Cardiology Heart Failure Research Articles

Mineralocorticoid receptor antagonists in patients with heart failure: current experience and future perspectives.

The 2016 European Society of Cardiology Heart Failure society as well as the 2016 American Heart Association/American College of Cardiology/Heart Failure Society of America heart failure (HF) guidelines confirm the class I indication for mineralocorticoid receptor antagonists (MRAs) in patients with chronic HF and a reduced left ventricular ejection fraction (HF-REF). MRAs in addition to an angiotensin converting enzyme inhibitor (ACEi), or an angiotensin receptor antagonist if an ACEi is not tolerated, along with a beta receptor antagonist and a diuretic (if required for congestion relief) make up the baseline therapy for all patients with chronic HF-REF. However, despite the finding that MRAs have been shown to reduce mortality as well as total and repeated hospitalizations in all patients with chronic HF-REF, as well as their class I indication in international guidelines, their use in guideline eligible patients remains suboptimal. Although much has been written about the mechanisms and role of MRAs in HF, this article will review the clinical studies and mechanisms thought responsible for their benefits in an attempt to increase their use in guideline eligible patients with HF as well as to provide the basis for understanding potential new opportunities for their use in patients with HF.

Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure Stages in the Community

ObjectivesThe purpose of this study was to describe the prevalence and prognosis of HF stages in the community; to evaluate if preclinical HF stages are characterized by elevation of pro-inflammatory (C-reactive protein), neurohormonal activation (B-type natriuretic peptide, renin and aldosterone), and cardiac stress biomarkers (high-sensitivity troponin I, ST-2, and growth differentiation factor-15). BackgroundThe American Heart Association/American College of Cardiology heart failure (HF) classification has 3 stages. Knowledge regarding the community burden of HF stages is limited, and data on the biomarker profile associated with HF stages are scarce, although higher concentrations of certain biomarkers are associated with preclinical HF. MethodsWe evaluated 6,770 participants (mean age 51 years; 54% women) from the Framingham Study, defining 4 stages: 1) healthy: no risk factors; 2) stage A: presence of HF risk factors (hypertension, diabetes, obesity, coronary artery disease), no cardiac structural/functional abnormality; 3) stage B: presence of prior myocardial infarction, valvular disease, left ventricular (LV) systolic dysfunction, LV hypertrophy, regional wall motion abnormality, or LV enlargement; 4) stage C/D: prevalent HF. ResultsThe prevalence of HF stages A and B were 36.5% and 24.2%, respectively, rising with age (odds ratio: 1.70 [95% confidence interval: 1.64 to 1.77] per decade increment). In age- and sex-adjusted models, we observed a gradient of increasing biomarker levels across HF stages (p < 0.05; n = 3,416). Adjusting for age and sex, mortality rose across HF stages (232 deaths, mean follow-up 7 years), with 2- and 8-fold mortality risks for stages B and C/D, respectively, compared with healthy. ConclusionsApproximately 60% of our sample has preclinical HF, and those in stage B had higher concentrations of HF biomarkers and experienced a substantial mortality risk.

European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions.

The European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT-R) was set up with the aim of describing the clinical epidemiology and the 1-year outcomes of patients with heart failure (HF) with the added intention of comparing differences between participating countries. The ESC-HF-LT-R is a prospective, observational registry contributed to by 211 cardiology centres in 21 European and/or Mediterranean countries, all being member countries of the ESC. Between May 2011 and April 2013 it collected data on 12 440 patients, 40.5% of them hospitalized with acute HF (AHF) and 59.5% outpatients with chronic HF (CHF). The all-cause 1-year mortality rate was 23.6% for AHF and 6.4% for CHF. The combined endpoint of mortality or HF hospitalization within 1 year had a rate of 36% for AHF and 14.5% for CHF. All-cause mortality rates in the different regions ranged from 21.6% to 36.5% in patients with AHF, and from 6.9% to 15.6% in those with CHF. These differences in mortality between regions are thought reflect differences in the characteristics and/or management of these patients. The ESC-HF-LT-R shows that 1-year all-cause mortality of patients with AHF is still high while the mortality of CHF is lower. This registry provides the opportunity to evaluate the management and outcomes of patients with HF and identify areas for improvement.

