Management Of Heart Failure Research Articles

Maternal heart failure: state-of-the-art review.

Pregnancy is a period of substantial changes to the body's normal physiology, and the failure to adapt to these changes can lead to life-threatening pathology, particularly involving the cardiovascular system. In comparison to pre-pregnancy physiology, pregnant women have increased blood volume and physical demands which exert increased stress on the heart. This is important to consider in women with and without previously diagnosed cardiovascular disease, as the physiologic changes during pregnancy and postpartum can lead to sudden decompensation. The management of heart failure is particularly important as it remains the most common cardiovascular complication during pregnancy and is associated with substantial maternal and fetal morbidity and mortality. This is especially true in patients with pre-existing heart failure, who should receive counseling before conception and in certain cases be advised against pregnancy. For these reasons, healthcare professionals must be well-versed in the different strategies of diagnosis, management, treatment, and monitoring. This review will outline the pathophysiology, diagnostics, management, and general approach to heart failure in pregnant patients.

Abstract 4135289: Renal Blood Perfusion is Closely Related to Right Ventricular Volume Overload in Congestive Heart Failure

Background: Cardiorenal syndrome (CRS) involves a bidirectional relationship where dysfunction in one organ exacerbates the other. A key factor in this interaction is the impact of right ventricular (RV) volume overload on renal blood flow, which is vital for the progression and management of heart failure (HF). Objective: This study aims to explore and quantify the relationship between right ventricular volume overload, i.e, echocardiographic assessments of right ventricular diameter (RVD), and the time-to-peak (TTP) of renal blood flow in patients with HF measured by 99mTc-DTPA renal scintigraphy. Methods: This single-center study included 304 stable, ambulatory HF patients admitted between October 2017 and August 2022. HF was diagnosed based on the 2016 ESC guidelines. Echocardiographic parameters, including RVD, and TTP of renal blood flow measured by 99mTc-DTPA renal scintigraphy, were collected. Statistical analysis was conducted using SPSS and R software, with Spearman correlation analysis used to assess the relationship between echocardiographic parameters and TTP. Results: The study showed there was a significant correlation between RVD and TTP (rs=0.535, P <0.001), indicating that RV volume overload is closely related to impaired renal perfusion. The median TTP among the study population was 27.25 seconds (IQR: 21-39 seconds). Corrected for body surface area (BSA), RVD was found to be significantly higher in patients with heart failure with reduced ejection fraction (HFrEF) compared to heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF) (HFrEF: 20.62 mm/m 2 , HFmrEF: 18.72 mm/m 2 , HFpEF: 18.09 mm/m 2 ; p < 0.001). Furthermore, right atrial diameter (RAD) corrected for BSA (RAD/BSA) demonstrated the strongest correlation with TTP in the HFrEF subgroup (rs=0.602, p<0.001). Conclusions: Our findings highlight the significant impact of right ventricular volume overload on renal perfusion, providing valuable insights into the pathophysiology of CRS. These results suggest that therapeutic strategies aimed at reducing RV overload could enhance renal perfusion and improve overall outcomes in HF patients.

Abstract 4123886: Health Disparities in Quality of Life Among Black Patients with Heart Failure: The Roles of Depressive Symptoms and Functional Status

Background: Black patients with heart failure (HF) have a higher physical and psychological distress which disproportionately worsens their health and quality of life (QOL) than those from other racial/ethnic groups. Black patients less commonly receive optimal therapy for HF than white patients, which can result in poorer functional status. Black patients report higher levels of depressive symptoms. Higher levels of depressive symptoms can further worsen functional status and lower QOL. Hypothesis: We hypothesized that depressive symptoms would predict QOL in Black patients with HF and that this relationship would be mediated by functional status. Methods: Using the RICH Heart Program HF Database, we included all 226 Black patients (57±12 years old, 49% male) with HF, who completed the Patient Health Questionnaire-9 to measure depressive symptoms, the Duke Activity Status Index for functional status, and the Minnesota Living with Heart Failure Questionnaire for QOL. Mediation analysis was performed using the PROCESS macro. Results: Depressive symptoms were directly associated with QOL (effect coefficient [c’] =2.386, 95% confidence interval [CI] = 2.549, 3.450). There was a significant indirect effect of depressive symptoms on QOL mediated by functional status (ab=0.614, 95% CI [0.406, 0.856]). Those with worse depressive symptoms had lower functional status (a = -0.901, p< 0.001), in turn, lower functional status was associated with worse QOL (b = -0.681 p<0.001). Conclusions: Depressive symptoms are directly associated with QOL and there also is an indirect association, mediated by functional status in Black patients with HF. Inequities in the management of HF among Black patients that contribute to these findings must be explored as the causes of the disparity in depressive symptoms are not yet known.

