EFFECTIVENESS OF TELEPHONE MONITORING OF PATIENTS WITH CHRONIC HEART FAILURE BY NURSES

Increased branched-chain amino acid levels are associated with long-term adverse cardiovascular events in patients with STEMI and acute heart failure

According to Russian epidemiological studies, the incidence of chronic heart failure (HF) in the general population is approximately 7%, increasing from 0.3% in the group aged 2029 years to 70% in patients aged 90 years [1]. In the general population, the incidence of atrial fibrillation (AF) ranges from 1% to 2%, which increases with age, that is, from 0.5% at the age of 4050 years to 5%15% at the age of 80 years [2]. HF and AF aggravate significantly each others course and mutually increase the risk of adverse outcomes [3, 4]. Moreover, the incidence of AF in patients with HF increases with increasing New York Heart Association (NYHA) grade; that is, among patients with HF of NYHA grade I, the incidence of AF is 5%, whereas among patients with HF NYHA grade IV, the AF incidence in 50% [5].
 Chronic HF is a syndrome with complex pathophysiology, which is characterized by the activation of neurohumoral systems, namely, the reninangiotensinaldosterone system (RAAS), sympathetic nervous system (SNS), and insufficient activity of the natriuretic peptide (NUP) system. In the early stage of HF, i.e. asymptomatic dysfunction of the left ventricle, the activation of the SNS and RAAS plays a compensatory role aimed at maintaining cardiac output and circulatory homeostasis [6]. Moreover, the NUP system has a counter-regulatory function in relation to the RAAS and SNS, and with prolonged and excessive activation of the SNS and RAAS or with insufficient NUP system activity, imbalance occurs and HF progresses [7].
 The brain natriuretic peptide (BNP) and biologically inactive N-terminal fragment of BNP (NT-proBNP) are the most studied and significant in clinical practice representatives of the NUP system. BNP and NT-proBNP are secreted by cardiomyocytes of the left ventricular (LV) myocardium in response to an increase in the mechanical load and stress of the LV myocardium. NT-proBNP is widely used as a test to rule out HF in patients with dyspnea. The NUP level also correlates with the severity and prognosis in patients with an established diagnosis of HF, and studies have reported that the NUP level acts as a criterion for treatment efficiency in patients with HF [8]. NT-proBNP is a biomarker not only for HF but also for several other conditions, such as acute coronary syndrome and myocardial infarction (MI), because it is associated with an increased risk of death from all causes, regardless of age, stable effort angina grade, myocardial infarction history, and LV ejection fraction (LVEF) [9].
 NT-proBNP levels can be influenced by several additional factors such as age, obesity, or glomerular filtration rate. The prognostic value of NT-proBNP is relevant in comorbid patients with AF associated HF because AF can increase NT-proBNP levels independently [10]. Given that NUP secretion depends on intracardiac hemodynamics, the NT-proBNP levels may also depend on the approach to managing AF. Tachycardia is associated with high NT-proBNP levels [11].
 The rhythm control approach has advantages over the heart rate control approach in patients with HF and LVEF 50% to reduce mortality and the number of unplanned hospitalizations due to HF progression [12].
 To date, the prognostic significance of NT-proBNP levels in relation to the risk of adverse events in patients with HF and reduced LV systolic function associated with AF, depending on the approach of AF management, remains unresolved.
 This study aimed to assess the predictive value of NT-proBNP in relation to the development of adverse cardiovascular events in patients with permanent or persistent AF associated with HF and LVEF 50%.