Diagnosis, Clinical Course, and 1-Year Outcome in Patients Hospitalized for Heart Failure With Preserved Ejection Fraction (from the Polish Cohort of the European Society of Cardiology Heart Failure Long-Term Registry)

Compared with heart failure (HF) with reduced ejection fraction (HF-REF), the diagnosis of HF with preserved EF (HF-PEF) is more challenging. The aim of the study was to assess the prevalence of HF-PEF among patients hospitalized for HF, to evaluate the pertinence of HF-PEF diagnosis and to compare HF-PEF and HF-REF patients with respect to outcomes. The analysis included 661 Polish patients hospitalized for HF, selected from the European Society of Cardiology (ESC)-HF Long-Term Registry. Patients with an EF of ≥50% were included in the HF-PEF group and patients with an EF of <50% - in the HF-REF group. The primary end point was all-cause death at 1year. The secondary end point was a composite of all-cause death and rehospitalization for HF at 1year. HF-PEF was present in 187 patients (28%). Of those 187 patients, mitral inflow pattern was echocardiographically assessed in 116 patients (62%) and classified as restrictive/pseudonormal in 37 patients (20%). Compared with HF-REF subjects, patients with HF-PEF were older, more often female, and had a higher prevalence of hypertension, atrial fibrillation and sleep apnea. Despite lower B-type natriuretic peptide concentrations and lower prevalence of moderate-to-severe mitral regurgitation in patients with HF-PEF, congestive symptoms at admission were as severe as in patients with HF-REF. There were no significant differences in in-hospital mortality between the HF groups. One-year mortality was high in both groups (17% in HF-PEF vs 21% in HF-REF, p= 0.22). There was a trend toward a lower frequency of the secondary end point in the HF-PEF group (32% vs 40%, p= 0.07). In conclusion, in clinical practice, even easily obtainable echocardiographic indexes of diastolic dysfunction are relatively rarely acquired. One-year survival rate of patients with HF-PEF is not significantly better than that of patients with HF-REF.

Heart Failure Association of the European Society of Cardiology heart failure nurse curriculum.

Recent advances in care and management of heart failure have improved outcome, largely as a result of the developing evidence basis for medications, implantable devices and the organization of heart failure follow-up. Such developments have also increased the complexity of delivering and coordinating care. This has led to a change to the way in which heart failure services are organized and to the traditional role of the heart failure nurse. Nurses in many countries now provide a range of services that include providing care for patients with acute and with chronic heart failure, working in and across different sectors of care (inpatient, outpatient, community care, the home and remotely), organising care services around the face-to-face and the remote collection of patient data, and liaising with a wide variety of health-care providers and professionals. To support such advances the nurse requires a skill set that goes beyond that of their initial education and training. The range of nurses' roles across Europe is varied. So too is the nature of their educational preparation. This heart failure nurse curriculum aims to provide a framework for use in countries of the European Society of Cardiology. Its modular approach enables the key knowledge, skills, and behaviours for the nurse working in different care settings to be outlined and so facilitate nursing staff to play a fuller role within the heart failure team.

Abstract 151: End-of-Life Care for Left Ventricular Assist Devices: Differing Perspectives of Cardiology and Palliative Care and Hospice Providers

Background: Destination therapy left ventricular assist devices (DT-LVADs) have become a treatment option for carefully selected patients with end-stage heart failure. Death is inevitable despite DT-LVAD, with 1-year mortality approximately 20% and median survival 5 years. However, end-of-life processes for LVAD patients vary significantly by institution, provider, and patient preference. Palliative care has played an increasing role in the care of this patient population, yet there remains little data on the most effective way to integrate palliative care and hospice in the DT-LVAD population. Therefore, we aimed to understand the end-of-life perspectives regarding LVADs among both cardiology and palliative care/hospice providers. Methods: Using internet-based, secure methods, we administered a 41-item survey via electronic mail to members of the American Academy of Hospice and Palliative Medicine, European Society of Cardiology-Heart Failure Association, the International Society for Heart and Lung Transplantation, and the Heart Failure Society of America to assess their perspectives on end-of-life care in patients with LVADs. Descriptive statistics were used to analyze data. Fisher’s exact test was used to compare categorical data. Results: From October to November 2011, there were a total of 440 respondents (palliative care/hospice=137; cardiology=303). Most were physicians (80%; n=320) and male (59%; n=232). The majority of providers in both groups viewed an LVAD as a life-sustaining treatment. The groups differed in their attitudes, beliefs, and comfort with end-of-life care in patients with an LVAD. Few palliative care/hospice providers believed a patient needed to be imminently dying to turn off an LVAD; whereas most cardiology providers noted patients should be imminently dying in order to consider LVAD deactivation (2% vs 60%; p=&lt;0.001). Most palliative care/hospice providers believed requests for turning off an LVAD in a patient who is not nearing death should be honored. In contrast, just over half of cardiology providers contended the request should be honored (88% vs 57%; p=&lt;0.001). The provider groups also disagreed on requiring ethics consultation, with most cardiology providers stating it was necessary prior to turning off an LVAD near the end of life (67% vs 24%; p=&lt;0.001). Conclusion: Cardiology providers and palliative care/hospice providers collectively have different perceptions on management of end of life in patients with an LVAD. Bridging the gaps between these two disciplines is a critical first step in creating a more cohesive approach to end-of-life care for these patients—one that honors autonomy but respects individual provider comfort levels.

