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More 'Malignant' Than Cancer? Five-Year Survival Following a First Admission for Heart Failure
Abstract
The prognostic impact of heart failure relative to that of 'high-profile' disease states such as cancer, within the whole population, is unknown.
All patients with a first admission to any Scottish hospital in 1991 for heart failure, myocardial infarction or the four most common types of cancer specific to men and women were identified. Five-year survival rates and associated loss of expected life-years were then compared.
In 1991, 16224 men had an initial hospitalisation for heart failure (n=3241), myocardial infarction (n=6932) or cancer of the lung, large bowel, prostate or bladder (n=6051). Similarly, 14842 women were admitted for heart failure (n=3606), myocardial infarction (n=4916), or cancer of the breast, lung, large bowel or ovary (n=6320). With the exception of lung cancer, heart failure was associated with the poorest 5-year survival rate (approximately 25% for both sexes). On an adjusted basis, heart failure was associated with worse long-term survival than bowel cancer in men (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97; P<0.01) and breast cancer in women (odds ratio, 0.59; 95% CI, 0.55-0.64; P<0.001). The overall population rate of expected life-years lost due to heart failure in men was 6.7 years/1000 and for women 5.1 years/1000.
With the notable exception of lung cancer, heart failure is as 'malignant' as many common types of cancer and is associated with a comparable number of expected life-years lost.
... While there are many similarities between HF and cancer, including mortality, there are significant distinctions that must be accounted for in clinical practice and public health interventions [23]. Recent treatment advances have resulted in a substantial improvement in survival for patients with HF [24], whereas the prognosis for cancer patients has not improved as much as for patients with HF [23], despite greater expenditures [25]. ...
... While there are many similarities between HF and cancer, including mortality, there are significant distinctions that must be accounted for in clinical practice and public health interventions [23]. Recent treatment advances have resulted in a substantial improvement in survival for patients with HF [24], whereas the prognosis for cancer patients has not improved as much as for patients with HF [23], despite greater expenditures [25]. In addition, we have more data regarding cancer awareness in the general population, which is generally regarded as adequate and analogous to patient knowledge [26][27][28][29]. ...
Background Heart failure (HF) continues to be a globally prevalent condition with a poor prognosis, severe morbidity, and a high mortality rate. Despite the severity of HF, relatively few studies on public awareness of the condition have been published, with the majority indicating that awareness is quite low. This study aimed to determine HF knowledge in the general Saudi community and its associated predictors. Methods An online survey was used to conduct a cross-sectional study on the Saudi population. The publicity committee of the Korean Society of Heart Failure drafted the questionnaire used in the present investigation. Three questions assessed knowledge of cardiovascular (CV) and cerebrovascular disorders; four questions assessed knowledge of HF, its etiology, and severity; and three questions assessed knowledge of readmission, mortality, and lifetime risk. Results A total of 1,124 respondents completed the questionnaire. Approximately half of the respondents (50.1%, n = 563) were unaware that HF is a pathological rather than a physiological process. Only 13.8% of the respondents were aware that the lifetime risk of developing HF is 20%, with even lower rates of correct responses for the one-year readmission rate (7.4%) and post-discharge one-year mortality from acute HF (7.3%). Female gender and lower levels of education were associated with a lack of HF awareness. A multivariate analysis revealed that income and information source were substantially associated with cardiovascular disorder knowledge. Age, education, alcohol consumption, and information source were associated with awareness of the severity of HF. Conclusion The general population in Saudi Arabia (SA) exhibited a relatively low degree of knowledge of HF. We suggest increasing public awareness of HF through an educational campaign led by medical personnel and disseminated via various social media websites. Changes should be made to national healthcare policies to provide healthcare institutions with continuous promotion and iterative campaigns about healthy lifestyles and preventive activities to reduce disease-related costs and disability. HF awareness must be raised through increased concentration and education.
... Stewart's study, which enrolled 16,224 men and 14,842 women admitted to the hospital for heart failure, myocardial infarction, or cancer, found that male patients lose about 6.7 years of life expectancy per 1,000 people, and 5.1 years per 1,000 for women. The mortality rate for heart failure was found to be higher than that of many cancers (13). An observational study suggested that the mortality rate of HF patients during five years of hospitalization is over 65% (14). ...
Background and aims
Hyperthyroidism is an endocrine disease with multiple etiologies and manifestations. Heart failure (HF) is a common, costly, and deadly medical condition in clinical practice. Numerous studies have suggested that abnormal thyroid function can induce or aggravate the development of heart disease. However, no study has demonstrated a causal relationship between hyperthyroidism and heart failure. Therefore, the purpose of this study was to explore the causal link between hyperthyroidism and HF.
Methods
Summary data for genetically predicted hyperthyroidism were obtained from a genetic association study. The data examined for genetically determined all-cause heart failure came from 218,208 individuals from the FinnGen Consortium. Two-sample Mendelian randomization (MR) analysis was used to estimate the causal link between hyperthyroidism and heart failure. Statistical analyses were conducted using the inverse variance-weighted, weighted median, simple median, weighted mode, MR-PRESSO (number of distribution = 5000), MR-Egger, and leave-one-out.
Results
The results of the inverse-variance weighted analysis indicated a causal association between hyperthyroidism and an increased risk of all-cause heart failure (IVW: β=0.048, OR=1.049, 95%CI: [1.013 to 1.087], P=0.007). Similarly, the weighted median approach demonstrated a positive correlation between hyperthyroidism and all-cause heart failure (OR=1.049, [95% CI, 1.001-1.100]; P=0.044). Additionally, no horizontal pleiotropy or heterogeneity was observed. The leave-one-out analysis revealed that the majority of the SNP-driven associations were not influenced by a single genetic marker.
Conclusion
Our study observed a causal relationship between hyperthyroidism and all-cause heart failure. Hyperthyroidism may associate with heart failure genetically.
... A large type 2 diabetes cohort from the national Swedish registry and followed-up for 5.7 years showed that type 2 diabetes without other risk factors had no or weak increase risk of MI, stroke or mortality compared to the general population, while they had a clear increase of HF risk [12]. This important HF incidence is particularly worrying in view of the very poor prognosis of this pathology with a reduced life expectancy compared to myocardial infarction and even to most solid cancers (except lung) [36]. It has also been shown that the prognosis of heart failure is even worse in association with diabetes, with a factor 2 higher all-cause mortality in this population [37]. ...
Background
Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal diseases (CVRD) manifestations for type 2 diabetes. The objective was to estimate the incidence of the first occurring CVRD manifestation and cumulative hospitalization costs of each CVRD manifestation for type 2 diabetes without CVRD history.
Methods
A cohort study of all type 2 diabetes free of CVRD as of January 1st 2014, was identified and followed-up for 5 years within the French SNDS nationwide claims database. The cumulative incidence of the first occurring CVRD manifestation was estimated using the cumulative incidence function, with death as a competing risk. Cumulative hospitalization costs of each CVRD manifestations were estimated from the perspective of all payers.
Results
From 2,079,089 type 2 diabetes without cancer or transplantation, 76.5% were free of CVRD at baseline with a mean age of 65 years, 52% of women and 7% with microvascular complications history. The cumulative incidence of a first CVRD manifestation was 15.3% after 5 years of follow-up with a constant linear increase over time for all CVRD manifestations: The most frequent was CKD representing 40.6% of first occurred CVRD manifestation, followed by HF (23.0%), then PAD (13.5%), stroke (13.2%) and MI (9.7%). HF and CKD together reached about one patient out of ten after 5 years and represented 63.6% of first CVRD manifestations. The 5-year global cost of all CVRD hospitalizations was 3.9 billion euros (B€), i.e. 2,450€ per patient of the whole cohort, with an exponential increase over time for each specific CVRD manifestation. The costliest was CKD (2.0 B€), followed by HF (1.2 B€), then PAD (0.7 B€), stroke (0.6 B€) and MI (0.3 B€).
Conclusions/interpretation
While MI, stroke and PAD remain classic major risks of complications for CVRD-free type 2 diabetes, HF and CKD nowadays represent individually a higher risk and cost than each of these classic manifestations, and jointly represents a risk and a cost twice as high as these three classic manifestations all together. This should encourage the development of specific HF and CKD preventive strategies.
... Heart failure is a condition that worsens over time and can significantly impact a person's quality of life and increase their risk of death [6,7]. It is characterized by elevated ventricular filling pressures and poor organ perfusion, which can lead to dysregulated homeostasis and metabolic issues. ...
Several studies have shown that an association exists between hyperuricemia and heart failure. Despite several innovative management strategies, heart failure is a significant cause of mortality worldwide. Hyperuricemia in heart failure patients leads to poorer outcomes. Additionally, hyperuricemia can be a strong surrogate marker for increased oxidative stress in heart failure patients. This oxidative stress leads to vascular endothelial damage and is linked to worsening heart failure and subsequent mortality. Hence, the measurement of serum uric acid levels in these patients can predict the present and future risk of complications of heart failure. Despite this knowledge, serum uric acid levels are not usually followed up in heart failure patients. This systematic review aims to give additional clarity to this association. We used research from the last twenty years (2002 to 2022) obtained from databases such as PubMed, PubMed Central (PMC), Google Scholar, and Science Direct. We used the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guidelines. We removed duplicates, screened articles on the basis of title and abstract, applied eligibility criteria, and performed quality appraisal. Eventually, 15 articles were selected for review. There were 12 observational studies, two randomized controlled trials, and one meta-analysis. Our review showed that serum uric acid elevation is associated with the severity and complications of congestive heart failure. Serum uric acid can serve as a useful surrogate marker of oxidative stress in congestive heart failure (CHF) patients. The role of xanthine oxidase inhibitors needs to be evaluated further in CHF patients.
... The readmission rate after discharge from hospital is high, up to 50% being readmitted within 6 months [74,75]. Despite remarkable improvements in therapy, the prognosis remains disappointedly poor with a 5-year mortality of 40-50% [76,77], with the greatest risk of death early after discharge from hospital [78]. Thus, systematic surveillance early post-discharge is important. ...
PCC in the field of cardiology is recommended in all contemporary cardiology guidelines. The few randomized studies and the many uncontrolled investigations on the effects of the PCC approach on clinical outcomes give scientific validity to the fact that PCC is not just ethical and associated with patient satisfaction, but it is also associated with better cardiology clinical outcomes. Evidence-based therapies are generally delivered following the Picker Institute’s eight principles of care by several cardiology teams, such as the heart failure clinic and the acute ST-segment elevation myocardial infarction care team. However, in other cardiology settings PCC is a work-in-progress in need of further education, dissemination, and implementation.In this chapter, a review of the strengths and weaknesses as well as possible barriers for an optimal PCC are presented in the most common cardiology settings. The ample opportunities for education, discussion, and addressing the preferences, needs, and values of individual patients with chronic conditions are in contrast with the time-constrains available when caring for patients with life-threatening acute cardiac conditions. Thus, superior communication skills and skilled and motivated multidisciplinary teams are needed to reach meaningful shared-decisions for management in each clinical scenario. Additionally, the need for a continuous open line of communication is emphasized since patient’s preferences may change quickly when their clinical condition changes suddenly. Lastly, we call for more randomized studies to accumulate additional data on the scientific validity of PCC, and perhaps then PCC and methods to accomplish it would be placed more prominently in all cardiology guidelines.KeywordsPerson centered cardiology carePerson centered careCoronary artery diseaseHypertensionDyslipidemiaEmpathyShared decisionsClinical outcomesAdherenceGuidelinesHeart failureAnginaPrimary and secondary prevention
... In many developed countries, acute HF is the main cause of hospital admission in patients over 65 years [8]. Its global prognosis is worse than that presented by patients with breast, prostate, or bowel cancer [9], and it worsens with each hospitalization [10]. ...
