Reduced Ejection Fraction Patients Research Articles

Elevated Cystatin C Predicts Higher Mortality in Chronic Heart Failure Independently of Renal Function.

Cystatin C (CysC) is a known prognostic marker in cardiovascular diseases and its role in acute heart failure (HF) has been documented. We prospectively recruited HF patients followed in a HF clinic. Inclusion criteria: HF diagnosed ≥6 months, optimized evidence-based therapy, and ejection fraction <40% (Heart Failure with reduced ejection fraction). Exclusion criteria: renal replacement therapy and hospitalizations or therapeutic adjustments in the previous 2 months. A venous blood sample and 24-hour urine were collected. Follow-up: 5 years; endpoint: all-cause mortality. CysC was measured and creatinine clearance (CrCl) was calculated using 24-hour urine creatinine excretion. A Receiver operating characteristic curve was used to assess association of CysC with 5-year mortality. The prognostic role of CysC was determined using Cox-regression analysis. The multivariate model included CrCl (24-hour urine). We evaluated 215 chronic stable Heart Failure with reduced ejection fraction patients. Mean age was 68 years, 72.1% were male. Median CysC = 1.15 mg/L, creatinine = 1.20 mg/dL, and CrCl = 63.6 mL/min. During follow-up, 103 (47.9%) patients died. The area under the curve for CysC in predicting mortality was 0.77 (0.70-0.83). Best cut-off value for death prediction = 1.00 mg/L with a sensitivity = 83.5%, specificity = 56.2%, positive predictive value = 63.7%, and negative predictive value = 78.7%. Multivariate-adjusted (age-, B-type natriuretic peptide-, evidence-based therapy, New York Heart Association class, and CrCl) 5-year mortality Hazard ratio = 2.40 (95% Confidence interval, 1.25-4.61), P value = 0.008 when CysC ≥1.00 mg/L. Patients with CysC <1.00 mg/L have almost 80% probability of being alive at 5 years; If CysC ≥1.00 mg/L, there is almost 2.5-fold higher death risk independently of B-type natriuretic peptide and CrCl.

Effect of Reduced Dose Spironolactone in Heart Failure With Reduced Ejection Fraction Patients Intolerant of Full Dose Mineralocorticoid Receptor Antagonists

Effect of Reduced Dose Spironolactone in Heart Failure With Reduced Ejection Fraction Patients Intolerant of Full Dose Mineralocorticoid Receptor Antagonists

Different levels of continuous training improve echocardiographic parameters, quality of life, and functional capacity in heart failure with reduced ejection fraction patients

Abstract Background Various comorbidities and physiological alterations contribute to the complexity of heart failure conditions, influencing the optimal approach to exercise-based rehabilitation. Purpose This study sought to investigate and compare the effects of continuous training at three distinct intensities, specifically examining left ventricular (LV) remodeling, functional capacity, and quality of life in patients with heart failure with reduced ejection fraction (HFrEF). Methods In a randomized control trial, 60 male patients (mean age: 54.33 ± 2.35 years) diagnosed with HFrEF were randomly assigned to three groups: 1) High-Intensity Continuous Training group (HICT), 2) Moderate-Intensity Continuous Training group (MICT), and 3) Low-Intensity Continuous Training group (LICT). All participants underwent training on a bicycle ergometer three times per week for 12 weeks. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, N-terminal pro–B-type natriuretic peptide (NT-proBNP)), quality of life (assessed through the Minnesota Living with Heart Failure Questionnaire), and functional capacity (measured by the 6-minute walking test) were evaluated before and after the study. Results The HICT group exhibited the most significant improvements in all assessed variables compared to the other two groups (P &amp;lt; 0.05). These findings were consistently observed across all measured outcomes. Conclusion It was deduced that High-Intensity Continuous Training (HICT) emerged as the most advantageous approach in enhancing echocardiographic measures, NT-proBNP levels, quality of life, and functional capacity among patients with heart failure and reduced ejection fraction (HFrEF).

HeartMate 3 for Heart Failure with Preserved Ejection Fraction: In Vitro Hemodynamic Evaluation and Anatomical Fitting.

Heart failure with preserved ejection fraction (HFpEF) constitutes approximately 50% of heart failure (HF) cases, and encompasses different phenotypes. Among these, most patients with HFpEF exhibit structural heart changes, often with smaller left ventricular cavities, which pose challenges for utilizing ventricular assist devices (VADs). A left atrial to aortic (LA-Ao) VAD configuration could address these challenges, potentially enhancing patient quality of life by lowering elevated mean left atrial pressure (MLAP). This study assessed the anatomical compatibility and left atrial unloading capacity using a simulated VAD-supported HFpEF patient. A HeartMate3-supported HFpEF patient in an LA-Ao configuration was simulated using a cardiovascular simulator. Hemodynamic parameters were recorded during rest and exercise at seven pump flow rates. Computed tomography scans of 14 HFpEF (NYHA II-III) and six heart failure with reduced ejection fraction patients were analysed for anatomical comparisons. HFpEF models were independently assessed for virtual anatomical fit with the HM3 in the LA-Ao configuration. Baseline MLAP was reduced from 15 to 11mmHg with the addition of 1L/min HM3 support in the rest condition. In an exercise simulation, 6L/min of HM3 support was required to reduce the MLAP from 29 to 16mmHg. The HM3 successfully accommodated six HFpEF patients without causing interference with other cardiac structures, whereas it caused impingement ranging from 4 to 14mm in the remaining patients. This study demonstrated that the HM3 in an LA-Ao configuration may be suitable for unloading the left atrium and relieving pulmonary congestion in some HFpEF patients where size-related limitations can be addressed through pre-surgical anatomical fit analysis.