Background There is a growing prevalence of diabetes worldwide in patients in the general population, including those with prior myocardial infarction (MI). Purpose To describe the characteristics, health status, resource utilization and clinical adverse events of stable post-MI patients with diabetes. Methods The long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) prospective observational study (NCT01866904) obtained data from 8985 stable patients 1–3 years post-MI from 369 centres in 25 countries, who provided diabetes status (no, yes, insulin-treated) and follow-up. Diabetes status, other patient characteristics, medications, medical history and healthcare resource utilization were recorded at enrolment. Health status was assessed at enrolment, 1 and 2 years by EQ-5D-3L and converted to an EQ-5D score. Deaths, cardiovascular (CV) events, bleeding events and related hospitalizations were recorded during 2 years of follow-up. Results Diabetes mellitus (DM) was prevalent at enrolment in 2966 (33%) patients of whom 872 (29%) were insulin-treated. Compared to patients without DM, those with DM had a higher mean body mass index (28.2 vs 26.6kg/m2) and heart rate (71 vs 67bpm), were more likely to have had ≥2 prior MIs (12% vs 10%), chronic kidney disease (10% vs 6%), peripheral artery disease (10% vs 5%), heart failure (15% vs 10%), anaemia (4% vs 2%), angina (12% vs 9%), stroke (6% vs 4%) and chronic obstructive pulmonary disease (9% vs 7%). Patients with DM reported more problems for each domain of the EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), which resulted in a lower mean EQ-5D utility score at enrolment (0.83±0.22 for no-diabetes vs 0.86±0.19 for diabetes). Moreover, they also had higher CV hospitalization rates in the 6 months prior to enrolment (6.4% vs 5%). All these measures were more marked in insulin-dependent diabetics. The incidences of all-cause death, CV death and the composite of CV death, MI and stroke were all significantly higher in patients with DM, especially those on insulin (see Figure). For CV death, MI and stroke the 2-year risk ratios, compared to patients without DM, were 2.64 (P<0.001) and 1.48 (P<0.001) respectively for those with insulin-treated DM and non-insulin treated. Figure 1 Conclusions Within a global population of stable post-MI patients, those with DM (especially those on insulin) have poorer health status and EQ-5D utility score, higher hospitalization rates and worse clinical outcomes compared with those without DM. Thus, in cardiac clinics worldwide, patients with DM require particularly close attention. Acknowledgement/Funding The study was funded by AstraZeneca

Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial

Background: Triple negative breast cancer (TNBC) accounts for 15% of newly diagnosed breast cancer cases and has higher risks of distant recurrence and death compared to other subtypes. The current standard-of-care regimen for locally advanced disease from the KEYNOTE-522 (KN-522) trial combines neoadjuvant chemotherapy (carboplatin, paclitaxel, doxorubicin, and cyclophosphamide) with neoadjuvant and adjuvant pembrolizumab. This regimen increased rates of pathologic complete response (pCR) and event-free and overall survival but had higher rates of adverse events (AEs). Of note, patient race was not reported in KN-522. Our goals were to examine rates of AEs, hospitalizations, and suspected immune-related adverse events (irAEs) in TNBC patients undergoing neoadjuvant chemo/immunotherapy in a diverse academic center population more representative of a real-world patient population. Methods: TNBC patients who received neoadjuvant treatment with pembrolizumab were retrospectively identified through pharmacy treatment records at 7 academic medical centers across the U.S. Electronic medical record review was conducted, and de-identified data were managed using electronic data capture tools. Descriptive statistics were used to report all variables, and total rates of AEs, grade 3+ AEs, and hospitalization rates for patient groups were estimated with 95% confidence intervals (CIs) calculated by 5000 Monte Carlo simulations. Fisher’s exact test was used to compare event rates between groups, and two sample proportions test was used to evaluate the difference in proportions between any two groups. Results: At the time of analysis, 137 patients had data collected from 4 sites. Median age was 48 years old. All identified as female. Racially, 59% identified as white, 34% as black, and 7% as other. Ethnically, 7% identified as Hispanic/Latino. 75% were overweight/obese based on initial BMI. 61% achieved a pCR following neoadjuvant treatment, and 4 (3%) died from progressive/metastatic disease at the time of data collection. 89% had a reported AE, and 36% had a grade 3+ AE. The most common grade 3+ AE was myelosuppression, and 70% required growth factor support at some point during neoadjuvant therapy. The most common suspected irAEs were dermatitis (20%), hypothyroidism (18%), arthralgias/myalgias (18%), diarrhea (15%), hepatitis (11%), and adrenal insufficiency (5%). 12% also had cardiac or thrombotic AEs. 24% were treated with systemic steroids for a suspected irAE, and only 58% received a full course (8 doses) of neoadjuvant pembrolizumab due to toxicity concerns. Pembrolizumab was permanently discontinued in 58% of patients with very few (6%) re-challenged once stopped. 31% were hospitalized during treatment, with the majority hospitalized during neoadjuvant therapy. Neutropenic fever was the most common admitting diagnosis, and 29% of hospitalizations had an irAE reported. There were no statistically significant differences in AE or hospitalization rates between white versus black patients or between patients with normal BMIs compared to overweight/obese patients, although there was a trend towards significance in overweight but not obese patients having lower rates of grade 3+ AE (p=0.07) compared to patients with normal BMIs. Conclusions: This study presents an analysis of AEs in a more diverse and representative of the real-world patient population receiving neoadjuvant chemo/immunotherapy for TNBC. Rates of pCR and AEs were similar to those reported in KN-522. However, a large proportion of patients stopped pembrolizumab early due to a suspected irAE and did not complete adjuvant treatment. Additionally, high rates of hospitalization and myelosuppression suggest that incorporating growth factor support may benefit TNBC patients receiving neoadjuvant treatment. Our study is ongoing with final data collection pending; this will be reported in the future. Citation Format: Jessica Sharpe, Chih-Yuan Hsu, David Choi, Ekaterina Proskuriakova, Sara Zelinskas, Mateo Campana Montalvo, Hollie Sheffield, Jennifer G. Whisenant, Keaton Gaffney, M. Scott Thompson, Kim Blenman, Lynn Symonds, Nisha Unni, Dionisia Quiroga, Karine Tawagi, Cesar Santa-Maria, Yu Shyr, Laura Kennedy. Adverse events in patients treated with neoadjuvant chemo/immunotherapy for triple negative breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-12-14.