Abstract 4129182: Transendocardial Stem Cell Therapy Improves Cardiac Parameters in Chronic Ischemic Heart Failure: A Meta-analysis of Randomized Controlled Trials

Introduction: Despite recent advances in therapy, chronic ischemic heart failure remains a significant cause of morbidity and mortality worldwide. Stem cell (SC) therapy has recently emerged as a potential therapeutic approach, yet its efficacy remains debatable. We aimed to systematically review and meta-analyze the current evidence to evaluate its effectiveness. Methods: A comprehensive literature search was conducted across the following databases: PubMed, Embase, and Cochrane, from inspection to April 2024. We identified RCTs with a blinded study design, done on patients diagnosed with chronic ischemic HFrEF, and utilized mesenchymal stem cells as an intervention in comparison to placebo/sham intervention using percutaneous endomyocardial catheter systems. Meta-analysis was conducted using RevMan v5.4 to calculate the odds ratio (OR) at 95% confidence intervals (CI) and a p-value of 0.05. I 2 was indicated for the assessment of heterogeneity. Sensitivity analysis was done in case of heterogeneity between studies. Results: A total of twenty studies were included in our meta-analysis. The overall change in left ventricular end-systolic volume (LVESV) and stress SPECT significantly favored the stem cell group (pooled effect size -7.59, 95% CI [-12.28 to -2.89], P=0.002), and (pooled effect size -5.33, 95% CI [-6.73 to -3.93], P=0.00001), respectively. Initially, the change in left ventricular end-diastolic volume (LVEDV) did not favor either group. However, sensitivity analysis which excluded one study at a time, reduced heterogeneity (P=0.01, I 2 =54%) and showed a significant effect favoring the stem cell group (pooled effect size -3.87, 95% CI [-6.77 to -0.97], P=0.009). However, the overall changes in left ventricular ejection fraction (LVEF) did not favor either of the two groups (pooled effect size 0.08, 95% CI [-0.1 to 0.26], P=0.39). Similarly, the overall change in myocardial oxygen consumption (MVO2) did not favor either group (pooled effect size 0.66, 95% CI [-0.1 to 1.32], P=0.05). Conclusion: Transendocardial SC therapy demonstrates promising results by significantly improving specific cardiac parameters. While the therapy shows potential, particularly after sensitivity adjustments, its impact on other critical measures like LVEF and MVO2 remains inconclusive. These findings highlight the need for further investigation to fully understand and enhance the therapeutic potential of stem cell interventions in heart failure management.

Therapeutic Potential of Melatonin: Multifaceted Applications in Muscle Health, Metabolic Disorders and Cardiovascular Disease

Melatonin, a hormone primarily synthesized by the pineal gland, is traditionally associated with the regulation of circadian rhythms. However, recent research has unveiled its broad spectrum of biological effects, positioning it as a valuable therapeutic agent in diverse health contexts. Known for its potent antioxidant and anti-inflammatory properties, melatonin plays a crucial role in maintaining homeostasis and protecting cellular integrity. This review explores melatonin’s therapeutic applications across multiple medical domains, including muscle health, metabolic disorders, chronic pain management, and cardiovascular health. In muscle health, melatonin facilitates muscle hypertrophy and regeneration by mitigating oxidative stress and enhancing the activity of satellite cells responsible for muscle repair. This action is particularly beneficial for individuals undergoing intense physical exertion, recovering from injuries, or combating age-related muscle. In metabolic disorders, such as type 2 diabetes, melatonin improves insulin sensitivity and reduces cellular oxidative damage, which supports beta-cell function and glucose regulation, potentially minimizing diabetes-related complications. Furthermore, in fibromyalgia - a condition marked by widespread pain and sleep disturbances - melatonin has demonstrated efficacy in alleviating pain and improving sleep quality, thus enhancing the overall quality of life for patients. In cardiovascular health, melatonin has shown promise in preventing and managing heart failure by reducing oxidative damage, modulating inflammatory pathways, and supporting endothelial function, which collectively contribute to improved cardiac health and reduced disease progression. This comprehensive review underscores melatonin’s emerging role as an integrative therapeutic agent in modern medicine.