Heart failure (HF) is a severe disease and one of the most important causes of death in our society nowadays. A significant percentage of patients hospitalized for decompensation of heart failure are readmitted after some weeks or months due to an expected bad and uncontrolled HF evolution due to the lack of the patient supervision in real time. Herein is presented a straightforward electric model useful for volume leg section calculus based on the bioimpedance test as a way to assist with the acute HF patient’s supervision. The method has been developed for time-evolution edema evaluation in patients’ corresponding legs. The data are picked up with a wearable device specifically developed for acute heart failure patients. As an initial step, a calibration method is proposed to extract the extracellular volume component from bioimpedance measurements done in healthy subjects, and then applied to unhealthy ones. The intra- and extracellular resistance components are calculated from fitted Cole–Cole model parameters derived from BI spectroscopy measurements. Results obtained in a pilot assay, with healthy subjects and heart failure subjects, show sensitivities in leg volume [mL/Ω], with much lower values for healthy than in unhealthy people, being an excellent biomarker to discriminate between both. Finally, circadian cycle evolution for leg volume has been measured from the bioimpedance test as an extension of the work, enabling an alternative parameter for the characterization of one day of human activity for any person.
... Heart failure (HF) is a progressive condition associated with poor quality of life 1 and high mortality. 2 It is characterised by a complex pathophysiology, including elevated ventricular filling pressure and impaired organ perfusion, affecting homeostasis and causing metabolic derangement. Hyperuricaemia refers to elevated uric acid (UA) level and is a metabolic complication frequently observed in HF. ...
Objective
The role of hyperuricaemia as a prognostic maker has been established in chronic heart failure (HF) but limited information on the association between plasma uric acid (UA) levels and central haemodynamic measurements is available.
Methods
A retrospective study on patients with advanced HF referred for right heart catherisation. Regression analyses were constructed to investigate the association between UA and haemodynamic variables. Cox models were created to investigate if UA was a significant predictor of adverse outcome where log1.1(UA) was used to estimate the effect on outcome associated with a 10% increase in UA levels.
Results
A total of 228 patients were included (77% males, age 49±12 years, mean left ventricular ejection fraction (LVEF) of 17%±8%). Median UA was 0.48 (0.39–0.61) mmol/L. UA level was associated to pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) in univariable (both p<0.001) and multivariable regression analysis (p<0.004 and p=0.025 for PCWP and CI). When constructing multivariable Cox models including PCWP, CI, central venous pressure, age, estimated glomerular filtration rate (eGFR), use of loop diuretics and LVEF, log1.1(UA) independently predicted the combined endpoint (left ventricular assist device, total artificial heart implantation, heart transplantation or all-cause mortality) (hazard ratio (HR): 1.10 (1.03–1.17), p=0.004) as well as all-cause mortality (HR: 1.15 (1.06–1.25), p=0.001).
Conclusions
Elevated UA is associated with greater haemodynamic impairment in advanced HF. In adjusted Cox models (age, eGFR, LVEF and haemodynamics), UA predicts the combined endpoint and all-cause mortality in long-term follow-up.
... Data showed that the 5-year mortality rate of patients with chronic heart failure is 52%, and the survival rate is even lower than that of malignant tumours (Go et al., 2013;Stewart et al., 2001). ...
Aim:
The purpose of this study is to explore the influence of self-management intervention on four prognostic indicators of readmission rate, mortality rate, self-management ability and quality of life in patients with chronic heart failure.
Design:
A meta-analysis.
Methods:
This study was selected from the related studies published from January 1999 to January 2022, and was searched by searching five databases: PubMed, Science of Website, China National Knowledge Infrastructure (CNKI), Wan Fang and Wei Pu (VIP). All standardized randomized controlled trial studies were collected, and the quality evaluation and meta-analysis of the included literature were conducted.
Results:
This study included 20 randomized controlled trials involving 3459 patients with chronic heart failure. Meta-analysis results showed that self-management intervention could reduce the readmission rate of patients with chronic heart failure, improved self-management ability of patients, improved quality of life, but there was no statistical significance in mortality.
... The prevalence of HF is increasing and the prognosis of survival is similar to that of cancer. 16 It is paramount then that public awareness on the issue be greater, which may contribute to more effective diagnosis and quicker implementation of the desired treatment, ultimately improving patient outcomes. Therefore, we decided to design a non-standardised survey in such a way that the subjects could freely choose which part of treatment and communication should be improved. ...
Objective:
The aim of this study was to analyse the understanding of heart failure (HF) by the general public and find the best way to raise people's awareness of this issue.
Methods:
This prospective, survey-based registry involved 501 people over 18 years old. The survey included information on the participants' gender, education, place of residence, medical history, involvement in any area of healthcare, and having relatives suffering from HF. The participants were divided into three age groups, young (< 40 years), middle aged (40-65 years) and elderly (> 65 years), and two groups, depending on whether the participant's relative was a HF sufferer or not.
Conclusion:
Despite an increasing prevalence of heart failure, the general public still has insufficient knowledge on symptoms, causes and treatment methods of this disease. New methods of disseminating information should be considered in order to stop an escalating problem of low awareness of heart failure.
Heart failure (HF) is associated with disabling symptoms, poor quality of life, and a poor prognosis with substantial excess mortality in the years following diagnosis. Overactivation of the sympathetic nervous system is a key feature of the pathophysiology of HF and is an important driver of the process of adverse remodelling of the left ventricular wall that contributes to cardiac failure. Drugs which suppress the activity of the renin-angiotensin-aldosterone system, including β-blockers, are foundation therapies for the management of heart failure with reduced ejection fraction (HFrEF) and despite a lack of specific outcomes trials, are also widely used by cardiologist in patients with HF with preserved ejection fraction (HFpEF). Today, expert opinion has moved away from recommending that treatment for HF should be guided solely by the LVEF and interventions should rather address signs and symptoms of HF (e.g. oedema and tachycardia), the severity of HF, and concomitant conditions. β-blockers improve HF symptoms and functional status in HF and these agents have demonstrated improved survival, as well as a reduced risk of other important clinical outcomes such as hospitalisation for heart failure, in randomised, placebo-controlled outcomes trials. In HFpEF, β-blockers are anti-ischemic and lower blood pressure and heart rate. Moreover, β-blockers also reduce mortality in the setting of HF occurring alongside common comorbid conditions, such as diabetes, CKD (of any severity), and COPD. Higher doses of β-blockers are associated with better clinical outcomes in populations with HF, so that ensuring adequate titration of therapy to their maximal (or maximally tolerated) doses is important for ensuring optimal outcomes for people with HF. In principle, a patient with HF could have combined treatment with a β-blocker, renin-angiotensin-aldosterone system inhibitor/neprilysin inhibitor, mineralocorticoid receptor antagonist, and a SGLT2 inhibitor, according to tolerability.
Vascular tissue regeneration has gained a lot of interest, especially in addressing the challenges associated with vascular-related diseases and injuries. Hydrogels have shown great promise in the field of vascular tissue regeneration because of their special features, which include biocompatibility and mechanical characteristics that may be adjusted, as well as their likeness to the natural extracellular matrix. The fabrication techniques for vascular scaffolds have been the subject of much investigation due to the effectiveness of scaffold-based tissue engineering in producing new blood vessel tissues. The creation of vascular scaffolds has been greatly aided by recent developments in 3D printing, which presents an encouraging concept for the vascularization of tissues. This review covers the various cutting-edge hydrogel formulations, fabrication techniques, and strategies for the development of functional and biocompatible vascular scaffolds. The review also reveals these novel hydrogel-based techniques’ possible uses, difficulties, and possibilities for the future of vascular tissue regeneration.
Ischemic heart disease, which is one of the top killers worldwide, encompasses a series of heart problems stemming from a compromised coronary blood supply to the myocardium. The severity of the disease ranges from an unstable manifestation of ischemic symptoms, such as unstable angina, to myocardial death, that is, the immediate life-threatening condition of myocardial infarction. Even though patients may survive myocardial infarction, the resulting ischemia-reperfusion injury triggers a cascade of inflammatory reactions and oxidative stress that poses a significant threat to myocardial function following successful revascularization. Moreover, despite evidence suggesting the presence of cardiac stem cells, the fact that cardiomyocytes are terminally differentiated and cannot significantly regenerate after injury accounts for the subsequent progression to ischemic cardiomyopathy and ischemic heart failure, despite the current advancements in cardiac medicine. In the last two decades, researchers have realized the possibility of utilizing stem cell plasticity for therapeutic purposes. Indeed, stem cells of different origin, such as bone-marrow- and adipose-derived mesenchymal stem cells, circulation-derived progenitor cells, and induced pluripotent stem cells, have all been shown to play therapeutic roles in ischemic heart disease. In addition, the discovery of stem-cell-associated paracrine effects has triggered intense investigations into the actions of exosomes. Notwithstanding the seemingly promising outcomes from both experimental and clinical studies regarding the therapeutic use of stem cells against ischemic heart disease, positive results from fraud or false data interpretation need to be taken into consideration. The current review is aimed at overviewing the therapeutic application of stem cells in different categories of ischemic heart disease, including relevant experimental and clinical outcomes, as well as the proposed mechanisms underpinning such observations.
Sarcopenia, a clinical syndrome primarily associated with reduced muscle mass in the elderly, has a negative impact on quality of life and survival. It can occur secondarily to other diseases such as heart failure (HF), a complex clinical syndrome with high morbidity and mortality. The simultaneous occurrence of these two conditions can worsen the prognosis of their carriers, especially in the most severe cases of HF, as in patients with reduced left ventricular ejection fraction (LVEF). However, due to the heterogeneous diagnostic criteria for sarcopenia, estimates of its prevalence present a wide variation, leading to new criteria having been recently proposed for its diagnosis, emphasizing muscle strength and function rather than skeletal muscle mass. The primary objective of this study is to evaluate the prevalence of sarcopenia and/or dynapenia in individuals with HF with reduced LVEF according to the most recent criteria, and compare the gene and protein expression of those patients with and without sarcopenia. The secondary objectives are to evaluate the association of sarcopenia and/or dynapenia with the risk of clinical events and death, quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength. The participants will answer questionnaires to evaluate sarcopenia and quality of life, and will undergo the following tests: handgrip strength, gait speed, dual-energy X-ray absorptiometry, respiratory muscle strength, cardiopulmonary exercise, as well as genomic and proteomic analysis, and dosage of N-terminal pro-B-type natriuretic peptide and growth differentiation factor-15. An association between sarcopenia and/or dynapenia with unfavorable clinical evolution is expected to be found, in addition to reduced quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength.
Anthracyclines are highly potent anti-cancer drugs, but their clinical use is limited by severe cardiotoxic side effects. The impact of anthracycline-induced cardiotoxicity (AIC) on left ventricular (LV) microarchitecture and diffusion properties remains unknown. This study sought to characterize AIC by cardiovascular magnetic resonance diffusion tensor imaging (DTI). Mice were treated with Doxorubicin (DOX; n = 16) for induction of AIC or saline as corresponding control (n = 15). Cardiac function was assessed via echocardiography at the end of the study period. Whole hearts (n = 8 per group) were scanned ex vivo by high-resolution DTI at 7 T. Results were correlated with histopathology and mass spectrometry imaging. Mice with AIC demonstrated systolic dysfunction (LVEF 52 ± 3% vs. 43 ± 6%, P < 0.001), impaired global longitudinal strain (−19.6 ± 2.0% vs. −16.6 ± 3.0%, P < 0.01), and cardiac atrophy (LV mass index [mg/mm], 4.3 ± 0.1 vs. 3.6 ± 0.2, P < 0.01). Regional sheetlet angles were significantly lower in AIC, whereas helix angle and relative helicity remained unchanged. In AIC, fractional anisotropy was increased (0.12 ± 0.01 vs. 0.14 ± 0.02, P < 0.05). DOX-treated mice displayed higher planar and less spherical anisotropy (CPlanar 0.07 ± 0.01 vs. 0.09 ± 0.01, P < 0.01; CSpherical 0.89 ± 0.01 vs. 0.87 ± 0.02, P < 0.05). CPlanar and CSpherical yielded good discriminatory power to distinguish between mice with and without AIC (c-index 0.91 and 0.84, respectively, P for both < 0.05). AIC is associated with regional changes in sheetlet angle but no major abnormalities of global LV microarchitecture. The geometric shape of the diffusion tensor is altered in AIC. DTI may provide a new tool for myocardial characterization in patients with AIC, which warrants future clinical studies to evaluate its diagnostic utility.