Impact of heart failure on outcome after percutaneous coronary intervention: is it the patient or the intervention?

Pulmonary Arterial Hypertension With Right Ventricular Failure: The Left Forgotten Ventricle

Temporal trends in the outcomes of acute heart failure: between consolatory evidences and real progress.

Comorbidities in heart failure: a key issue

Background: Heart failure remains a significant socioeconomic burden and leads to critical health problems due to its high mortality and hospitalization rates. Therefore, proper treatment of heart failure is very important in terms of long-term prognosis and quality of life.Current Concepts: The use of evidence-based drugs, intervention treatment, and patient education are essential recommendations to improve the prognosis of heart failure. However, these recommendations of treatment guidelines are not well implemented in actual clinical situations. A more realistic solution can be sought considering the domestic situation. First, it is necessary to improve public awareness of the disease. It is also necessary to actively educate medical personnel, including primary care doctors. Second, efforts to improve clinical inertia or neglect of treatment of medical personnel are needed. For a systematic treatment approach, developing performance indicators in heart failure management are necessary, which can be a realistic and suitable alternative to the domestic clinics.Discussion and Conclusion: Applying a well-proven treatment to patients with heart failure should be essential, which is not an option in actual clinical practice. To solve this problem, social attention and efforts, more grand decisions by academic societies, and creative concerns from public institutions should be necessary in the face of the so-called heart failure epidemic around the world and in Korea.