Abstract 4123391: CardioMEMS and Mavacamten: A Synergistic Approach in Managing Hypertrophic Obstructive Cardiomyopathy with HFpEF Phenotype

Introduction: Mavacamten is a cardiac myosin inhibitor that has been approved for obstructive hypertrophic cardiomyopathy (oHCM). The CardioMEMS PA (pulmonary artery) sensor allows remote pulmonary artery diastolic (PAD) pressure monitoring to adjust diuresis in heart failure with preserved ejection fraction (HFpEF). We present the case of a patient with oHCM and HFpEF where data extrapolated from CardioMEMS provided valuable insight to the hemodynamic impact of cardiac myosin inhibitors. Case: A 66-year-old female with hypertension, obesity and oHCM presented with worsening dyspnea and was evaluated for septal myectomy. However, surgery was deferred because of decompensated HFpEF, as evidenced by significant leg edema on exam, and severely elevated left and right-side filling pressure, with restrictive physiology on right heart catheterization. A CardioMEMS PA sensor was implanted to guide decongestion, however, escalation of diuresis was limited due to severe left ventricular outflow tract (LVOT) obstruction. PAD remained elevated at 20-30 mmHg. Due to the refractory LVOT obstruction and despite the use of maximally tolerated beta blockers, Mavacamten was initiated and escalated according to protocol. LVOT obstruction resolved on follow up echocardiogram. Without any adjustment in her diuretic regimen, her PAD decreased to 15-20 mmHg. On follow-up visit, the patient reported improvement in dyspnea and reduction in lower extremity edema. Discussion: Managing oHCM is challenging, particularly when complicated by HFpEF. Mavacamten has shown promise in reducing LVOT gradients and improving symptoms in oHCM. However, managing fluid status in these patients can be difficult due to the risk of exacerbating LVOT obstruction while optimizing filling pressures. Our case provides direct evidence that treating LVOT obstruction with a cardiac myosin inhibitor leads to improvement in decompensated heart failure, as evidenced by the reduction in PAD. Conclusion: Addressing LVOT obstruction is key to decongesting and managing heart failure in oHCM patients. In our case, the use of CardioMEMS PA sensor system allowed a novel perspective of assessing hemodynamic impact of cardiac myosin inhibitors.

Abstract 4135905: The Impact of Emergent Atrial Fibrillation in Patients With Newly Diagnosed Heart Failure and Differences in Risk Among Preserved vs. Reduced Ejection Fraction

Background: Atrial fibrillation (AF) and heart failure (HF) are associated with an increased risk of adverse events, with their diagnoses often coexisting. The impact of AF in HF needs additional study, with further delineation among HF type. Therefore, this study sought to determine the degree of AF burden among newly diagnosed HF patients and whether differences in risk exist between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) patients. Methods: Patients with new-onset HF between 2000-2019 were studied. To be included, patients had to have 1-year of follow-up, an ejection fraction (EF) measurement within 30 days of HF diagnosis, and no history of cancer. EF was used to define HFrEF (EF <40%) and HFpEF (EF > 40%). Multivariable Cox hazard regression was used to evaluate the risk of death and HF hospitalization at 1- and 3-years. Results: A total of 21,925 patients were studied with HFrEF (n=7931 [36.2%]) and HFpEF (n=13,994 [63.8%]). HFpEF patients were older (74 vs. 65 years) and more often female (53.7% vs. 33.1%). Prevalent AF was 40.5% (n=8879), being more common in HFpEF compared to HFrEF (65.2% vs. 34.8%). Among AF patients, HFpEF patients were also older (76 vs. 72 years) and more often female (52.7% vs. 30.8%) compared to HFrEF. The presence of AF was associated with an increased risk of HFpEF (OR=1.11, p=0.001). Prevalent AF was associated with an increased risk of death and follow-up HF hospitalization (Table). Death at 1-year and 3-years were similar between the HF groups (Table). However, the risk of HF hospitalization was greater among HFrEF patients (Table). Similar associations persisted when AF patients were propensity matched (Table). Conclusions: Among a newly diagnosed HF population, AF was common (40%) and was associated with an increased risk of HFpEF, death, and HF hospitalization. These results provide a rationale for aggressive management of HF and AF patients and the need for a randomized clinical trial to determine optimal therapy by ablation and 4-pillar HF therapy.