Acute coronary syndromes (ACS) and cancer are among the leading causes of death worldwide. In recent years, increasing evidence has suggested an interplay between these 2 conditions. This article reviews the pathophysiology, diagnostic challenges, and treatment options for ACS and cancer. The interplay between these conditions may be due to environmental, genetic, and metabolic factors. For example, smoking, hypertension, and obesity are risk factors for both ACS and cancer. Diagnosis of ACS and cancer can be challenging because the symptoms of these conditions often overlap. For example, chest pain can be a symptom of both ACS and a neoplasms. Treatment options for ACS and cancer are varied and depend on the type of disease, stage of disease, and individual patient factors. Treatment for ACS may include angioplasty, stenting, or medication therapy. Treatment for cancer may include surgical removal of the tumour, radiation therapy, or chemotherapy.
Chronic heart failure is the most common cause of hospitalization in Europe and rates are steadily increasing due to aging of the population. Hospitalization identifies a fundamental change in the natural history of heart failure (HF) increasing the risk of re-hospitalization and mortality. Heart failure management programs improve the quality of care for HF patients and reduce hospitalization burden. The goals of the heart failure management programs include optimization of drug therapy, patient education, early recognition of signs of decompensation, and management of comorbidities. Randomized clinical trials evidenced that system of care for heart failure patients improved adherence to treatment and reduced unplanned re-admissions to hospital. Multidisciplinary programs and home-visiting have shown improved efficacy with reductions in HF and all-cause hospitalizations and mortality. Community HF clinics should take care of the management of stable patients in strict contact with primary care, while hospital out-patients clinics should care of patients with severe disease or persistent clinical instability, candidates to advanced treatment options. In any case a holistic, patient-centered approach is suggested, to optimize care considering the needs of the individual patient. Telemonitoring is a new opportunity for HF patients, because it allows the continuity of care at home. All heart failure patients should require follow-up in a specific management program, but most of date come from clinical trials that included high-risk patients. While clinical trials have a specified duration (from months to some years), lifelong follow-up is recommended with differentiated approaches according to the patient’s need.
Cardiovascular disease (CVD) is the leading cause of death among women globally, emphasizing the need for a healthcare approach that empowers women through agency. This review focuses on the critical role of women’s agency in navigating CVD, integrating insights from various fields, including medicine, education, psychology, and sociology. The review highlights the shift toward patient-centred care, a framework in which women are recognized as key decision-makers, a crucial change given the historical underemphasis on women’s health issues in medical practice. The diagnosis of CVD in women often involves emotional and psychological challenges. Unexpected diagnoses significantly disrupt perceived well-being, and prolonged diagnostic processes lead to professional skepticism and neglect of symptoms, resulting in delayed or inaccurate diagnoses and strained healthcare relationships. Effective management of CVD necessitates continuous self-management and a holistic approach to care, particularly for those with trauma who are at increased risk of cardiac incidents. Empowerment for women with CVD involves promoting self-confidence, autonomy, and active patient participation in healthcare. Implementing comprehensive care models is crucial for improving chronic CVD management, highlighting the need for healthcare systems that prioritize patient agency and empowerment. From the perspective of a woman with lived experience, this article examines the impact of CVD on women’s agency throughout the diagnostic journey. By highlighting women’s agency rather than particular behavioural changes, this review offers a comprehensive analysis that can shape policy, stimulate new research, and foster a more equitable, efficient, and empathetic healthcare system for women with CVD.
In patients with heart failure, guideline directed medical therapy improves outcomes and requires close patient monitoring. Pulmonary artery pressure monitors permit remote assessment of cardiopulmonary haemodynamics and facilitate early intervention that has been shown to decrease heart failure hospitalization. Pressure sensors implanted in the pulmonary vasculature are stabilized through passive or active interaction with the anatomy and communicate with an external reader to relay invasively measured pressure by radiofrequency. A body mass index > 35 kg/m² and chest circumference > 165 cm prevent use due to poor communication. Pulmonary vasculature anatomy is variable between patients and the pulmonary artery size, angulation of vessels and depth of sensor location from the chest wall in heart failure patients who may be candidates for pressure sensors remains largely unexamined. The present study analyses the size, angulation, and depth of the pulmonary artery at the position of implantation of two pulmonary artery pressure sensors: the CardioMEMS sensor typically implanted in the left pulmonary artery and the Cordella sensor implanted in the right pulmonary artery. Thirty-four computed tomography pulmonary angiograms from patients with heart failure were analysed using the MIMICS software. Distance from the bifurcation of the pulmonary artery to the implant site was shorter for the right pulmonary artery (4.55 ± 0.64 cm vs. 7.4 ± 1.3 cm) and vessel diameter at the implant site was larger (17.15 ± 2.87 mm vs. 11.83 ± 2.30 mm). Link distance (length of the communication path between sensor and reader) was shorter for the left pulmonary artery (9.40 ± 1.43 mm vs. 12.54 ± 1.37 mm). Therefore, the detailed analysis of pulmonary arterial anatomy using computed tomography pulmonary angiograms may alter the choice of implant location to reduce the risk of sensor migration and improve readability by minimizing sensor-to-reader link distance.
Introduction and objectives:
Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future.
Methods:
A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses.
Results:
Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for Patient Education and HF-awareness and 2 in 4 statements of both HF-diagnosis and Healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF-treatment statements registered full agreement but 3 of 4 achieved ≥ 80% of level 4 (agree) responses.
Conclusion:
This document aims to be a call to action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.
Background
Patients with heart failure have significant palliative care needs, but few are offered palliative care. Understanding the experiences of delivering and receiving palliative care from different perspectives can provide insight into the mechanisms of successful palliative care integration. There is limited research that explores multi-perspective and longitudinal experiences with palliative care provision. This study aimed to explore the longitudinal experiences of patients with heart failure, family carers, and health professionals with palliative care services.
Methods
A secondary analysis of 20 qualitative three-month apart interviews with patients with heart failure and family carers recruited from three community palliative care services in the UK. In addition, four group interviews with health professionals from four different services were analysed. Data were analysed using ‘reflexive thematic’ analysis. Results were explored through the lens of Normalisation Process Theory.
Results
Four themes were generated: Impact of heart failure, Coping and support, Recognising palliative phase, and Coordination of care. The impact of heart failure on patients and families was evident in several dimensions: physical, psychological, social, and financial. Patients developed different coping strategies and received most support from their families. Although health professionals endeavoured to support the patients and families, this was sometimes lacking. Health professionals found it difficult to recognise the palliative phase and when to initiate palliative care conversations. In turn, patients and family carers asked for better communication, collaboration, and care coordination along the whole disease trajectory.
Conclusions
The study provided broad insight into the experiences of patients, family carers, and health professionals with palliative care. It showed the impact of heart failure on patients and their families, how they cope, and how they could be supported to address their palliative care needs. The study findings can help researchers and healthcare professionals to design palliative care interventions focusing on the perceived care needs of patients and families.
Objective:
To investigate the correlation between serum laminin (LN) level and the prognosis of acute heart failure (AHF).
Methods:
A total of 199 patients with AHF treated in Nantong First People's Hospital from March 2019 to November 2021 were included in this study. The patients were divided into the event group and the non-event group according to whether major adverse cardiovascular events (MACEs) occurred during hospitalization. We collected the baseline data of all patients and their LN levels were measured. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of LN for the occurrence of MACE in AHF patients during hospitalization. Multivariate Logistic regression analysis was used to screen the independent factors associated with the occurrence of MACE in patients with AHF.
Results:
Among 199 patients with AHF, 43 were in the event group and 156 were in the non-event group. The area under ROC curve of LN to predict MACE in AHF patients during hospitalization was 0.8144, 95% confidence interval (CI): 0.7433-0.8855, p < .0001, cutoff point = 77.9, specificity 58.33%, and sensitivity 88.37%. Multivariate logistic regression analysis showed that the independent factors associated with the occurrence of MACE in AHF patients were the increase of LN level (odds ratio [OR]: 1.020, 95% CI: 1.012-1.028), the decrease of ejection fraction (OR: 0.007, 95% CI: 0.000-0.362) and diastolic blood pressure (OR: 0.946, 95% CI: 0.913-0.981; p < .05).
Conclusion:
The increase of LN level is independently correlated with the occurrence of MACE in AHF patients during hospitalization, which has the potential to be a serological indicator for poor prognosis in patients with AHF.
Infection is a common cause of hospitalization in patients with heart failure (HF). The impact of infection on long term cardiovascular outcome in HF is not well studied. The aim of this study was to compare the long term risk of major adverse cardiovascular events (MACE) in HF patients with or without prior hospitalization for infection. From 2009 to 2015, 310,485 patients with their first HF admissions were enrolled from the Taiwan National Health Insurance Research Database. Among the patients, those with readmission due to infection within one year after HF discharge were defined as infection group and those without any infection admission were controls. The propensity score matching method was used to balance covariates between the two groups. Patients were followed until the occurrence of any component of the MACE or the end date of the study, December 31, 2019. In a mean follow-up time of 4.29 ± 2.92 years, 86.19% of patients in the infection group and 63.63% of patients in the control group had MACE. Multivariate Cox proportional hazards analysis showed the infection group had a higher risk of MACE (HR 1.760, 95% CI 1.714–1.807), including all-cause mortality (HR 1.587, 95% CI 1.540–1.636), myocardial infarction (HR 1.332, 95% CI 1.224–1.450), stroke (HR 1.769, 95% CI 1.664–1.882) and hospitalization for HF (HR 1.993, 95% CI 1.922–2.066). In conclusion, many HF patients discharged from the hospital experienced acute infection that required readmission. The patients had worse cardiovascular outcome after readmission for infectious disease compared to those without any infection.
Over the past decades, huge scientific efforts have been put into cardiac regeneration strategies. Although several strategies have been accepted for use in clinical practice, none has demonstrated great success in regenerating the cardiac tissue. Therefore, there are still significant challenges in repairing or regenerating cardiac tissue, which serves a predominantly biomechanical function. Furthermore, it is now evident that the mechanobiological interaction between cells and their mechanical environment is essential for tissue function and regeneration. Current cardiac regenerative strategies (i.e. cardiac cell therapy and tissue engineering) are based on administrating new healthy contractile cells within (or without) a healthy scaffold into the diseased cardiac environment. However, these strategies have widely omitted to restore the cellular mechanical environment present after cardiac injury. Therefore, the future cardiac regeneration strategies need to address the challenges of and questions on the role of biomechanics and mechanobiology in cardiac regeneration. This includes measurement and characterisation of multiscale mechanical properties of healthy and diseased cardiac tissue; development of in vitro and in silico models to understand the role of biomechanical factors in tissue regeneration; and translation of this information into the design of novel tissue-engineered strategies. In this chapter, we want to introduce the reader to the importance of mechanical considerations in the design of effective cardiac regeneration strategies.
Cardiac resynchronization therapy (CRT) is one of the few effective treatments for dyssynchronous heart failure (HF), where heart function is worsened due to an electrical substrate pathology causing delayed left ventricular activation. However, 40–50% of patients do not respond to treatment. In this book chapter, we review cardiac computer models of the electrophysiology, electromechanics, and hemodynamics of the heart that have been used to investigate HF pathophysiology and mechanisms underpinning CRT response. In the last decades, multi-scale heart models for dyssynchronous HF have been used to study the optimization of CRT delivery, in particular lead location and device settings, and to investigate emerging technologies to solve dyssynchrony. Nevertheless, these models require a large amount of clinical and experimental data to be generated and parametrized, as well as significant computational resources. These factors limit computational studies to one single heart or small patient numbers. Once these technical challenges are overcome, personalized models of the heart have the potential to help in HF diagnosis and treatment and to be incorporated into the clinical workflow.
