rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to 5 years after they were admitted to the HF department to follow up on their treatment.
Results
Out of 285 patients with HF, 93(32.6%) of the respondents were dying within 5 years of follow-up. Anemia was the common comorbid disease (30.5%), and valvular heart disease was the most common etiology (33.7%) of chronic heart failure in this study. This study showed a significant mortality difference between hospitals. HF patients with hypertension [adjusted hazard ratio (AHR): 3.5076, 95% confidence interval (CI): 1.43, 8.60], anemia (AHR: 2.85, 95% 1.61, 5.03), pneumonia (AHR: 2.02, 95% 1.20, 3.39), chronic kidney disease (2.23, CI: 1.31, 3.77), and diabetes mellitus (AHR: 2.42, 95% CI: 1.43, 4.09) were at a higher risk of death. Moreover, patients with symptoms listed in the New York Heart Association Class (III and IV), Ischemic Heart Disease and unknown etiologies, men (AHR: 2.76, 95%:1.59, 4.78), and those with a high pulse rate (AHR: 1.02, 95%:1.00, 1.04) were at a higher risk of death.
Conclusion
There was a mortality difference between hospitals. This study has revealed that HF patients with anemia, diabetes mellitus, pneumonia, hypertension, chronic kidney disease, HF etiologies, severe New York Heart Association Class (III and IV), men, and high pulse rate were the main factors associated with death. Health professionals could give more attention to patients whose pulse rate is high, men, and a patient who had comorbidities in the ward.
... While we categorize overall CV risks as "stages" to make this classification scheme consistent with that being used in the classification of heart failure. 240,241 Further, stages, compared with grades, have a broader meaning concerning BP burden, damages incurred, and prognostic prediction. ...
Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.
... Recent studies have supported the notion that recurrent dysfunction with rechallenge from chemotherapy treatment may lead to intractable heart failure or death without suitable interventions and adjustments in the chemotherapy regimen. The concept of type I irreversible and type II reversible cardiotoxicity was introduced by Ewer and Lippman, whose studies mainly focused on anthracyclines and trastuzumab [5,6]. Emerging evidence has been reported that doxorubicin, an anthracycline that blocks topoisomerase 2, can cause type I cancer therapeutics-related cardiovascular dysfunction (CTRCD). ...
... Electron micrographic observations of myocardial biopsies have shown that trastuzumab does not result in cell damage [7]. Type II CTRCD has also been observed in other cancer treatments, such as anti-HER2-targeted therapies (the monoclonal antibodies pertuzumab and trastuzumab emtansine), and the tyrosine kinase inhibitor (TKI) lapatinib [6,8]. ...
Cardiovascular toxicity has emerged as the leading cause of death in patients undergoing cancer treatment. Thus, cardio-oncology (CO) care must also focus on the prevention and management of related cardiovascular (CV) complications caused by cancer therapy. Neutrophil extracellular traps (NETs)—entities with released DNA, proteases, proinflammatory and prooxidative substances from blasted neutrophils—play an important role in cancer proliferation, propagation metastasis, and incident CV events (acute coronary syndrome, thromboembolic events, and heart failure). Although NETs have been shown to be involved in cancer progression and incident CV events, little is known about their relationship with cardio-oncology, especially on cancer treatment-related cardiovascular toxicity (CTRCT). This review aims to explore the evidence of the impact of NETs on cancer, CV events, and CTRCT, and the possible solutions based on the mechanism of NETs activation and NETs released toxic substances.
... [7][8][9][10] It has been also employed for use in nonpulmonary conditions such as chronic left heart failure, cerebro-vascular diseases, hemoglobinopathies, as well as for relief of breathlessness in advanced malignancies and chronic neuro-psychiatric conditions. [11,12] It is an important question to ponder whether one should consider LTOT as one of the maintenance and/or palliative drugs The COVID-19 pandemic during the last 2 years has brought oxygen therapy in a sharp focus. The widely televised visuals of people waiting for oxygen continue to haunt the health personnel. ...
... The diagnoses of HF and ischemic stroke were based on the definitions of clinical guidelines. 12,13 Myocarditis was diagnosed based on a guideline-recommended criteria that incorporate several variables, including clinical, biomarker, and imaging features. 14,15 Extracardiac immune-related adverse events were defined as pneumonitis, hepatitis, colitis, myositis/ dermatitis, endocrine disorders such as hypophysitis, pituitary or adrenal insufficiency, and neurologic disorders. ...
Background:
Despite the increasing prevalence of therapies utilizing immune checkpoint inhibitors (ICIs), the associated cardiovascular complications have been poorly reported. Given the fatality of ICI-related complications, especially myocarditis, optimal risk stratification to predict major adverse cardio- and cerebrovascular events (MACCEs) in patients receiving ICIs is mandatory.
Methods:
We collected clinical data from patients receiving ICIs, and the primary outcomes were MACCEs, including myocarditis, heart failure, and ischemic stroke. Other systemic immune responses relating to ICIs were also recorded. The median follow-up duration was 3 years.
Results:
Among 580 patients, the incidence of MACCEs was 3.9%. Older patients, male patients, and patients with lung cancer, liver cirrhosis, or diabetes had higher risks of MACCEs. There was no significant difference between the use of PD-1/PD-L1 inhibitors or CTLA inhibitors in terms of developing cardiovascular toxicities. The development of ICI-related MACCEs was associated with worse survival. Notably, after re-review by specialists, three patients eventually diagnosed with ICI-related myocarditis had not previously been identified. Only one was treated with pulse steroids, and none survived. The most common concomitant extracardiac immune-related adverse events were myositis/dermatitis, endocrine toxicity and hepatitis.
Conclusions:
Collectively, ICIs may lead to severe cardiovascular toxicities and require more attention. Early identification, proper diagnosis, and prompt treatment are pivotal for improving survival.