0440: Patient journey during hospitalization for acute heart failure in cardiology and geriatric departments of greater Paris university hospitals

Acute heart failure is a major health care problem and data on patient journey before/during/after hospitalization are limited. The aim of this study was to analyze patient journey from pre-hospital to discharge in acute heart failure in a multicentre observational study. This observational study enrolled, one day per week, 257 patients with acute heart failure during five months (September 2014 – February 2015) in 14 departments of Paris (cardiology: 10; geriatrics: 4). Mean age was 77±15 years, 56% were male. First medical contact was an emergency department in 45% of cases, a general practitioner (GP) in 16%, and a cardiologist or a medical ambulance (13% each). There was a single medical actor intervention before hospitalization in 78% of cases. 64% of patients were finally admitted through emergency departments. Previous history of heart failure was common (71%) and most frequent precipitating factors were arrhythmia (29%), infection (26%) and non-compliance to medical therapy (16%). Diabetes (28%), chronic pulmonary disease (19%) and cognitive disabilities (18%) were the most frequent co-morbidities. LVEF was preserved (>50%) in 32%. In-hospital stay was 13±12 days and 61% of patients stayed in an intensive cardiologic care unit (ICCU) for an average duration of 5.5±3.9 days. 64% of patients were directly discharged home and 21% were transferred to rehabilitation care units. In-hospital mortality was 2.4%. Although heterogeneous patient admission for acute heart failure is made through emergency departments and GPs in the majority of cases, a stay in intensive care unit is observed in 61% of cases. Discharge from hospital is made at home in 2/3 of cases. Therefore, actions to improve cooperation between professionals in the management of acute heart failure should target emergency departments and GPs. Abstract 0440 – Figure

0481: Clinical profile of patients hospitalized for acute heart failure in cardiology and in geriatrics. A survey in greater Paris University hospitals

Acute heart failure is a major cause of hospitalizations, particularly in patients over 65 years. The purpose of this analysis was to compare medical demographics of patients referred to cardiology departments and those referred to geriatric departments. Consecutive patients hospitalized for acute heart failure were included in 10 cardiology departments (CD, n=192) and 4 geriatrics departments (GD, n=65) between September 2014 and February 2015. There was no difference in duration of hospital stay (13.1±12.7 vs 11.3±5.6 days, p=0.7). Mean age was different between CD and GD (73.1±15 vs 89.1±5.7 years, p<0.0001) with a greater proportion of women in GD (37% versus 65%, p=0.0006). Comorbidities were more frequent in geriatric population (p=0.0004). Geriatric patients were more often staying in long stay institutions (13% vs 2.7% p<0.0017) or were living alone with medical support (29% vs 16% p<0.02). Cognitive disorders and falls were more prevalent (47% vs 9%, p<0.0001 and 19% vs 3%, p<0.0001 respectively) and there was a trend for more depressions. Infection was a much more frequent trigger (56% vs 16%, p<0.0001) whereas poor compliance was similar in the two subgroups (16%). Patients referred to geriatrics were more likely to be referred by a general practitioner (23% vs 13%, ns) and by emergency departments (76% vs 28% p=0.016) and less likeky to stay in an intensive care unit (13% versus 48%) and to receive nitrates or inotropic support. Fewer patients in geriatrics were discharged home (51% vs 69%, p<0.0001) with more home medical support (43% vs 13% p<0.0001) and more were referred to rehabilitation centers (37% vs 16%, p=0.008). Patients referred to geriatrics departments for acute heart failure have a different patient journey from those referred to cardiology departments. The high prevalence of cognitive disorders makes management of this condition complex and often requires home medical support.