A significant aspect of Person Centered Medicine involves the empowerment of individuals and communities, recognizing them as actors and protagonists in the construction of their own health. Thus, the empowering of community members may be helpfully framed by the proper understanding of person-centered care. Core notions or principles of this approach posit whole contextualised persons as the centre of health and as the goal and protagonists of health actions. But what is the relevant context? In recent years, it has become clear that the persons’ health is intimately linked to their social situation and to the broader environment in which they live.Substantial attention is directed in this manuscript to the understanding and procedures related to self-care praxis, including the Seven Pillars of Self-Care, the Self-Care Continuum and the Self-Care Matrix. Some attention is given to the emerging concept of inter-care or mutual care, and its potential conceptual and policy implications.This chapter focuses on three contextual levels—firstly, whole contextualised individuals and the range of their activities and behaviours relevant to their health. Secondly considered is the social situation (family and community) and, thirdly, the broader environment (the health system and the green and built environment) and how these can affect the health of persons as individuals and communities. Everyone lives in some sort of community and environment, which may either empower and enrich or hinder their health. A person-centred approach should consider these broader contexts while focusing on the persons involved.The chapter concludes with a discussion on the social and economic impact of self-care and inter-care by the empowered individuals and community, and how such forms of care can be considered as fundamental acts of person-centeredness.KeywordsEmpowermentIndividualsCommunitySelf-careInter-care person-centerednessSocial contextEnvironment
Prevention reduces lifestyle causes of poor health and targets those with the highest risk of ill health, which requires a nationally led drive that makes the priority to be people instead of the system. The fundamental difference between prevention and promotion is that prevention stops the illness from happening or deteriorating, while promotion encourages, enhances and even creates health. However, as prevention and promotion act synergistically in fulfilling each one’s scope, they are often used in tandem. In fact, some consider them as two separate but collaborating sectors in medicine and public health. The authors adopted the latter approach in this chapter, shaping the outline around the person- and people-centred perspective. Person-centred prevention can help with the current range of health sector pressures, which makes clear that a paradigm shift in effort and investment is needed from the curative biomedical approach to a more preventive or risk-avoiding approach to care. History has shown that preventive methods can be significant changers of population health outcomes. Many of the current pathologies burdening our health systems now have their origins in our lifestyle, behaviour, and environment.KeywordsPerson-centred preventionHealth factorsPublic health policyPatient-centred preventionPublic health stakeholdersHealth systemsCOVID-19
Covid-19 has rapidly spread and affected millions of people worldwide. For that reason, the public healthcare system was overwhelmed and underprepared to deal with this pandemic. Covid-19 also interfered with the delivery of standard medical care, causing patients with chronic diseases to receive subpar care. As chronic heart failure becomes more common, new management strategies need to be developed. Mobile health technology can be utilized to monitor patients with chronic conditions, such as chronic heart failure, and detect early signs of Covid-19, for diagnosis and prognosis. Recent breakthroughs in Artificial Intelligence and Machine Learning, have increased the capacity of data analytics, which may now be utilized to remotely conduct a variety of tasks that previously required the physical presence of a medical professional. In this work, we analyze the literature in this domain and propose an AI-based mHealth application, designed to collect clinical data and provide diagnosis and prognosis of diseases such as Covid-19 or chronic cardiac diseases.KeywordsCovid-19mHealth AppTelemonitoringData collection
Aims:
Heart failure (HF) therapy trials usually exclude cancer patients. We examined the association between cancer history and outcomes in trial participants with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF).
Methods and results:
We combined PARADIGM-HF and ATMOSPHERE, which enrolled HFrEF patients (n = 15 415) and we pooled HFpEF patients (ejection fraction ≥45%) enrolled in PARAGON-HF and CHARM-Preserved (n = 7363). The associations between cancer history, cardiovascular (CV) death, HF hospitalization, non-CV and all-cause death in these trials were examined. Incident cancer diagnoses during these trials were also measured. There were 658 (4.3%) and 624 (8.5%) patients with a cancer history in the HFrEF and HFpEF trials, respectively. HFrEF patients with a cancer history had a higher risk of HF hospitalization (adjusted hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.07-1.52, p = 0.007) and non-CV death (adjusted HR 1.57; 95% CI 1.16-2.12, p = 0.003) than those without. The risks of other outcomes were similar. There were no differences in the risk of any outcome in HFpEF patients with and without a cancer history. Adjusting for age and sex, the incidence of new cancer in the HFrEF and HFpEF trials was 1.09 (95% CI 0.83-1.36) and 1.07 (95% CI 0.81-1.32) per 100 person-years, respectively.
Conclusions:
Although participants in HFrEF trials with a cancer history had higher risks of HF hospitalization and non-CV death than those without, the risks of CV and all-cause death were similar. Outcomes in HFpEF patients with and without a cancer history were similar. Incident cancer diagnoses were similar in HFrEF and HFpEF trials.
Purpose of the Review
Multimorbidity, the presence of two or more comorbidities, is common in patients with heart failure (HF) and worsens clinical outcomes. In Asia, multimorbidity has become the norm rather than the exception. Therefore, we evaluated the burden and unique patterns of comorbidities in Asian patients with HF.
Recent Findings
Asian patients with HF are almost a decade younger than Western Europe and North American patients. However, over two in three patients have multimorbidity. Comorbidities usually cluster due to the close and complex links between chronic medical conditions. Elucidating these links may guide public health policies to address risk factors. In Asia, barriers in treating comorbidities at the patient, healthcare system and national level hamper preventative efforts.
Summary
Asian patients with HF are younger yet have a higher burden of comorbidities than Western patients. A better understanding of the unique co-occurrence of medical conditions in Asia can improve the prevention and treatment of HF.
The main hallmark of myocardial substrate metabolism in cardiac hypertrophy or heart failure is a shift from fatty acid oxidation to greater reliance on glycolysis. However, the close correlation between glycolysis and fatty acid oxidation and underlying mechanism by which causes cardiac pathological remodelling remain unclear. We confirm that KLF7 simultaneously targets the rate-limiting enzyme of glycolysis, phosphofructokinase-1, liver, and long-chain acyl-CoA dehydrogenase, a key enzyme for fatty acid oxidation. Cardiac-specific knockout and overexpression KLF7 induce adult concentric hypertrophy and infant eccentric hypertrophy by regulating glycolysis and fatty acid oxidation fluxes in male mice, respectively. Furthermore, cardiac-specific knockdown phosphofructokinase-1, liver or overexpression long-chain acyl-CoA dehydrogenase partially rescues the cardiac hypertrophy in adult male KLF7 deficient mice. Here we show that the KLF7/PFKL/ACADL axis is a critical regulatory mechanism and may provide insight into viable therapeutic concepts aimed at the modulation of cardiac metabolic balance in hypertrophied and failing heart.
End stage heart failure carries a poor prognosis with a 5-year survival of only 25%. This review article describes the progress of heart transplantation as a separate surgical discipline in India over that last 30 years, selection of heart transplant donors, selection of recipients and details of technique, post operative management and factors affecting long-term outcome.
YiQiFuMai injection (YQFM), derived from Shengmai Powder, is wildly applied in the treatment of cardiovascular diseases, such as coronary heart disease and chronic cardiac insufficiency. YiQiFuMai injection is mainly composed of Radix of Panax ginseng C.A. Mey. (Araliaceae), Radix of Ophiopogon japonicus (Thunb.) Ker Gawl (Liliaceae), and Fructus of Schisandra chinensis (Turcz.) Baill (Schisandraceae), and Triterpene saponins, steroidal saponins, lignans, and flavonoids play the vital role in the potency and efficacy. Long-term clinical practice has confirmed the positive effect of YiQiFuMai injection in the treatment of heart failure, and few adverse events have been reported. In addition, the protective effect of YiQiFuMai injection is related to the regulation of mitochondrial function, anti-apoptosis, amelioration of oxidant stress, inhibiting the expression of inflammatory mediators, regulating the expression of miRNAs, maintaining the balance of matrix metalloproteinases/tissue inhibitor of metalloproteinases (MMP/TIMP) and anti-hypoxia.
Background
Chronic heart failure is a common condition, and its prevalence is expected to rise significantly over the next two decades. Research demonstrates the increasing multidimensional needs of patients and caregivers. However, access to palliative care services for this population has remained poor. This systematic review was to provide an evidence synthesis of the effectiveness and cost-effectiveness of palliative care interventions for people with chronic heart failure and their caregivers.
Methods
Relevant publications were identified via electronic searches of MEDLINE, Embase, PsychInfo, CINAHL, CENTRAL and HMIC from inception to June 2019. Grey literature databases, reference list, and citations of key review articles were also searched. Quality was assessed using the Revised Cochrane Risk of Bias Tool.
Results
Of the 2083 records, 18 studies were identified including 17 having randomised controlled trial (RCT) designs and one mixed methods study with an RCT component. There was significant heterogeneity in study settings, control groups, interventions delivered, and outcome measures used. The most commonly assessed outcome measures were functional status (n = 9), psychological symptoms (n = 9), disease-specific quality of life (n = 9), and physical symptom control (n = 8). The outcome measures with the greatest evidence for benefit included general and disease-specific quality of life, psychological symptom control, satisfaction with care, physical symptom control, medical utilisation, and caregiver burden. Moreover, the methodological quality of these studies was mixed, with only four having an overall low risk of bias and the remaining studies either demonstrating high risk of bias (n = 10) or showing some concerns (n = 4) due to small sample sizes and poor retention. Only two studies reported on economic costs. Both found statistically significant results showing the intervention group to be more cost effective than the control group, but the quality of both studies was at high risk of bias.
Conclusions
This review supports the role of palliative care interventions in patients with chronic heart failure and their caregivers across various outcomes, particularly quality of life and psychological wellbeing. Due to the highly heterogeneous nature of palliative care interventions, it is not possible to provide definitive recommendations as to what guise palliative care interventions should take to best support the complex care of this population. Considerable future research, particularly focusing on quality of care after death and the caregiver population, is warranted.
Purpose
Subclinical cardiac dysfunction is common in patients with obesity. Bariatric surgery is associated with normalization of subclinical cardiac function in 50% of the patients with obesity. The aim of this study was to identify predictors for a lack of improvement of subclinical cardiac dysfunction 1-year post-bariatric surgery.
Methods
Patients who were referred for bariatric surgery were enrolled in a longitudinal study. Inclusion criteria were age 35–65 years and BMI ≥ 35 kg/m². Patients with a suspicion of or known cardiovascular disease were excluded. Conventional and advanced echocardiography, Holter monitoring, and blood tests were performed pre- and 1-year post-bariatric surgery. Subclinical cardiac dysfunction was defined as either a reduced left ventricular ejection fraction, decreased global longitudinal strain (GLS), diastolic dysfunction, arrhythmia, or an increased BNP or hs Troponin I.
Results
A total of 99 patients were included of whom 59 patients had cardiac dysfunction at baseline. Seventy-two patients completed the 1-year follow-up after bariatric surgery. There was a significant reduction in weight and cardiovascular risk factors. Parameters of cardiac function, such as GLS, improved. However, in 20 patients cardiac dysfunction persisted. Multivariate analysis identified a decreased heart rate variability (which is a measure of autonomic function), and a decreased vitamin D pre-surgery as predictors for subclinical cardiac dysfunction after bariatric surgery.
Conclusion
Although there was an overall improvement of cardiac function 1-year post-bariatric surgery, autonomic dysfunction and a decreased vitamin D pre-bariatric surgery were predictors for a lack of improvement of subclinical cardiac dysfunction.