Introduction: Immune checkpoint inhibitors (ICI) can trigger cardiac-related immune adverse effects by activating T cells against myocardial self-antigens, which can cause myocarditis, arrhythmias, and cardiomyopathy. SGLT2 inhibitors have anti-inflammatory properties and can help regulate immune cells, which might play a role in preventing immune related cardiac adverse events in patients on ICI. Study Aim: To evaluate SGLT2 inhibitor impact on preventing major adverse cardiovascular events in patients receiving ICI Methods: This retrospective cohort study utilized the TrinetX Global Collaborative Network to analyze patients aged ≥ 18 from January 2014 and May 2025. Two cohorts were identified: cohort 1 included patients receiving ICI in combination with SGLT2 inhibitors, and cohort 2 received ICIs without SGLT2 inhibitors. Both cohorts excluded individuals with cardiomyopathy or heart failure (HF). The outcomes assessed were HF, atrial fibrillation/flutter (AF), acute myocardial infarction (AMI), myocarditis, and mortality. Absolute risk, relative risk (RR), 95% confidence interval (CI), and p-value were calculated using TrinetX platform. Kaplan-Meier analysis was used to estimate survival probabilities and log-rank tests to compare the survival curves. Results: After propensity score matching, both cohorts had 2,862 patients with mean age at index diagnosis 68 with 35% females and 62% males. SGLT-2 group had 0% incidence of heart failure vs 1.103% in control group with a p-value of < 0.0001, and RR being 0 as there were no events in cohort 1. There was lower risk of AF in SGLT-2 group compared to non-user group (RR 0.7, 95% CI: 0.535-0.916, p-value 0.009). The risk of AMI (RR 0.85, 95% CI: 0.592-1.212, p-value 0.3625) and myocarditis (RR 1.001, 95% CI: 0.417-2.401, p-value 0.998) was similar between both groups. All-cause mortality was lower in SGLT-2 inhibitor group compared to control group (RR 0.658, 95% CI: 0.613-0.706, p-value < 0.0001) Conclusion: SGLT2 inhibitors were associated with a lower incidence of HF, AF, and all-cause mortality in patients receiving ICIs, with no significant impact on AMI or myocarditis. Further studies are needed to explore the potential benefits of SGLT2 inhibitors for primary prevention of major adverse cardiovascular events in this patient population.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish National Science Council and The Swedish Heart-Lung Foundation Background Many people with chronic heart failure have a sedentary lifestyle. Alternative forms of physical activity might be beneficial, and should be considered, especially for patients with heart failure who are less inclined to start programs using traditional modes of exercise. Exergaming and yoga are promising interventions for improving functional capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure. Objective To explore effects of exergaming at home and medical yoga in a group on functional capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure. Methods This is a sub-study within a larger randomized controlled trial (the HF-Wii trial) with a three-months intervention and outcomes measures at baseline, three, six, and twelve months. Study particpants were recruited from nurse-led heart failure clinics at two university hospitals in Sweden. Randomization was in a 1:1:1 ratio to either an exergame intervention, a medical yoga intervention, or an active control group. Exercise capacity was assesed using the six-minute walk test. Symptoms (shortness of breath and fatigue) were assessed with a numeric rating scale ranging from 0-10. Well-being was assessed with Cantril’s ladder of life. Health-related quality of life was examined by the Minnesota Living with Heart failure Questionnaire. Anxiety and depression were measured with the hospital anxiety and depression scale. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time. Results In total, 104 patients (37% women, mean age 71±12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n=35), medical yoga (n=33), or an active control group (n=36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life (all p< 0.05) and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at three months (p = 0.047). Conclusions This randomized sub-study showed that both exergaming and medical yoga had favorable effects on outcomes, with exergaming, with its higher physical intensity, having effects on physical health and with medical yoga being a mind-body intervention with effects on emotional well-being.

Background Heart failure (HF) is one of the cardiovascular diseases with high mortality and morbidity and high hospitalization rate, associated with a high degree of disability in terms of quality of life, by reducing exercise capacity and limiting the possibilities to make individual physical effort. Although diagnostic and treatment methods are increasingly complex, mortality and hospitalization rates are still very high, which equals a large consumption of financial resources. Purpose Identifying a potential prognostic parameter could represent in future a salutary solution for prophylactic intervention in the management of patients with decompensated HF. Through the present study, I aimed to identify a potential predictive factor by means of which the risk of rehospitalization and mortality in the first year after the last discharge can be evaluated right from the admission of a patient with decompensated HF. The parameter I set out to research is red cell distribution width (RDW), a parameter easy to obtain by collecting blood samples, that is included in any usual blood count, and expressed in percentages (%), and its normal values are between 12-15%. The data from the current medical literature regarding the prognostic impact of RDW in the population of patients with HF are minimal, being a topic poorly explored. Methods The research was carried out in a retrospective manner on a number of 260 patients with HF, the parameter of interest being RDW. The main objective of my study was to determine if RDW could represent o possible prognostic parameter in HF patients, by exploring if there is a correlation between its increased values and 3 months, 6 months rehospitalization, and 1 year death. The statistical analysis was based on the logistic regression model by which I conceived a mathematical formula represented by the following model: Score (of event occurrence) = event estimation coefficient + RDW estimation coefficient * RDW value (Yi= β0+β1Xi+εi ). To convert the value of the score obtained by applying the above-mentioned formula into probabilities, I applied the following equation: p=1/1+e-score. Results Based on the logistic regression model, the statistical results revealed that HF patients with high RDW (at least 14%) had a higher probability of being readmitted at 3 months, 6 months, and of dying at 1 year, the model being considered statistically significant at a p-value below 0.05. Conclusions Using logistic regression models, the results of my study revealed that certain negative events in patients with HF such as rehospitalization and 1-year death, can be predicted based on the RDW value, therefore we can consider RDW as a future prognostic predictor in patients with HF. 3-month rehospitaliztion based on RDW 6-month rehospitaliztion based on RDW