Nonagenarians presenting to the diagnostic heart failure clinic

BackgroundThe prevalence of heart failure (HF) and the complexities of its management increase with age. Our city serves a population of 551,800inhabitants with a growing elderly population. The size of the 90years and above age group has increased by 26% since 2001 to 4300people. MethodsPatients with suspected HF and a natriuretic peptide (NTproBNP) greater than 400pg/mL undergo an echo and are reviewed by a HF cardiologist. We characterised the patients aged 90–99years presenting to the diagnostic HF clinic between March 2012 and September 2014 by the diagnoses, co-morbidities, symptoms and whether the clinic changed their management. ResultsOf 1785patients seen, 144patients (9%) were nonagenarians with HF. The male to female ratio was 1:1.38. The diagnoses were HF due to left ventricular systolic dysfunction (HF-LVSD) (44%), heart failure with preserved ejection fraction (HFPEF) (38%), pulmonary hypertension (12%), valve disease (5%) and heart failure due to right ventricular systolic dysfunction (HF-RVSD) in 1 patient (<1%). The average number of co-morbidities was four. The majority of patients (62%) had mild symptoms (New York Heart Association Class II). Management was changed in 92.4% of patients. Further follow-up was offered to 14% of patients at a HF nurse-led clinic and 9% at a cardiologist-led clinic. ConclusionsHF-LVSD, and not HFPEF, is the most common HF diagnosis amongst nonagenarians presenting to the diagnostic HF clinic. Beyond making detailed diagnosis, the clinic changed the management of 92.4% of patients.

Abstract 14841: Definitions of Stage D Heart Failure and Survival: Comparing INTERMACS Profiles, ESC Criteria, and Physician Assessment

Introduction: Care for patients with stage D heart failure (HF) is becoming increasingly complex in the era of mechanical circulatory support (MCS). However, an operational consensus definition of stage D HF is currently lacking. Hypothesis: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles better identify outpatients with stage D HF compared to European Society of Cardiology Heart Failure Association (ESC-HFA) criteria and physician assessment. Methods: We evaluated 474 outpatients with systolic HF (ejection fraction [EF] &lt;40%) who received care in Q1 2012 and have not previously received advanced therapies (age, 61±15 years; 35.4% women; 44.7% white, 46.8% black; EF 24±10%; 67.2% with ischemic heart disease; 6.3% on home inotropes). We applied INTERMACS profiles (defining stage D as profiles 2-5) and ESC-HFA criteria to identify stage D HF, and compared with physician-derived stage D identification based on evaluations for advanced therapies (MCS, heart transplant, or palliative care). We then compared 3-year mortality across definitions. Results: INTERMACS profiles, ESC-HFA criteria, and physicians identified 50 (10.5%), 59 (12.4%), and 64 (13.5%) of 474 patients, respectively, as having stage D HF. Concordance between definitions was low, with κ =0.35 (optimal: 1.0). After a median of 3.1 years (1.6, 3.3), 95 patients died (3-year mortality: 21.4%). In addition, 24 patients received MCS and 11 received heart transplant. Mortality was 51.2%, 43.7%, and 34.5% for INTERMACS-, ESC-HFA-, and physician-identified stage D HF patients, respectively ( Figure 1 ). The INTERMACS definition provided the best prognostic separation between stage D and C HF patients, as measured by the Royston’s R 2 statistic ( Figure 1 ). Conclusions: INTERMACS profiles provide a reasonable alternative for the identification of stage D patients in ambulatory systolic HF populations and offer better prognostic information than the ESC-HFA criteria.

Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology.

Takotsubo syndrome is an acute reversible heart failure syndrome that is increasingly recognized in modern cardiology practice. This Position Statement from the European Society of Cardiology Heart Failure Association provides a comprehensive review of the various clinical and pathophysiological facets of Takotsubo syndrome, including nomenclature, definition, and diagnosis, primary and secondary clinical subtypes, anatomical variants, triggers, epidemiology, pathophysiology, clinical presentation, complications, prognosis, clinical investigations, and treatment approaches. Novel structured approaches to diagnosis, risk stratification, and management are presented, with new algorithms to aid decision-making by practising clinicians. These also cover more complex areas (e.g. uncertain diagnosis and delayed presentation) and the management of complex cases with ongoing symptoms after recovery, recurrent episodes, or spontaneous presentation. The unmet needs and future directions for research in this syndrome are also discussed.