Evidence for Aldosterone Antagonism in Heart Failure

Activation of the renin–angiotensin–aldosterone system is the ultimate pathophysiological hallmark in heart failure. Though aldosterone primarily appears to regulate electrolyte homeostasis by acting on distal nephrons in the kidneys, its effects are far-reaching across the cardiovascular system as its receptors are also expressed in vascular smooth muscle cells, endothelial cells, macrophages and cardiomyocytes. Aldosterone excess leads to vascular stiffness, vasoconstriction, endothelial dysfunction, inflammation, oxidative stress, cardiac fibrosis and hypertrophy, atherogenesis and thrombosis. Hence, aldosterone antagonism is an attractive proposition for heart failure management. The first-generation non-selective mineralocorticoid receptor antagonist spironolactone produced a spectacular reduction of cardiovascular outcomes in the seminal RALES study, while the selective second-generation congener eplerenone boasts two positive studies: EPHESUS and EMPHASIS-HF. The TOPCAT trial indicated that a specific subgroup of patients with heart failure with preserved ejection fraction may benefit from targeted therapy of mineralocorticoid receptor antagonists. Newer-generation non-steroidal mineralocorticoid antagonists and aldosterone synthase inhibitors are being evaluated in randomised trials.

Abstract 4115947: Empagliflozin Inhibits the Mobilization of CCR2+ Monocyte-Derived Macrophages by Reducing CCL2 Expression in Fibroblasts and Slows the Progression of Heart Failure After Pressure Overload.

Background: The positive effects of sodium glucose co-transporter-2 (SGLT2) inhibitors on reducing cardiovascular mortality and hospitalizations due to heart failure have been well established. Although numerous theories propose explanations for the cardioprotective actions of SGLT2 inhibitors, these hypotheses primarily rely on initial findings and require further validation. Studies have shown that immune cells, particularly macrophages marked by C-C chemokine receptor type 2 (CCR2), contribute to the progression of heart failure by infiltrating the myocardium and inducing detrimental structural changes following myocardial infarction or pressure overload. Purpose: This study aims to investigate whether SGLT2 inhibitors can mitigate heart damage by inhibiting the migration of CCR2+ monocyte-derived macrophages. Methods: In this experiment, male B6 mice were subjected to transverse aortic constriction (TAC) to induce heart failure. Two weeks post-TAC, with heart function confirmed as equal across all groups by echocardiography, one group began receiving daily oral doses of empagliflozin, while another served as the control. At four weeks post-TAC, cardiac function was reassessed. The animals were then euthanized, and their hearts were analyzed using flow cytometry, staining, and qPCR to evaluate heart failure and the involvement of immune cells. Additionally, isolated cardiac fibroblasts were subjected to cyclic stretching to mimic post-TAC mechanical stress. Results: Treatment with empagliflozin resulted in improved cardiac function and reduced congestion in the heart and lungs, indicating alleviation of heart failure. The treatment notably decreased myocardial fibrosis, evident from Picrosirius-red staining and reduced expression of fibrosis-related mRNA. Importantly, empagliflozin specifically reduced the number of CCR2-positive macrophages in the heart, without affecting other types of immune cells. In cardiac fibroblasts that underwent cyclic stretching, empagliflozin pre-treatment diminished the expression of C-C motif chemokine ligand 2 (CCL2), the ligand for CCR2. Conclusion: Empagliflozin’s ability to suppress CCL2 expression in fibroblasts and curtail the recruitment of CCR2+ macrophages may represent a potential strategy to decelerate heart failure progression. These findings advance our understanding of the cardioprotective mechanisms of SGLT2 inhibitors and propose novel therapeutic avenues for heart failure management.