Graphical abstract
Aim: To determine the association between inpatient palliative care encounter (PCE) and 30-day rehospitalization. Materials & methods: The Nationwide Readmission Database was used in a cross-sectional design study. Comorbidities and a palliative care encounter (PCE; V66.7) were defined using ICD -9 codes. Results: Overall, 21.28% of 3,534,480 index hospitalizations were readmitted. PCE occurred in 1.66% of index hospitalizations and was associated with a lower odds of 30-day rehospitalization (adjusted odds ratio, 0.38; 95% CI: 0.35–0.40). This association remained significant when assessed by discharge destination. Conclusion: PCE was associated with a lower relative odds of 30-day rehospitalization. A 73% decrease in the relative odds of 30-day rehospitalization among discharges to a facility, 64% for home with home health, and 22% for discharges to home.
Aims
The purpose of this study was to investigate the effects of cardiac rehabilitation (CR) on elderly patients with Chronic heart failure (CHF) by literature search and meta-analysis.
Methods
We conducted an electronic search on PubMed, Cochrane Library, Embase, CNKI, Wanfang, and VIP database platforms. The search period was from the establishment of the database to November 2021 for randomized controlled studies (RCTs) related to the effects of CR on elderly patients with CHF. The RevMan 5.4 was used for meta-analysis.
Results
This study included 16 articles involving a total of 1782 patients, including 892 in the CR group and 890 in the control group. Meta-analysis showed that compared with conventional interventions, CR increased left ventricular ejection fraction in elderly patients with CHF [mean difference (MD):5.73,95% confidence interval (CI):2.05 to 9.40,Z = 3.05,P = 0.002], and decreased left ventricular end-diastolic diameter in elderly patients with CHF (MD:-4.82,95%CI:-7.49 to 15,Z = 3.54,P = 0.0004), increased the 6-minute walk test distance (MD:62.66,95% CI:44.40 to 80.92,Z = 6.72,P<0.00001), decreased the rehospitalization rate (OR:0.32,95%) CI: 0.21 0.49, Z = 5.33, P < 0.000001).
Conclusions
CR can improve cardiac function, prognosis and reduce rehospitalization rate of elderly patients with CHF.
To explore the role and possible mechanism of miRNA-212 in heart failure (HF). The rat model of abdominal aortic constriction was constructed, the changes of myocardial morphology were observed by hematoxylin-eosin (HE) staining, and the hypertrophy-related marker molecules were detected by quantitative real-time polymerase chain reaction (qRT-PCR). At the cellular level, phenylephrine and angiotensin II were added to induce cardiomyocyte hypertrophy. The overexpression of miR-212 adenovirus was constructed, and the expression of miR-212 was overexpressed, and its effect on cardiac hypertrophy (CH) was detected by immunofluorescence and qRT-PCR. Then, the mechanism of miR-212 regulating CH was verified by website prediction, luciferase reporter gene assay, qRT-PCR, and western blotting assay. In the successfully constructed rat model of abdominal aortic constriction and cardiomyocyte hypertrophy, ANP and myh7 were dramatically increased, myh6 expression was decreased, and miRNA-212 expression was increased. Overexpression of miRNA-212 in cardiomyocytes can promote cardiomyocyte hypertrophy, while knocking down miR-212 in cardiomyocytes can partially reverse cell hypertrophy. In addition, miR-212 targets TCF7L2 and inhibits the expression of this gene. miRNA-212 targets TCF7L2 and inhibits the expression of this gene, possibly through this pathway to promote cardiomyocyte hypertrophy.
Background:
Autoimmune diseases, including systemic lupus erythematosus, have been associated with a substantial risk of cardiovascular morbidity and mortality. However, data on the long-term risk of incident heart failure and other adverse cardiovascular outcomes among patients diagnosed with cutaneous lupus erythematosus (CLE) are limited.
Methods:
In this cohort study, all patients ≥ 18 years with newly diagnosed CLE between 1996 and 2018 were identified through Danish nationwide registries and matched 1:4 by age, sex, and comorbidity with individuals without CLE. Incident adverse cardiovascular outcomes, including heart failure, were compared between the matched groups, overall, and according to sex.
Results:
Of 2085 patients diagnosed with CLE, 2062 patients were matched with 8248 control subjects from the Danish background population (median age 50 years [25th-75th percentile: 37-62 years]; 22.3% men). The median follow-up was 6.2 years. The 10-year cumulative incidences and adjusted hazard ratios (HR) of outcomes were as follows: heart failure: 3.29% (95% CI, 2.42-4.36%) for CLE patients versus 2.59% (2.20-3.02%) for the background population, HR 1.67 (95% CI, 1.24-2.24); atrial fibrillation or flutter: 5.15% (3.99-6.52%) versus 3.84% (3.37-4.36%), HR 1.40 (1.09-1.80); the composite of ICD implantation, ventricular arrhythmia, or cardiac arrest: 0.72% (0.34-1.40%) versus 0.44% (0.29-0.64%), HR 1.71 (0.85-3.45); the composite of pacemaker implantation, atrioventricular block, or sinoatrial dysfunction: 0.91% (0.48-1.59%) versus 0.54% (0.37-0.76%), HR 1.32 (0.72-2.41); myocardial infarction: 3.05% (2.18-4.15%) versus 1.59% (1.29-1.93%), HR 2.15 (1.53-3.00); ischemic stroke: 3.25% (2.38-4.32%) versus 2.50% (2.13-2.93%), HR 1.56 (1.16-2.10); and venous thromboembolism: 2.74% (1.94-3.75%) versus 2.05% (1.71-2.44%), HR 1.60 (1.16-2.21). Sex did not modify the association between CLE and adverse cardiovascular outcomes (Pinteraction ≥ 0.12 for all outcomes).
Conclusions:
Patients with CLE had a higher associated risk of adverse cardiovascular outcomes compared with the background population, irrespective of sex. Key Points • Findings: In this nationwide cohort study, including 2062 patients with cutaneous lupus erythematosus and 8248 matched controls, cutaneous lupus erythematosus was associated with an increased long-term risk of heart failure, cardiac arrhythmias, and thromboembolic events, irrespective of sex.
Background
It is important to identify patients at increased risk of worsening of left ventricular ejection fraction (LVEF) after a myocardial infarction (MI). We aimed to identify the association of various potential biomarkers with LVEF impairment after an MI in South American patients.
Methods
We studied adult patients admitted to a University Hospital and diagnosed with an acute MI. Plasma concentrations of high-sensitivity C-reactive protein (hsCRP), proprotein convertase subtilisin/kexin type 9 (PCSK9), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and heart-type fatty-acid-binding protein (FABP3) were determined in samples drawn shortly after the event. Participants had a follow-up visit at least 45 days after the event. The primary endpoint was defined as any decline in LVEF at follow-up relative to baseline.
Results
The study included 106 patients (77.4% men, 22.6% women), mean age was 64.1, mean baseline LVEF was 56.6, 19% had a prior MI. We obtained a follow-up evaluation in 100 (94.4%) of participants, mean follow-up time was 163 days. There was a significant correlation between baseline PCSK9 and hsCRP (r = 0.39, p < 0.001). Baseline hsCRP concentrations were higher in patients who developed the endpoint than in those who did not (32.1 versus 21.2 mg/L, p = 0.066). After multivariate adjustment, baseline PCSK9, male sex and age were significantly associated with impairment in LVEF. The absolute change in LVEF was inversely correlated with baseline hsCRP (standardized coefficient = − 0.246, p = 0.004).
Conclusion
High plasma levels of PCSK9 and hsCRP were associated with early decreases in LVEF after an MI in Latin American patients.
Aims:
Heart failure (HF) has a lower public profile compared with other serious health conditions, notably cancer. This discourse analysis study investigates the extent to which HF is discussed in general contemporary English, UK parliamentary debates and the ways in which HF is framed in discussions, when compared with two other serious health conditions, cancer and dementia.
Methods:
The Oxford English Corpus (OEC) of 21st century English-language texts (2 billion words) and the UK Hansard Reports of parliamentary debates from 1945 to early 2021 were used to investigate the relative frequencies, contexts and use of the terms 'heart failure', 'cancer' and 'dementia'.
Results:
In the OEC, the term 'heart failure' occurs 4.26 times per million words (pmw), 'dementia' occurs 3.68 times pmw and 'cancer' occurs 81.96 times pmw. Cancer is talked about 19 times more often than HF and 22 times more often than dementia. These are disproportionately high in relation to actual incidence: annual cancer incidence is 1.8 times that of the other conditions; annual cancer mortality is two times that caused by coronary heart disease (including HF) or dementia.'Heart failure' is used much less than 'cancer' in UK parliamentary debates (House of Commons and House of Lords) between 1945 and early 2021, and less than 'dementia' from 1990 onwards. Moreover, HF is even mentioned much less than pot-holes in UK roads and pavements. In 2018, for example, 'pot-hole/s' were mentioned over 10 times pmw, 37 times more often than 'heart failure', mentioned 0.28 times pmw. Discussions of HF are comparatively technical and formulaic, lacking survivor narratives that occur in discussions of cancer.
Conclusions:
HF is underdiscussed in contemporary English compared with cancer and dementia and underdiscussed in UK parliamentary debates, even compared with the less-obviously life-threatening topic of pot-holes in roads and pavements.
Heart failure (HF), as the leading cause of death, is continuing to increase along with the aging of the general population all over the world. Identification of diagnostic biomarkers for early detection of HF is considered as the most effective way to reduce the risk and mortality. Herein, we collected plasma samples from HF patients (n = 40) before and after medical therapy to determine the change of circulating miRNAs through a quantitative real-time PCR (QRT-PCR)-based miRNA screening analysis. miR-30a-5p and miR-654-5p were identified as the most significantly changed miRNAs in the plasma of patients upon treatment. In consistence, miR-30a-5p showed upregulation and miR-654-5p showed downregulation in the circulation of 30 HF patients, compared to 15 normal controls in the training phase, from which a two-circulating miRNA model was developed for HF diagnosis. Next, we performed the model validation using an independent cohort including 50 HF patients and 30 controls. As high as 98.75% of sensitivity and 95.00% of specificity were achieved. A comparison between the miRNA model and NT-pro BNP in diagnostic accuracy of HF indicated an upward trend of the miRNA model. Moreover, change of the two miRNAs was further verified in association with the therapeutic effect of HF patients, in which miR-30a-5p showed decrease while miR-654-5p showed increase in the plasma of patients after LVAD implantation. In conclusion, the current study not only identified circulating miR-654-5p for the first time as a novel biomarker of HF, but also developed a novel 2-circulating miRNA model with promising potentials for diagnosis and prognosis of HF patients, and in association with therapeutic effects as well.
Background
To date, no study has investigated the effects of probiotic yogurt as a functional food in patients with chronic heart failure (CHF). Therefore, the aim of this study was to compare the impact of probiotic yogurt versus ordinary yogurt on inflammatory, endothelial, lipid and renal indices in CHF patients. In this randomized, triple‐blind clinical trial, 90 patients with CHF were randomly allocated into two groups to take either probiotic or ordinary yogurt for 10 weeks. Serum levels of soluble tumor necrosis factor‐like weak inducer of apoptosis (sTWEAK), soluble cluster of differentiation 163 (sCD163), asymmetric dimethylarginine (ADMA), and lecithin cholesterol acyltransferase (LCAT) were measured by using ELISA kits, and blood urea nitrogen (BUN) was measured by calorimetry method at baseline and at the end of trial. The P‐value <0.05 was defined as statistically significant.
Results
Seventy‐eight patients completed the study. At the end of the intervention, the levels of sTWEAK in both groups increased significantly, and this increase was greater in the probiotic yogurt group [691.84 (335.60, 866.95)] compared to control group [581.96 (444.99, 929.40)], and the difference between the groups was statistically significant after adjusting for confounders (P‐value: 0.257, adjusted P‐value: 0.038). However, no significant differences were found between the groups in the cases of other study indices.