Assessment of treatment adherence among black Africans with heart failure

to analyze patient-related factors that may influence adherence in patients with heart failure in an African cardiology department. This prospective observational study took place in the in-patient department of the Abidjan cardiology institute and enrolled consecutive patients hospitalized for decompensated heart failure from January to November 2014. The inclusion criteria were chronic heart failure in patients older than 18 years, developing for at least 6 months and treated by medication. The revised heart failure compliance questionnaire was used. The study included 121 patients. Overall adherence was poor in 88.4% of patients. Multiple linear regression analyses showed that use of traditional medicine was associated with poor adherence for the following 3 components: keeping follow-up appointments, medication intake, and sodium limitations. Overall adherence increased with the number of hospitalizations (OR = 1.69, 95% CI 1.13-2.53; p = 0.01). This increase persisted after adjustment for age, sex, educational level, marital status, medical insurance coverage and the use of alternative medicines (traditional and Chinese) (OR = 1.70; CI 1.12-2.28; p = 0.01). Adherence among black Africans with heart failure remains poor, influenced too much by traditional medicine. Therapeutic education is essential to improve patients’ knowledge about their disease and its treatment.

Anti-inflammatory therapy in the treatment of cardiovascular diseases.

Copyright © Polskie Towarzystwo Kardiologiczne Mariusz Tomaniak — cardiology resident and doctoral candidate in the 1st Department of Cardiology at Medical University of Warsaw, graduated with honours from the 1st Faculty of Medicine at Medical University of Warsaw in 2013, accepted for residency and PhD studies with the highest scores in 2014. Awarded with Ministry of Health (2010, 2011) and Ministry of Science and Higher Education Scholarships (2012) for scientific and experimental achievements. His current areas of research involve individualisation of cardiovascular pharmacotherapy with emphasis on antiplatelet and antithrombotic agents, novel technologies applied in the treatment of coronary artery disease, invasive cardiology, cardiac biomarkers and acute heart failure. His recent publications include papers on platelet function testing, non-vitamin K oral anticoagulants, bioresorbable vascular scaffolds, microRNAs and galectin-3 in acute decompensated heart failure and monographies on “Fondaparinux” and “Hypercholesterolaemias and dyslipidaemias”.

The Fondation Leducq. A French Foundation that supports research in cardiovascular and neurovascular diseases on both sides of the Atlantic.

The Fondation Leducq. A French Foundation that supports research in cardiovascular and neurovascular diseases on both sides of the Atlantic.

Appropriateness of Prescriptions of Recommended Treatments in Organisation for Economic Co-operation and Development Health Systems: Findings Based on the Long-Term Registry of the European Society of Cardiology on Heart Failure

ObjectiveThis observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries. MethodsThree data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development’s Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance. ResultsOf 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4; 95% confidence interval 1.1–1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7; 95% confidence interval 0.5–0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness. ConclusionsCombining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to design more effective policies to improve adherence to guidelines, improve health care outcomes, and potentially reduce costs.

Clinical trials update from the European Society of Cardiology-Heart Failure meeting 2015: AUGMENT-HF, TITRATION, STOP-HF, HARMONIZE, LION HEART, MOOD-HF, and renin-angiotensin inhibitors in patients with heart and renal failure.

This article provides an overview on the key trials relevant to the pathophysiology, prevention, and treatment of heart failure (HF) presented at the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) annual meeting held in Seville, Spain in May 2015. Trials reported include AUGMENT-AF (myocardial injections of calcium-alginate hydrogel), a propensity score-matched study of renin-angiotensin system antagonists in patients with HF and severe renal dysfunction, HARMONIZE (sodium zirconium cyclosilicate used to bind potassium), TITRATION, comparing two regimes for introducing LCZ696, STOP-HF, a trial of intramyocardial stromal cell-derived factor-1, MOOD-HF (escitalopram for patients with heart failure and depression), and LION HEART, a trial of intermittent levosimendan therapy. Unpublished reports should be considered as preliminary, since analyses may change in the final publication.