Abstract 4144526: A Case Presentation of Severe Left Ventricular Dysfunction from Focal Myocarditis due to Immune Checkpoint Inhibitor

Introduction: Immune checkpoint inhibitors (ICI), such as pembrolizumab, are an effective immunotherapy for several malignancies, however, have been associated with adverse events including myocarditis and accelerated atherosclerosis. ICI myocarditis is associated with a mortality rate of up to 33%. This case reports a patient on pembrolizumab with an atypical presentation. Case presentation: A 75-year-old female with a past medical history significant for lung cancer on pembrolizumab and myasthenia gravis presented to the hospital with dyspnea and mild, intermittent exertional chest discomfort. She denied nausea, radiation of pain, diplopia, weakness in extremities, or dysphagia. Workup revealed a leucocyte count of 13,500 cells/uL, pro-brain natriuretic peptide of 13,458 pg/mL, troponin of 26 ng/L, and a normal erythrocyte sedimentation rate and C reactive protein. A chest computed tomography was performed that showed mild bilateral pleural effusion and no pulmonary embolism. A nuclear stress test showed no evidence of ischemia but showed a severely reduced left ventricular ejection fraction (LVEF) at 29%. An echocardiogram confirmed that the ejection fraction was reduced at 23% (baseline LVEF was 60% from 1 year ago). Cardiac MRI revealed a mildly increased regional T2 signal in the anterolateral wall, mildly elevated extracellular volume fraction, and no late gadolinium enhancement. With ongoing clinical suspicion despite equivocal findings on cardiac MRI, an endomyocardial biopsy was done that revealed a single small aggregate of lymphocytes present in 1 of 6 tissue samples. Ultimately, with the single site of aggregated lymphocytes on biopsy, a diagnosis of ICI myocarditis was determined, and the patient was started on high-dose intravenous glucocorticoids as well as bisoprolol, empagliflozin, spironolactone, and Entresto for heart failure management as she was able to tolerate. Discussion: Myocarditis due to pembrolizumab is a rare, but potentially lethal adverse effect. Patients typically have abnormal electrocardiograms and elevated cardiac biomarkers. Cardiac MRIs have sensitivity and specificity of 68% and 91% respectively for diagnosis, and the gold standard is endomyocardial biopsy however, it is limited due to sampling error. Our patient had an unusual presentation, but with both imaging and biopsy, we found a case of focal myocarditis with severe left ventricular dysfunction, which typically is seen with fulminant myocarditis.

Abstract 4147608: Trends in Mortality and 30-Day Readmission Rates Among Heart Failure Patients Undergoing Cardiac Rehabilitation: A Nationwide Analysis from 2017 to 2020

Background: Heart failure (HF) is a significant public health concern, affecting approximately 6.2 million adults in the United States, with high mortality and readmission rates. Cardiac rehabilitation (CR) programs have been widely recognized as a crucial component of HF management, aiming to improve physical function, reduce symptoms, and enhance quality of life. Despite the established benefits of CR, there is a need to understand the trends in mortality and readmission rates among HF patients participating in these programs. We aim to analyze mortality and 30-day readmission rate trends among heart failure patients undergoing cardiac rehabilitation from 2017 to 2020 using NRD data. Hypothesis: We hypothesize a significant downward trend in mortality rates and significant yearly variation in 30-day readmission rates among heart failure patients undergoing cardiac rehabilitation. Methods: We analyzed NRD data from 2017 to 2020, including patients with ICD-10 codes I50 (heart failure) and Z5189 (cardiac rehabilitation). Trend analyses were performed using Ordinary Least Squares (OLS) regression for mortality rates and the Cochrane-Armitage test for binary data. Multivariate regression adjusted for age, sex, and comorbidities. Statistical analyses were conducted using STATA version 18. Results: From 2017 to 2020, annual mortality rates were 6.9% (95% CI: 0.95% to 12.85%), 5.5% (95% CI: 0.47% to 10.52%), 4.6% (95% CI: -0.51% to 9.68%), and 1.9% (95% CI: -1.90% to 5.74%), respectively. The mean age was 78 years, with 54% were female. OLS regression showed a significant downward trend in mortality (p = 0.025), while the Cochrane-Armitage test did not (p = 0.998). Multivariate regression also indicated a downward trend, though individual predictors were insignificant (p=0.576). For 30-day readmission rates from 2017 to 2020, annual margins were 21.5% (2017), 21.7% (2018), 18.0% (2019), and 34.3% (2020), showing significant yearly variation. Conclusion: Despite the varying range of 30-day readmission within the years of interest, there seems to be a significant downward trend in mortality for heart failure patients who underwent cardiac rehabilitation. Further studies are required to corroborate these findings as understanding CR program outcomes can help identify improvement areas, guide resource allocation, and inform healthcare policy decisions.