Conclusion
Probiotic yogurt may be useful for improving the inflammatory status in patients with CHF through increasing sTWEAK levels, however, further studies are needed in this area. © 2022 Society of Chemical Industry.
Introduction and objectives
Neurohormonal blockade (NB)/modulation is the combination of two renin-angiotensin-aldosterone system inhibitors (RAASi) with a beta blocker. It is the core therapy for heart failure with reduced ejection fraction (HFrEF). While improving long term prognosis, it also induces hyperkalemia (serum K⁺ >5.0 mEq/L) due to RAASi effects. This may cause lethal arrhythmias and increase mortality in the short term. Thus, hyperkalemia frequently leads to withholding or reducing the intensity of neurohormonal blockade/modulation, which is associated with worsening long term prognosis. We assessed the relevance of hyperkalemia as a limiting factor of neurohormonal blockade/modulation in real life clinical conditions.
Methods
We reviewed the medical records of HFrEF patients attending a HF clinic at a tertiary Portuguese hospital during 2018 (n=240). The number of patients not tolerating maximal neurohormonal blockade/modulation due to hyperkalemia was determined. The incidence and characteristics of hyperkalemia episodes were also assessed.
Results
Only six patients (3%) achieved maximal doses of neurohormonal blockade/modulation. Hyperkalemia was the limiting factor in 48 (20%) patients. A total of 185 hyperkalemia episodes occurred in 100 (42%) patients. Forty-five (24%) episodes were moderate or severe (serum K⁺ >5.5 mEq/L). In these HFrEF patients, the co-existence of hypertension, diabetes or renal failure was associated with the occurrence of hyperkalemia.
Conclusions
In daily clinical practice, hyperkalemia is frequent and limits neurohormonal blockade/modulation by leading to the withholding or reducing of the intensity of RAAS inhibition. Considering the negative prognostic impact associated with sub-optimal neurohormonal blockade/modulation, addressing hyperkalemia is an important issue when treating HFrEF patients.
Cardiovascular tissue engineering and regeneration strive to provide long-term, effective solutions for a growing group of patients in need of myocardial repair, vascular (access) grafts, heart valves, and regeneration of organ microcirculation. In the past two decades, ongoing convergence of disciplines and multidisciplinary collaborations between cardiothoracic surgeons, cardiologists, bioengineers, material scientists, and cell biologists have resulted in better understanding of the problems at hand and novel regenerative approaches. As a side effect, however, the field has become strongly organized and differentiated around topical areas at risk of reinvention of technologies and repetition of approaches and across the areas. A better integration of knowledge and technologies from the individual topical areas and regenerative approaches and technologies may pave the way towards faster and more effective treatments to cure the cardiovascular system. This review summarizes the evolution of research and regenerative approaches in the areas of myocardial regeneration, heart valve and vascular tissue engineering, and regeneration of microcirculations and discusses previous and potential future integration of these individual areas and developed technologies for improved clinical impact. Finally, it provides a perspective on the further integration of research organization, knowledge implementation, and valorization as a contributor to advancing cardiovascular tissue engineering and regenerative medicine.
Background
Compliance with recommended pharmacological and non-pharmacological treatments to modify risk factors is associated with improved outcomes for patients with heart failure (HF).
Methods
We conducted an analysis of the National Health and Nutrition Examination Survey (NHANES) years 1999–2018 to evaluate the adequacy of risk factor control and compliance with recommended lifestyle and medications according to the clinical guidelines for the management of HF. Demographic, clinical, and healthcare-access factors associated with having risk factors uncontrolled or not receiving recommended medications were determined using logistic regression analyses.
Results
We collected 1906 participants aged 18 years or older with a self-reported history of HF. The majority were at target goals for blood pressure (45.07%), low-density lipoprotein cholesterol (22.04%), and glycated hemoglobin (72.15%), whereas only 19.09% and 27.38% were at targets for body mass index and waist circumference respectively. Besides, 79.49% and 67.23% of respondents reported smoking cessation and recommended alcohol consumption, whereas only 11.54% reported adequate physical activity. Proportion of taking beta blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) and diuretics was 54.77%, 52.62% and 49.37%, respectively. Finally, the logistic regression analysis showed that metabolic syndrome and diabetes mellitus were associated with a higher likelihood of having risk factor uncontrolled, while metabolic syndrome, diabetes mellitus, and chronic kidney disease were predictors for not receiving recommended medications.
Conclusions
Risk factor control and adherence to recommended lifestyle and medications are non-ideal among HF patients in the USA. A systematic approach for risk factor optimization in people with HF is urgently needed.
Detecting high-risk patients for early rehospitalization is crucial in heart failure patient care. An association of albuminuria with cardiovascular events is well known. However, its predictive impact on rehospitalization for acute decompensated heart failure (ADHF) remains unknown. In this study, 190 consecutive patients admitted due to ADHF between 2017 and April 2019 who underwent urinalysis were enrolled. Among them, 140 patients from whom urine albumin-to-creatinine ratio (UACR) was measured with spot urine samples on admission were further analyzed. The association between UACR and rehospitalization due to HF during 1 year after discharge was evaluated. The mean age of 140 participants was 77.6 years and 55% were men. Only 18% (n = 25) of patients presented with normoalbuminuria (UACR < 30 mg/g∙creatinine), whereas 59% (n = 83) and 23% (n = 32) showed microalbuminuria (UACR 30–300 mg/g·creatinine) and macroalbuminuria (UACR > 300 mg/g·creatinine), respectively. The level of UACR on admission was correlated with the risk of subsequent rehospitalization due to HF (p = 0.017). The receiver operating characteristic analysis indicated that the best cut-off values for the UACR and B-type natriuretic peptide (BNP) levels to predict ADHF rehospitalization were 50 mg/g·creatinine and 824 pg/ml, respectively. When the patients were divided into four groups using both cut-off values, the individual predictive impacts of UACR and BNP on rehospitalization were comparable. Patients with both elevated UACR and BNP levels had a higher rate of HF rehospitalization than those with elevated BNP levels alone (p < 0.05). The combination of both values enabled more accurate prediction of HF rehospitalization than BNP levels alone. In conclusion, UACR could be a new useful biomarker to predict HF rehospitalization in patients with ADHF, especially in combination with the levels of BNP, and should be further evaluated in a prospective study.
Background
Congestive heart failure (CHF) is a common disease with high health care costs and high mortality rates. Knowledge of the health-related quality of life outcomes of CHF may guide decision making and be useful in assessing new therapies for this population.Methods
A prospective cohort study was conducted involving 1390 adult patients hospitalized with an acute exacerbation of severe CHF (New York Heart Association class III-IV). Demographic data and health-related quality of life were determined by interview; physiologic status and cost and intensity of care were determined from hospital charts.Results
The median (25th, 75th percentiles) age of patients was 68.0 (58.2, 76.9) years; 61.7% were male. Survival was 93.4% at discharge from the index hospitalization, 72.9% at 180 days, and 61.5% at 1 year. Of patients interviewed at 180 days, the median health rating on a scale of 0 to 100 (0 indicates death; 100, excellent health) was 60 (interquartile range, 50-80), and 59.7% were independent in their activities of daily living. Overall quality of life was reported to be good, very good, or excellent in 58.2% at 180 days. Patients with worse functional capacity were more likely to die. Health perceptions among the patients with available interview data improved at 60 and 180 days after acute exacerbation of severe CHF.Conclusions
Patients hospitalized for acute exacerbation of severe CHF have a generally poor 6-month survival, but survivors retain relatively good functional status and have good health perceptions. Furthermore, health perceptions improve after the acute exacerbation.
Enhancing daily functioning and well-being is an increasingly advocated goal in the treatment of patients with chronic conditions. We evaluated the functioning and well-being of 9385 adults at the time of office visits to 362 physicians in three US cities, using brief surveys completed by both patients and physicians. For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions. Each condition had a unique profile among the various health components. Hypertension had the least overall impact; heart disease and patient-reported gastrointestinal disorders had the greatest impact. Patients with multiple conditions showed greater decrements in functioning and well-being than those with only one condition. Substantial variations in functioning and well-being within each chronic condition group remain to be explained.
A programme to detect and treat asymptomatic left ventricular dysfunction would seem to fulfil all five principles of screening. Indeed, such a programme would appear to be at least as firmly based as those already in existence for, for example, cervical and breast cancer. Further evaluation of the screening of high risk groups to detect asymptomatic left ventricular systolic dysfunction with the aim of giving treatment to prevent the development of heart failure is merited.
As heart failure is a syndrome arising from an underlying condition, such as coronary heart disease, it is not recorded as the primary cause of death in official mortality statistics. We carried out a retrospective, computer assisted analysis of all death certificates in Scotland between 1979 and 1992. Death certificates where heart failure was coded by the Registrar General for Scotland, as either the primary or a contributory cause of death, were selected for further analysis. From a total of 883622 deaths in Scotland between 1979 and 1992, heart failure was recorded as the primary cause in only 13695 deaths (1.5%), but a contributory cause in a further 126073 deaths (14.3%). For all ages, heart failure was a more frequent cause of death in women than men (70109 vs. 49948), whereas male deaths predominate in those <65 years (11372 vs. 6362). While there has been little change in the total numbers of deaths caused by heart failure from '79 to '92, a fall in mortality in those <65 years in both men (996 to 679) and women (608 to 344), has been balanced by a rise in absolute mortality in older age groups, especially in women ≥85 years (1509 to 1995). However, when adjusted for age, a reduction in deaths from heart failure in both sexes is seen in all age groups. The increase seen in the age at time of death from heart failure from 72.3 to 74.6 (+2.3) years in men, and from 77.4 to 80.3 (+2.7) in women is compared to a more modest increase in age adjusted life expectancy during the same time period (+1.5 years[M] and +1.1 [F]). Further analysis of certificates for which ischaemic heart disease (IHD) has also been coded shows that, compared with total IHD mortality, heart failure is contributing to a higher percentage of IHD deaths from '79 to '92 (28.5 to 34.1% [M]; 40.4 to 44.8% [F]). This data confirms that death from heart failure is considerably underestimated by official statistics. While the age-adjusted mortality from heart failure is falling, absolute numbers of deaths remain constant as a consequence of the ageing population. Additionally, the importance of heart failure as the true cause of death, in deaths currently attributed to IHD, is likely to be increasing.
Aims
As heart failure is a syndrome arising from another condition, such as coronary heart disease, it is rarely officially coded as the underlying cause of death regardless of the cause recorded by the physician at the time of certification. We sought to assess the true contribution of heart failure to overall mortality and coronary heart disease mortality and to examine how this contribution has changed over time.
Methods and Results
We carried out a retrospective analysis of all death certificates in Scotland between 1979 and 1992 for which heart failure was coded as the under-lying or a contributory cause of death. From a total of 833622 deaths in Scotland between 1979 and 1992, heart failure was coded as the underlying cause in only 1·5% (13695), but as a contributory cause in a further 14·3% (126073). In 1979, 28·5% of male and 40·4% of female deaths attributed to coronary heart disease (coded as the underlying cause of death) also had a coding for heart failure. In 1992 these percentages had risen significantly to 34·1% and 44·8%, respectively (bothP<0·001). Mortality rates for heart failure as the underlying or contributory cause of death, standardized by age and sex, fell significantly over the period studied in all ages and in both sexes: by 31% in men and 41% in women <65 years and 15·8% in men and 5·1% in women ≥65 years, respectively (P<0·01 for all changes).
Conclusions
Death from heart failure is substantially underestimated by official statistics. Furthermore, one third or more of deaths currently attributed to coronary heart disease may be related to heart failure and this proportion appears to be increasing. While the absolute numbers of deaths caused by heart failure remains constant, this study is the first to show that standardized mortality rates are declining.
Background:
The American Cancer Society, the National Cancer Institute (NCI), and the Centers for Disease Control and Prevention (CDC), including the National Center for Health Statistics (NCHS), provide the second annual report to the nation on progress in cancer prevention and control, with a special section on lung cancer and tobacco smoking.