Case Presentation: A 71-year-old man with coronary artery disease, left ventricular (LV) systolic dysfunction (ejection fraction, 30%), and recent admission for heart failure presented with acute dyspnea and hypoxemia. A pro-brain–type natriuretic peptide level was elevated at 2450 pg/mL (normal <350 pg/mL). Chest x-ray demonstrated cardiomegaly and small bilateral pleural effusions. After an hour of diuresis, the patient developed systemic arterial hypotension and worsened hypoxemia, prompting cardiology consultation. Based on the absence of rales on physical examination and lack of pulmonary edema on chest x-ray, an alternative diagnosis of pulmonary embolism (PE) was suggested, and contrast-enhanced chest tomography (CT) was obtained. Chest CT demonstrated large bilateral proximal PE. Venous thromboembolism (VTE), which encompasses deep vein thrombosis and PE, is an increasingly common and challenging complication of heart failure. The relative risk of PE is at least double that of patients without heart failure and increases as LV systolic function declines.1 PE patients with heart failure have a higher overall mortality rate than those without heart failure (17% versus 10%).2 In addition, PE is an independent predictor of death or rehospitalization among heart failure patients.3 ### Risk Factors Heart failure patients often have a high medical acuity and multiple risk factors that amplify the risk of VTE.4 The increased risk of VTE observed with heart failure itself has been attributed to reduced flow caused by low cardiac output and abnormalities of hemostasis, platelet function, and endothelial function. Central venous catheters and leads from implantable cardiac defibrillators and pacemakers are common among heart failure patients and have been shown to increase the risk of upper-extremity deep vein thrombosis. Heart failure patients tend to be older, and VTE in the elderly is problematic.5 ### Hemodynamics Acute PE increases pulmonary vascular resistance and right ventricular (RV) afterload through direct physical obstruction, hypoxemia, and pulmonary …

Given the rising burden of heart failure (HF), stratification of patients at increased risk for adverse events is critical. We aimed to compare the predictive value of various maximal and submaximal cardiopulmonary exercise test (CPET) variables for adverse events in patients with HF. A total of 237 patients with HF (66 (58-73) yr, 30% women, 70% HF with reduced ejection fraction) completed a CPET and had 5 yr of follow-up. Baseline characteristics and clinical outcomes (all-cause mortality, major adverse cardiovascular events, and cardiovascular-related hospitalization) were extracted from electronic patient files. Receiver operating characteristics curves for maximal (e.g., peak V̇O 2 ) and submaximal CPET variables (e.g., VE/V̇CO 2 slope, cardiorespiratory optimal point (COP), V̇O 2 at anaerobic threshold) were compared using the Akaike Information Criterion (AIC) method, whereas their calibration was assessed. One hundred three participants (43%) reached the composite endpoint, and 55 (23%) died. Percent predicted peak V̇O 2 was the best predictor for adverse outcomes (AIC: 302.6) followed by COP (AIC: 304.3) and relative peak V̇O 2 (mL·(kg·min) -1 , AIC: 304.4). Relative peak V̇O 2 (AIC: 217.1) and COP (AIC: 224.4) were also among the three best predictors for mortality, together with absolute peak V̇O 2 (mL·min -1 , AIC: 220.5). A good calibration between observed and predicted event rate was observed for these variables. Percent predicated and relative peak V̇O 2 had the best predictive accuracy for adverse events and mortality, but the submaximal COP had a noninferior predictive accuracy for adverse events in patients with HF. These findings highlight the potential of submaximal exercise testing in patients with HF.