Staging Heart Failure with Preserved Ejection Fraction by Assessing Cardiac Chamber Involvement

The management of heart failure with preserved ejection fraction (HFpEF) remains largely unresolved due to our limited understanding of the underlying mechanisms of the pathology and the challenges in accurately phenotyping this heterogeneous syndrome. A paradigm shift is required to personalise care and unify our approaches to HFpEF patients for future clinical trials. Accordingly, we propose a staging classification for HFpEF based on the identification of the involved cardiac chambers by echocardiography.

Efficacy of Intravenous Ferric Carboxymaltose in Heart Failure Patients with Iron Deficiency Anemia: A Meta-analysis of 6271 Patients.

Iron deficiency is prevalent among heart failure patients and is associated with worse clinical outcomes, including decreased quality of life and functional capacity. This condition often results in a higher incidence of hospitalization and mortality. Iron supplementation, particularly with intravenous ferric carboxymaltose (FCM), has shown potential benefits as an adjunct therapy in heart failure management. This study aims to evaluate the efficacy of FCM in the treatment of patients with heart failure and iron deficiency anemia, with a focus on its impact on mortality and hospitalization rates. A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases from their inception until 1st December 2023. Meta-analysis was performed using RevMan 5.4, employing a random-model effect. The results were reported as risk ratios (RRs), standard mean differences (SMDs), and 95 % confidence intervals (CIs). The meta-analysis included 13 studies with a total of 6271 patients. Ferric carboxymaltose administration resulted in a significant improvement in the 6-minute walk distance (SMD: 1.45; 95 % CI: 0.55, 2.36; p = 0.002), quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) (SMD: 1.49; 95 % CI: 0.87, 2.11; p < 0.00001), the rate of first hospitalization for heart failure or cardiovascular death (RR: 0.91; 95 % CI: 0.84, 0.98; p = 0.02). However, FCM did not show a significant impact on the risk of cardiovascular death (RR: 0.90; 95 % CI: 0.77, 1.05; p = 0.17), the need for intervention due to worsening heart failure (RR: 0.41; 95 % CI: 0.04, 4.51; p = 0.47), or all-cause mortality rates (RR: 0.89; 95 % CI: 0.69, 1.16; p = 0.28). While FCM treatment in patients with heart failure and iron deficiency anemia significantly improves functional capacity and quality of life, it has no notable effect on mortality rates or the likelihood of hospitalization. These findings highlight the need for further research to explore comprehensive treatment strategies that address both the symptomatic and survival aspects of heart failure management in this patient population.

Heart Failure Prediction Using Machine Learning

This study explores the use of XGBoost and Shapley values for heart failure prediction, in addition to processing models such as neural network, CNN, and SVM. By comparing the performance of these different machine learning algorithms, we aim to develop a robust and accurate predictive model for identifying individuals at risk of heart failure. Our findings highlight the strengths and limitations of each approach, providing valuable insights for future research in this area. Ultimately, this research aims to improve the early detection and management of heart failure, leading to better patient outcomes and more efficient healthcare practices. Key Words: heart failure prediction, XGBoost, SHAPley values, neural network, CNN, SVM, machine learning algorithms, early detection, death events.

Patients’ perspective and practices of heart failure recurrence prevention in Yancheng City

Effective self-management is essential for patients with heart failure, but many struggle with acquiring the necessary skills. Given the complexity of heart failure management and the importance of patient adherence to prescribed regimens, this study aims to investigate the knowledge, attitudes, and practices (KAP) concerning the prevention of heart failure recurrence among patients. A cross-sectional study was conducted at the Third People’s Hospital of Yancheng City from September 1, 2023, to December 31, 2023, employing a self-administered KAP questionnaire. The study included 421 heart failure patients, of whom 230 (54.6%) were male. Median scores for knowledge, attitudes, and practices were 12.00 [10.00, 13.00] (possible range: 1–18), 20.00 [19.00, 21.00] (possible range: 5–25), and 16.00 [15.00, 17.00] (possible range: 5–22), respectively. Pearson’s correlation analysis indicated a positive correlation between knowledge and attitude scores (r = 0.183, P < 0.001), as well as between knowledge and practice scores (r = 0.169, P < 0.001). A higher attitude score was significantly associated with a higher practice score (r = 0.245, P < 0.001), as supported by structural equation modelling. Multivariate logistic regression revealed that attitude score (OR = 1.238), suburban residence (OR = 2.524), monthly household income exceeding 5000 RMB (OR = 3.539), BMI less than 20 kg/m2 (OR = 2.155, P = 0.029), BMI between 20 and 24 kg/m2 (OR = 2.387), and BMI between 25 and 29 kg/m2 (OR = 4.063) were independently linked to proactive practices (all P < 0.05). Additionally, Structural Equation Modelling (SEM) elucidated the intricate relationship between sociodemographic factors and KAP dimensions. Despite positive attitudes and proactive prevention efforts, heart failure patients exhibit a knowledge gap. Tailored educational interventions by healthcare providers could effectively bridge this gap, leveraging patients’ positive attitudes and proactive behaviours to reinforce preventive measures.