Methods:
Age-adjusted rates (using the 1970 U.S. standard population) were based on cancer incidence data from NCI and underlying cause of death data compiled by NCHS. The prevalence of tobacco use was derived from CDC surveys. Reported P values are two-sided.
Results:
From 1990 through 1996, cancer incidence (-0.9% per year; P = .16) and cancer death (-0.6% per year; P = .001) rates for all sites combined decreased. Among the 10 leading cancer incidence sites, statistically significant decreases in incidence rates were seen in males for leukemia and cancers of the lung, colon/rectum, urinary bladder, and oral cavity and pharynx. Except for lung cancer, incidence rates for these cancers also declined in females. Among the 10 leading cancer mortality sites, statistically significant decreases in cancer death rates were seen for cancers of the male lung, female breast, the prostate, male pancreas, and male brain and, for both sexes, cancers of the colon/rectum and stomach. Age-specific analyses of lung cancer revealed that rates in males first declined at younger ages and then for each older age group successively over time; rates in females appeared to be in the early stages of following the same pattern, with rates decreasing for women aged 40-59 years.
Conclusions:
The declines in cancer incidence and death rates, particularly for lung cancer, are encouraging. However, unless recent upward trends in smoking among adolescents can be reversed, the lung cancer rates that are currently declining in the United States may rise again.
The study was designed to determine the prevalence and mortality rate of congestive heart failure in noninstitutionalized men and women in the U.S.
Congestive heart failure is a serious condition with significant morbidity and mortality. Earlier epidemiologic descriptions of congestive heart failure were constructed from small surveys, limited data, hospital records or death certificates. No nationally representative data from noninstitutionalized persons have been examined.
Data collected from the National Health and Nutrition Examination Survey (NHANES-I, 1971 to 1975) were used to determine the prevalence of heart failure on the basis of both self-reporting and a clinical definition. Mortality data were derived from the NHANES-I Epidemiologic Follow-up Study (1982 to 1986).
The prevalence of self-reported congestive heart failure approximates 1.1% of the noninstitutionalized U.S. adult population; the prevalence of congestive heart failure based on clinical criteria is 2%. These estimates suggest that between 1 and 2 million adults are affected. Mortality at 10 and 15 years for those persons with congestive heart failure increases in graded fashion with advancing age, with men more likely to die than women. In the group greater than or equal to 55 years old, the 15-year total mortality rate was 39.1% for women and 71.8% for men.
Congestive heart failure is a common problem in the U.S., with significant prevalence and mortality, both of which increase with advancing age. As the population of the U.S. becomes older, the health care impact of congestive heart failure will probably grow.
The natural history of congestive heart failure was studied over a 16-year period in 5192 persons initially free of the disease. Over this period, overt evidence of congestive heart failure developed in 142 persons. In almost every five-year age group, from 30 to 62 years, the incidence rate was greater for men than for women. Although the usual etiologic precursors were found, the dominant one was clearly hypertension, which preceded failure in 75 per cent of the cases. Coronary heart disease was noted at an earlier examination in 39 per cent, but in 29 per cent of the cases it was accompanied by hypertension. Precursive rheumatic heart disease, noted in 21 per cent of cases of congestive heart failure, was accompanied by hypertension in 11 per cent. Despite modern management, congestive heart failure proved to be extremely lethal. The probability of dying within five years from onset of congestive heart failure was 62 per cent for men and 42 per cent for women.
This prospective study was designed to assess whether patients with terminal cancer, and their relatives, find that competent home care sufficiently maintains comfort and helps adjustment. A random sample from a home care service with readily available beds comprised 77 adults and their relatives who were able and willing to be interviewed separately each week. They were asked the nature and degree of current problems and regular assessments were made of some qualities of life including mood, attitude to the condition, perceived help and preferred place of care. These patients had 90% of their care at home; 29% died at home but 30% were finally admitted for one to three days and 41 % for longer.
In the final eight weeks, tolerable physical symptoms were volunteered by a mean of 63% each week and psychological symptoms by 17%. Some distress was felt by 11 % of patients; this was usually from pain, depression, dyspnoea, anxiety or weakness, and generally did not persist. Relatives suffered grief, strain or their own ill health. Patients' and relatives' reports generally matched except for the strain on carers.
Regular assessments found that 64% of patients thought death certain or probable, and 27% thought it possible. Various proportions coped by optimism, fighting their disease, partial suppression or denial, but 50% reached positive acceptance. Relatives were more aware and accepting. About three-quarters of patients and half the relatives were composed, often enjoying life. Serious depression affected 5% of patients and anxiety 4%, but relatives' manifest depression in the later stages increased to 17% and anxiety to 14%. Many consciously disguised their feelings. Treatment was usually praised but realistic preference for home care fell steadily from 100% to 54% of patients and 45% of relatives. At follow-up most relatives approved of where patients had received care and died.
To determine the referral rates to hospital and level of investigation of patients with heart failure, and to assess whether they are receiving optimum management.
A retrospective survey.
Nottingham Health District.
505 patients receiving loop diuretic treatment prescribed by their general practitioner.
Referral to hospital as an inpatient or outpatient for assessment of assumed cardiac failure; investigations--electrocardiography, chest radiography, and echocardiography; treatment with angiotensin converting enzyme inhibitors.
Only 56% of patients prescribed loop diuretics fulfilled the diagnostic criteria for heart failure. Of these, 74% had been referred to hospital, of whom 80% had had an electrocardiograph, 75% a chest radiograph, but only 31% an echocardiogram. Only 17% of patients with heart failure were being treated with angiotensin converting enzyme inhibitors in conjunction with loop diuretics.
Patients with heart failure in the Nottingham Health District are not being adequately investigated or receiving the optimum treatment.
Many developed countries have seen declining mortality rates for heart disease, together with an alleged decline in incidence and a seemingly paradoxical increase in health care demands. This paper presents a model for forecasting the plausible evolution of heart disease morbidity.
The simulation model combines data from different sources. It generates acute coronary event and mortality rates from published data on incidences, recurrences, and lethalities of different heart disease conditions and interventions. Forecasts are based on plausible scenarios for declining incidence and increasing survival.
Mortality is postponed more than incidence. Prevalence rates of morbidity will decrease among the young and middle-aged but increase among the elderly. As the milder disease states act as risk factors for the more severe states, effects will culminate in the most severe disease states with a disproportionate increase in older people.
Increasing health care needs in the face of declining mortality rates are no contradiction, but reflect a tradeoff of mortality for morbidity. The aging of the population will accentuate this morbidity increase.
Relatively limited epidemiological data are available regarding the prognosis of congestive heart failure (CHF) and temporal changes in survival after its onset in a population-based setting.
Proportional hazards models were used to evaluate the effects of selected clinical variables on survival after the onset of CHF among 652 members of the Framingham Heart Study (51% men; mean age, 70.0 +/- 10.8 years) who developed CHF between 1948 and 1988. Subjects were older at the diagnosis of heart failure in the later decades of this study (mean age at heart failure diagnosis, 57.3 +/- 7.6 years in the 1950s, 65.9 +/- 7.9 years in the 1960s, 71.6 +/- 9.4 years in the 1970s, and 76.4 +/- 10.0 years in the 1980s; p < 0.001). Median survival after the onset of heart failure was 1.7 years in men and 3.2 years in women. Overall, 1-year and 5-year survival rates were 57% and 25% in men and 64% and 38% in women, respectively. Survival was better in women than in men (age-adjusted hazards ratio for mortality, 0.64; 95% CI, 0.54-0.77). Mortality increased with advancing age in both sexes (hazards ratio for men, 1.27 per decade of age; 95% CI, 1.09-1.47; hazards ratio for women, 1.61 per decade of age; 95% CI, 1.37-1.90). Adjusting for age, there was no significant temporal change in the prognosis of CHF during the 40 years of observation (hazards ratio for men for mortality, 1.08 per calendar decade; 95% CI, 0.92-1.27; hazards ratio for women for mortality, 1.02 per calendar decade; 95% CI, 0.83-1.26).
CHF remains highly lethal, with better prognosis in women and in younger individuals. Advances in the treatment of hypertension, myocardial ischemia, and valvular heart disease during the four decades of observation did not translate into appreciable improvements in overall survival after the onset of CHF in this large, unselected population.
SMR1 is an episode based record relating to all inpatients and day cases discharged from non psychiatric, non obstetric wards in Scottish hospitals. A record is raised when a patient is discharged from hospital, changes consultant or is transferred to another hospital. SMR1 records contain clinical and non clinical data. Approximately 1 million records are created annually.
What do we know about human lifespan with regard to the length or shortness of life? The information to be had is small, observation careless and tradition based on fables.
—Francis Bacon, Historia Vitae et Mortis, 1645
Longevity in the future will alter both the practice of medicine generally and cardiovascular disease in particular. Fig 1⇓, the curve of human survival by Gompertz, was first described in 1825 in the Philosophical Transactions of the Royal Society of London. It illustrates ideal human survival unaltered by any disease process. The inner curve at 1900 and the middle curve at 1990 show the change in mean survival in this century. Both infant mortality and diseases of mid-life have drastically changed, resulting in a longer lifespan and as a result many older people in our society.
Figure 1.
Curves illustrating human life span at 1900 and 1990 compared with ideal survival.
Life expectancy in the United States in 1900 was 47 years, with 4% of the population older than 65. In 1996 life expectancy is 76 years, with 12.3% of the population over 65. By 2026 life expectancy will be a mean of 82 years, with 20% of the population over 65. Aging is therefore a social phenomenon of the 20th century with profound medical and social implications. The rapid increase is more than either predicted or expected and is still not generally appreciated. In the United States, more than 30 million people are older than 65 years. The aged now constitute 12% of our population but use one third of the drugs and account for roughly one third of the healthcare costs. Forty-five percent of those treated have cardiovascular disease. There are also major social implications. In the over-75-years age group, there are approximately 185 women to each 100 men; at 85, …
In most previous epidemiological studies on the prevalence of chronic heart failure (CHF) the disorder has been defined on clinical criteria. In a cross-sectional survey of 2000 men and women aged 25-74, randomly sampled from one geographical area, we assessed left-ventricular systolic function by echocardiography.
1640 (83%) of those invited took part. They completed a questionnaire on current medication, history, and symptoms of breathlessness. Blood pressure was measured and electrocardiography (ECG) and echocardiography were done. Left-ventricular ejection fraction was measurable in 1467 (89.5%) participants by the biplane Simpson's rate method.
The mean left-ventricular ejection fraction was 47.3%. The prevalence of definite left-ventricular systolic dysfunction (defined as a left-ventricular ejection fraction < or = 30%) was 2.9% overall (43 participants); it increased with age and was higher in men than in women (4.0 vs 2.0%). The left-ventricular systolic dysfunction was symptomatic in 1.5% of participants and asymptomatic in 1.4%, 83% of participants with left-ventricular systolic dysfunction had evidence of ischaemic heart disease (IHD) from history or ECG criteria compared with 21% of those without this abnormality (p < 0.001). Hypertension was also more common in those with left-ventricular systolic dysfunction (72 vs 38%, p < 0.001), but there was no difference between those with and without left-ventricular systolic dysfunction in the rate of hypertension without IHD.
Left-ventricular systolic dysfunction was at least twice as common as symptomatic heart failure defined by clinical criteria. The main risk factors are IHD and hypertension in the presence of IHD; screening of such high-risk groups for left-ventricular systolic dysfunction should be considered.
To characterise the morbidity, mortality and patterns of care for patients hospitalised with congestive heart failure (CHF).
Prospective cohort study with one-year follow-up.
409 patients aged 60 years and over admitted to hospital with congestive heart failure between 1 May and 30 November 1993.
John Hunter Hospital (tertiary referral for cardiology) and Mater Hospital (non-tertiary referral for cardiology), Newcastle, New South Wales.
Length of hospital stay (LOS); unplanned readmissions; mortality at 28 days and one year; and relationship between outcomes and patient and disease characteristics determined by multivariate analysis.