Proteomics of pediatric heart failure: from traditional biomarkers to new discovery strategies.

Heart failure in children is a complex clinical syndrome with multiple aetiologies. The underlying disorders that lead to heart failure in children differ significantly from those in adults. Some clinical biomarkers for heart failure status and prognosis appear to be useful in both age groups. This review outlines the use and the present status of biomarkers for heart failure in paediatric cardiology. Furthermore, clinical scenarios in which development of new biomarkers might address management or prognosis are discussed. Finally, strategies for proteomic discovery of novel biomarkers and application to practice are described.

Clinical characteristics and management of hospitalized and ambulatory patients with heart failure-results from ESC heart failure long-term registry-Egyptian cohort.

AimsOur aim is to describe the clinical characteristics and management of patients hospitalized with acute heart failure (HHF) and ambulatory patients with chronic heart failure (CHF) in Egypt and compare them with heart failure (HF) patients from other countries in the European Society of Cardiology‐Heart Failure (ESC‐HF) registry.Methods and resultsThe ESC‐HF Long‐term Registry is a prospective, multi‐centre, observational study of patients presenting to cardiology centres in member countries of the ESC. From April 2011 to February 2014, a total of 2145 patients with HF were recruited from 20 centres all over Egypt. Of these patients, 1475 (68.8%) were hospitalized with HHF, while 670 (31.2%) had CHF. Less than one‐third (32.1%) of all patients were females. HHF patients {median age of 61 years [interquartile range (IQR), 53–69]} were older than CHF patients [median age of 57 years (IQR,46‐64)]; P < 0.0001. They had more diabetes mellitus (45.4% vs. 31.8%; P < 0.0001). Left ventricular ejection fraction > 45% was present in 22% of HHF vs. 25.6% of CHF (P = 0.17). Atrial fibrillation existed in about a quarter of all patients (24.5%). Ischaemic heart disease was the main cause of HF in Egyptian patients. All‐cause in‐hospital mortality was 5%. Egyptian patients presented at a much earlier age than in other regions in the registry. They had more diabetes mellitus. Atrial fibrillation prevalence was remarkably lower. Other co‐morbidities (renal dysfunction, stroke, and peripheral arterial disease) occurred less frequently.ConclusionPatients in the Egyptian cohort exhibited distinct features from HF patients in other countries in the ESC‐HF Long‐term Registry.

Assessing the Quality and Comparative Effectiveness of Team-Based Care for Heart Failure

Team-based or multidisciplinary care may be a potential way to positively impact outcomes for heart failure (HF) patients by improving clinical outcomes, managing patient symptoms, and reducing costs. The multidisciplinary team includes the HF cardiologist, HF nurses, clinical pharmacists, dieticians, exercise specialists, mental health providers, social workers, primary care providers, and additional subspecialty providers. The timing and setting of multidisciplinary care depends on the needs of the patient and the resources available. Multidisciplinary HF teams should be evaluated based on their ability to achieve goals, as well as their potential for sustainability over time.

Adherence to clinical guidelines in heart failure (HF) outpatients: Impact of an interprofessional HF team on evidence-based medication use

Clinical systolic heart failure (HF) guidelines specify recommendations for ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta blockers according to doses used in clinical trials. However, many HF patients remain suboptimally treated. We sought to determine which provider type, between an interprofessional HF team, non-HF cardiologists, and primary care physicians (PCP), most optimally manages HF medications and doses. A retrospective chart review was performed on adult patients at an academic county hospital with an ejection fraction ≤40% and a diagnosis of HF, seen by a single provider type (HF team, cardiologist, or PCP) at least twice within a 12-month period. Utilization rates of any ACEI/ARB and any beta blocker were robust across provider types, though evidence-based ACEI/ARB and beta blocker were greatest from the HF team. Doses of evidence-based therapies dropped markedly in the non-HF team groups. The percent of patients prescribed optimal doses of an evidence-based ACEI/ARB AND beta blocker was 69%, 33%, and 25% for the HF team, cardiologists and PCPs, respectively (p < 0.0167). Patients followed by the HF team were more frequently prescribed evidence-based medications at optimal doses. This supports using specialized interprofessional HF teams to attain greater adherence to evidence-based recommendations in treating systolic HF.