Sodium-glucose co-transporter 2 inhibitors in left ventricular assist device and heart transplant recipients: a mini-review.

In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i) emerged as promising therapeutic agents in managing heart failure (HF). They demonstrated a significant impact on reducing HF hospitalizations and related mortality in patients with reduced and preserved ejection fraction. However, evidence supporting their use in patients with left ventricular assist device (LVAD) and heart transplant (HT) recipients is still limited. We identified six key studies investigating the safety and efficacy of SGLT2i in LVAD and HT recipients. In patients with LVAD, prescription of SGLT2i was predominantly associated with improved fluid management and reduced pulmonary artery pressures. However, the results regarding their effects on body weight, hemoglobin A1c, diuretic use, and right ventricular function were contradictory. In terms of safety, SGLT2i were generally well-tolerated in the LVAD population, and the reported incidence of adverse events was low. In HT recipients, SGLT2i were associated with better glycemic control and weight reduction. No relevant adverse events were reported. Despite these encouraging results, the long-term safety and efficacy of SGLT2i in these vulnerable patient populations are yet to be investigated. Future randomized controlled trials are needed to address existing gaps in evidence and help integrate SGLT2i into clinical practice for LVAD and HT recipients.

A quality improvement model to identify undiagnosed heart failure at chronic obstructive pulmonary disease annual reviews

Abstract Introduction Heart failure (HF) is a common comorbidity in people with chronic obstructive pulmonary disease (COPD). The estimated prevalence of HF comorbidity in patients with COPD is up to 40%1. COPD and HF have overlapping symptoms which could delay the diagnosis of HF. Studies have shown that in UK primary care, HF treatment for COPD patients is delayed by almost twelve months compared to patients without COPD2. Early diagnosis and management of HF for COPD patients in primary care could reduce risk of recurrent exacerbation and subsequent hospitalisation. HF screen is not currently emphasised in the primary care COPD annual reviews. NICE guidance for COPD diagnosis mentions the use of serum natriuretic peptides to aid differential diagnosis of HF3. Pharmacists in general practice are the patients’ first point of contact, they are able to take leading roles in the holistic management of long-term conditions such as HF and COPD. Aim Reduce HF related complication including exacerbations and subsequent hospital admissions for COPD patients through early HF identification programme at COPD annual review. Methods Electronic Emis search was conducted on the practice database to identify patients on the COPD register. Patients with existing diagnosis of HF or NT-ProBNP in the last 12 month were excluded. Patients were invited for COPD annual review and screened for HF symptoms (breathlessness, fluid retention, fatigue, lightheadness) as per NICE guidance for HF identification. NT-ProBNP test was added to routine annual blood test for patients experiencing any of the HF symptoms. Patients with elevated NT-ProBNP &amp;gt;400ng/L were referred for further assessment for suspected HF. The project was a small scale service improvement project, it did not require ethical approval, this was confirmed with the Broad Street Health Centre clinical lead. Results Twenty six patients were screened out of 48 (54 %). Six patients (23%) had NT-pro BNP results over 400ng/L and were referred for further investigation for suspected HF. Diagnosis was confirmed for three patients 11%. Two of the newly diagnosed patients had an MRC score of 3, while one had and MRC score of 2. No patients with MRC score 1, 4 or 5 where among the newly diagnosed group. Discussion Results analysis correlates with published data regarding the prevalence of HF in COPD patients. Screening for HF in primary care might be most beneficial for patients with MRC of 2 or 3. Patients with score of 1 might have milder symptoms however annual screening will allow early detection of future deterioration. There were no newly diagnosed patients from the MRC score of 4 and 5 groups as they might have already been diagnosed if their symptoms were related to underlying HF. The three patients diagnosed with HF were treated for HF as per NICE guidance. Patients’ spontaneous feedback was positive regarding the new management approach. Conclusion Pharmacists in general practice can play a dynamic role in early identification of existing co-morbidities while conducting annual long-term conditions reviews. This in return facilitates vital early interventions to improve prognosis and reduce further complications along the way.