Annual hospitalisation rate for CHF in the 60 years and over age group was 783/100,000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly between hospitals. ACE inhibitors were being taken by 66% of subjects at discharge. Rate of unplanned readmissions within 28 days was 20%. Mortality was 12.5% at 28 days and 33% at one year. For a first admission for CHF, 28-day mortality was lower than for readmissions (odds ratio, 0.25; 95% confidence interval, 0.1-0.62), and average LOS was 17% lower. Increasing age and renal impairment were significantly associated with higher one-year mortality. Greater comorbidity was associated significantly with longer LOS and non-significantly with higher 28-day and one-year mortality.
CHF is a common reason for admission, often results in unplanned readmissions, and has a high mortality. Undertreatment with ACE inhibitors continues. The importance of avoiding recurrent admissions was clear. A program of intensive case management may reduce the burden attributable to CHF.
In a retrospective, cohort design, clinical usage of digoxin, diuretic, and angiotensin-converting enzyme (ACE) inhibitor was assessed in all patients readmitted over a 36-month period for congestive heart failure (CHF) diagnostic-related group (DRG) 127. ACE inhibitor dose-response analysis used the discharge dose of ACE inhibitor, converted to enalapril-equivalent doses and adjusted for renal function. Principal end points were time-to-readmission and 90-day readmission rate. Of 314 total patients, digoxin was used in 72%, diuretic in 86%, and 67% received an ACE inhibitor. Only 22% of those on an ACE inhibitor received currently recommended doses of enalapril > or = 20 mg/day or equivalent, whereas 41% received enalapril < or = 5 mg/day. Time-to-readmission was increased by an ACE inhibitor (p = 0.002) but not digoxin or diuretic. An ACE inhibitor was the principal covariate of 90-day readmission rate (p <0.05). The readmission rate was not reduced with daily ACE inhibitor doses of < or = 5 mg enalapril, whereas daily doses of > or = 10 mg enalapril reduced 90-day readmission rates by 28% compared to those receiving diuretic or digoxin therapy (p <0.05). Using a dynamic model, the dose required to achieve 90% to 95% of the theoretical maximum ACE inhibitor effect exceeded 100 mg enalapril daily. Thus, CHF readmission rates are lower when daily ACE inhibitor doses exceed 5 mg enalapril or the equivalent daily, but are unaffected by digoxin or diuretic. Modeled maximum ACE inhibitor benefits require doses 8- to 10-fold higher than current usage patterns.
To compare the incidence of congestive heart failure and the survival in patients with congestive heart failure in Rochester, Minn, in 1981 with that observed in 1991.
Population-based, descriptive epidemiological study with ecological and individual level comparisons over time. Olmsted County, Minnesota, where the Rochester Epidemiology Project provides passive surveillance of the population for health outcomes. All 248 patients fulfilled the Framingham criteria, 107 patients presenting with the new onset of congestive heart failure in 1981 and 141 patients in 1991. The community inpatient and outpatient medical records of all incident cases were reviewed to evaluate the presenting characteristics of patients at diagnosis.
The incidence of congestive heart failure after adjustment for age and sex to the US population was not significantly different in the 1991 cohort compared with that in 1981 (3.0 per 1000 person-years; 95% confidence interval, 2.5-3.5 vs 2.8 per 1000 person-years; 95% confidence interval, 2.2-3.3; P = .55). The survival of patients with new diagnosis of congestive heart failure was similar in the 2 cohorts (P = .53). Survival adjusted for age, sex, and New York Heart Association functional class was not significantly different in patients with congestive heart failure in 1981 and 1991 (relative risk, 0.907; P = .55).
These data suggest that recent advances in management of cardiovascular disease, as used in the community, had not yet impacted incidence or survival of patients with congestive heart failure in the community during the 10-year study period. This highlights the need to continue efforts to ensure that advances in diagnosis and therapy are incorporated into the care of patients with congestive heart failure in the community.
In the United States, heart failure has emerged as the leading first-listed diagnosis among hospitalized older adults.
The number and prevalence of hospitalizations, procedure use, and discharge outcomes for men and women aged >/=35 years hospitalized with heart failure were estimated from National Hospital Discharge Survey data for the years 1985 through 1995.
In 10 years, the number of hospitalizations increased from 577,000 to 871,000 for a first-listed diagnosis and from 1.7 to 2.6 million for any diagnosis of heart failure. Almost 78% of men and 85% of women hospitalized with heart failure were aged >/=65 years. Among persons hospitalized with any diagnosis of heart failure, in-hospital mortality rate decreased from 1985 to 1995 whereas prevalence of discharge to long-term care increased. In 1995, 67% of male patients were discharged home, 12% were discharged to long-term care, and 8% died during hospitalization; the corresponding values for female patients were 58%, 21%, and 8%. Men had twice the prevalence of invasive cardiac procedures as did women during hospitalization.
The growing burden of heart failure can be expected to increase during the next decade unless innovative interventions and primary and secondary prevention strategies are implemented.
The purpose of this study was to assess the relative proportions of normal versus impaired left ventricular (LV) systolic function among persons with congestive heart failure (CHF) in the community and to compare their long-term mortality during follow-up.
Several hospital-based investigations have reported that a high proportion of subjects with CHF have normal LV systolic function. The prevalence and prognosis of CHF with normal LV systolic function in the community are not known.
We evaluated the echocardiograms of 73 Framingham Heart Study subjects with CHF (33 women, 40 men, mean age 73 years) and 146 age- and gender-matched control subjects (nested case-control study). Impaired LV systolic function was defined as an LV ejection fraction (LVEF) <0.50.
Thirty-seven CHF cases (51%) had a normal LVEF; 36 (49%) had a reduced LVEF. Women predominated in the former group (65%), whereas men constituted 75% of the latter group. During a median follow-up of 6.2 years, CHF cases with normal LVEF experienced an annual mortality of 8.7% versus 3.0% for matched control subjects (adjusted hazards ratio = 4.06, 95% confidence interval 1.61 to 10.26). Congestive heart failure cases with reduced LVEF had an annual mortality of 18.9% versus 4.1% for matched control subjects (adjusted hazards ratio = 4.31, 95% confidence interval 1.98 to 9.36).
Normal LV systolic function is often found in persons with CHF in the community and is more common in women than in men. Although CHF cases with normal LVEF have a lower mortality risk than cases with reduced LVEF, they have a fourfold mortality risk compared with control subjects who are free of CHF.
Hospital admissions among patients with congestive heart failure (CHF) are a major contributor to health-care costs. Previous investigations suggest that the therapeutic efficacy of pharmacotherapy in CHF may be improved by strategies incorporating home visits to identify and address factors precipitating deterioration and resultant readmission.
Chronic CHF patients discharged home after acute hospital admission were randomly assigned usual care (n=100) or a multidisciplinary, home-based intervention (n=100), consisting of a home visit by a cardiac nurse 7-14 days after discharge. The primary endpoint of the study was frequency of unplanned readmission plus out-of-hospital death within 6 months.
During 6 months' follow-up there were 129 primary endpoint events in the usual-care group and 77 in the intervention group (p=0.02). More intervention-group than usual-care patients remained event-free (38 vs 51; p=0.04). Overall, there were fewer unplanned readmissions (68 vs 118; p=0.03) and associated days in hospital (460 vs 1173; p=0.02) among intervention-group patients. Hospital-based costs were Australian $490,300 for the intervention group and A$922,600 for the usual-care group (p=0.16); the mean cost of the intervention was A$350 per patient, and other community-based costs were similar for both groups.
A home-based intervention has the potential to decrease the rate of unplanned readmissions and associated health-care costs, prolong event-free and total survival, and improve quality of life among patients with chronic CHF.
A 1999 study found no decrease in breast-cancer mortality in Sweden, where screening has been recommended since 1985. We therefore reviewed the methodological quality of the mammography trials and an influential Swedish meta-analysis, and did a meta-analysis ourselves.
We searched the Cochrane Library for trials and asked the investigators for further details. Meta-analyses were done with Review Manager (version 4.0).
Baseline imbalances were shown for six of the eight identified trials, and inconsistencies in the number of women randomised were found in four. The two adequately randomised trials found no effect of screening on breast-cancer mortality (pooled relative risk 1.04 [95% CI 0.84-1.27]) or on total mortality (0.99 [0.94-1.05]). The pooled relative risk for breast-cancer mortality for the other trials was 0.75 (0.67-0.83), which was significantly different (p=0.005) from that for the unbiased trials. The Swedish meta-analysis showed a decrease in breast-cancer mortality but also an increase in total mortality (1.06 [1.04-1.08]); this increase disappeared after adjustment for an imbalance in age.
Screening for breast cancer with mammography is unjustified. If the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six. If the Swedish trials (apart from the Malmö trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality.
The statistics pertaining to heart failure are awesome. It now affects 4.6 million Americans, and 400,000 new cases are diagnosed each year. After a diagnosis is made, less than 50% of patients survive more than five years, and less than 25% survive more than 10 years. Class IV heart failure carries
Unlabelled:
BACKGROUND AND METHODS": Heart failure is common and effective therapy exists but as yet there is little evidence that the overall prognosis is improving in clinical practice. We sought to determine if mortality, re-admission with heart failure and re-admission for any cause, had changed between cohorts of first-time admissions for heart failure identified in 1984, 1988 and 1992 using linked hospital discharge and mortality data from Scotland (population approximately 5 million).
Findings:
The number of first-time admissions for heart failure increased by 30% between 1984 and 1992, from 9716 to 12640. Their mean age was 74 years and 54% were women. Over the same period 3-year mortality declined in patients < 65 years from 53 to 41% (reduction in risk 12% (95% confidence interval 9-15%. Log-rank 70.0; P<0.001) and for patients > or =65 years from 71% to 66% (reduction in risk 5% (95% confidence interval 3-6%. Log-rank 74.5; P<0.0001). Time to death or first re-admission with heart failure also improved but not time to death or first re-admission for any cause. The total number of re-admissions increased between 1984 and 1992 but bed-days occupancy for heart failure and for any cause, adjusted for days alive, declined due to a reduction in length of stay.
Interpretation:
These data suggest that the prognosis of patients with a first admission for heart failure is improving. The timing of improvement coincides with the gradual increase in the use of angiotensin converting enzyme inhibitors for heart failure although a causal link cannot be proved from these data.
Contemporary survival in unselected patients with heart failure and the population impact of newer therapies have not been widely studied. Therefore, we have documented case-fatality rates (CFRs) over a recent 10-year period.
In Scotland, all hospitalizations and deaths are captured on a single database. We have studied case fatality in all patients admitted with a principal diagnosis of heart failure from 1986 to 1995. A total of 66 547 patients (47% male) were studied. Median age was 72 years in men and 78 years in women. Crude CFRs at 30 days and at 1, 5, and 10 years were 19.9%, 44.5%, 76.5%, and 87.6%, respectively. Median survival was 1.47 years in men and 1.39 years in women (2.47 and 2. 36 years, respectively, in those surviving 30 days). Age had a powerful effect on survival, and sex, comorbidity, and deprivation had modest effects. One-year CF was 24.2% in those aged <55 years and 58.1% in those aged >84 years. After adjustment, 30-day CFRs fell between 1986 and 1995, by 26% (95% CI 15 to 35, P<0.0001) in men and 17% (95% CI 6 to 26, P<0.0001) in women. Longer term CFRs fell by 18% (95% CI 13 to 24, P<0.0001) in men and 15% (95% CI 10 to 20, P<0.0001) in women. Median survival increased from 1.23 to 1. 64 years.
Heart failure CF is much higher in the general population than in clinical trials, especially in the elderly. Although survival has increased significantly over the last decade, there is still much room for improvement.
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Hypertension control. Report of a WHO Expert Committee
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Our future society: a global challenge
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DM Facts and figures of cancer in the European Community Lyon International Agency for Research on
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