Clinical utility of echocardiography in internal medicine: a narrative review

Echocardiography has emerged as an invaluable tool in internal medicine, providing real-time, non-invasive evaluation of cardiac structure and function. Its clinical utility spans a wide range of applications, including the diagnosis and management of heart failure, valvular heart diseases, and cardiomyopathies, as well as systemic conditions like sepsis and chronic kidney disease. The ability to perform bedside echocardiography has made it particularly useful in critical care settings, allowing for rapid assessment of cardiac function in hemodynamically unstable patients. Echocardiography also plays a key role in guiding therapeutic interventions, from fluid management to valvular repair and replacement procedures. Despite its many advantages, echocardiography is not without limitations. Image quality may be compromised in patients with obesity, lung disease, or prior thoracic surgery, necessitating alternative imaging modalities like cardiac magnetic resonance imaging or computed tomography. Operator expertise is another critical factor influencing diagnostic accuracy, underscoring the importance of proper training. Recent advancements, including artificial intelligence integration and portable devices, are expected to further expand the role of echocardiography, making it more accessible in diverse clinical settings. This narrative review highlights the broad clinical utility of echocardiography in internal medicine, its challenges, and the future directions that promise to enhance its role in patient care.

Renal Denervation in Heart Failure Treatment: Data for a Self-Fulfilling Prophecy

Renal denervation (RDN), a transcatheter renal sympathetic nerve ablation procedure, is a relatively novel established procedure for the treatment of hypertension, with it being recognized as a third option for hypertension management in the most recent European guidelines, together with pharmacotherapy, for achieving blood pressure targets. Given the relationship between both hypertension and sympathetic overdrive and the development of heart failure (HF), even studies at the dawn of research on RDN explored it as a treatment to overcome diuretic resistance in those patients. As it is now recognized that RDN does not only have organ-specific but also systemic effects, several investigators have aimed to delineate whether renal sympathetic denervation could alter the prognosis, symptoms, and adverse events of HF patients. Data are available in both HF patients with reduced and preserved ejection fraction. As the significance of neuromodulation is gaining grounds in the HF therapeutic arsenal, in this review, we aim to provide a rationale for using RDN in HF and an up-to-date overview of available data in both HF phenotypes, as well as discuss the future of neuromodulatory therapy in HF management.

Neuroimmune cross-talk in heart failure.

Heart failure (HF) is characterized by autonomic nervous system (ANS) imbalance and low-grade chronic inflammation. The bidirectional relationship between the ANS and immune system (IS) is named "neuroimmune cross-talk" (NICT), and is based on common signaling molecules, receptors, and pathways. NICT may be altered in HF, and neuroinflammation seems to be a main driver of HF progression. In HF, heightened sympathetic nerve activity triggers inflammatory cascades that lead to cardiomyocyte death and myocardial interstitial fibrosis. Concurrently, parasympathetic withdrawal may impair the cholinergic anti-inflammatory pathway, with a less effective immune response to infections or inflammatory events. Additionally, microglial activation and inflammatory molecules contribute to autonomic imbalance by acting on central nuclei and peripheral visceral feedbacks, which in turn promote adverse cardiac remodeling, HF decompensation, and potentially life-threatening arrhythmias. Therefore, neuroinflammation has been identified as a potential target for treatment. Pharmacological antagonism of the neurohormonal system remains the cornerstone of chronic HF therapy. While some drugs used in HF management may have additional benefits due to their anti-inflammatory properties, clinical trials targeting inflammation in patients with HF have so far produced inconclusive results. Nevertheless, considering the pathophysiological relevance of NICT, its modulation seems an appealing strategy to optimize HF management. Current research is therefore investigating novel pharmacological targets for anti-inflammatory drugs, and the immunomodulatory properties of denervation approaches and bioelectronic medicine devices targeting NICT and neuroinflammation in HF. A deeper understanding of the complex relationship between the ANS and IS, as outlined in this review, could therefore facilitate the design of future studies aimed at improving outcomes by targeting NICT in patients with HF.