127 Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Heart Failure with Reduced Ejection Fraction Patients: A Systematic Review and Meta-Analysis Stratified by Left Ventricular Ejection Fraction

Abstract Aim The primary objectives were to assess differences in mortality, repeat revascularization, new postoperative myocardial infarction (MI), and cerebrovascular accidents (CVA/stroke) between PCI and CABG in HFrEF patients, stratified by the degree of LVEF reduction. Method A comprehensive search of electronic databases was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria comprised clinical trials or observational cohort studies with ≥20 patients per group, comparing long-term outcomes in HFrEF patients (LVEF &amp;lt;50%) who underwent PCI or CABG. Data was extracted, and quality was assessed using the New Castle Ottawa (NOS) Risk of Bias tool. Hazard ratios (HRs) were pooled for time-to-event outcomes, with subgroup analysis based on LVEF. Heterogeneity was assessed, sensitivity analysis conducted, and publication bias evaluated. Results Twenty studies involving 25,031 patients met the inclusion criteria. In the severe LVEF reduction group (&amp;lt;35%), CABG was associated with significantly higher long-term survival, reduced repeat revascularization, and fewer postoperative MIs compared to PCI. In patients with moderate LVEF reduction (&amp;lt;40%), there was no difference in long-term survival, but repeat revascularization was lower in the CABG group . In the mild LVEF reduction group (&amp;lt;50%), CABG was associated with superior long-term survival and reduced repeat revascularization. Stroke rates were similar between PCI and CABG in all groups. Conclusions Individualized patient care should consider the degree of LVEF reduction when selecting between PCI and CABG, with CABG generally favored for improved outcomes in HFrEF patients. However, clinical presentation, patient characteristics, and cost-effectiveness should also be considered in the decision-making process.

Digoxin and Risk of Ventricular Tachyarrhythmia and Death in ICD Recipients

BackgroundSome studies have shown digoxin use to be associated with adverse outcomes, including increased mortality. There are limited data on whether digoxin use is associated with increased risk of ventricular tachycardia/ventricular fibrillation (VT/VF) in heart failure patients with an implantable cardioverter-defibrillator (ICD). ObjectivesThis study sought to assess whether digoxin use is associated with increased risk of VT/VF in patients with heart failure with reduced ejection fraction with a primary prevention ICD in landmark clinical trials. MethodsThe study cohort consisted of patients with an ICD or cardiac resynchronization therapy-defibrillator who were enrolled in 4 landmark MADIT trials (Multicenter Automatic Defibrillator Implantation Trials). We employed propensity score quintile stratification for treatment with digoxin as well as additional multivariable adjustment to assess the risk of digoxin vs no-digoxin therapy for the endpoints of first and recurrent VT/VF and all-cause mortality. The proportional hazards regression models for arrhythmia-specific endpoints incorporated adjustments for the competing risk of death. ResultsAt baseline, 1,155 of 4,499 patients were on digoxin (26%). After propensity score quintile stratification, patients prescribed digoxin were shown to exhibit a statistically significant 48% increased risk of VT/VF (P < 0.001), 42% increased risk of the composite of VT/VF or death (P < 0.001), and a 37% increased risk of all-cause mortality (P = 0.006). Digoxin use was also associated with increased risk of appropriate ICD shocks (HR: 1.91; P < 0.001) and with increased burden of VT/VF events (HR: 1.46; P = 0.001). ConclusionsOur findings suggests that digoxin use is associated with ventricular tachyarrhythmia and death in heart failure with reduced ejection fraction patients with an ICD.

Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction patients: A meta-analysis

BackgroundThe optimal treatment of atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) remains unsettled. ObjectiveThe purpose of this study was to assess the efficacy of catheter ablation (CA) and medical therapy compared to medical therapy alone in patients with AF and HFrEF. MethodsWe performed a systematic review of randomized controlled trials (RCTs) comparing CA with guideline-directed medical therapy for AF in patients with HFrEF (left ventricular ejection fraction [LVEF] ≤ 40%). We systematically searched PubMed, Embase, and Cochrane for eligible trials. A random effects model was used to calculate the risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). ResultsSix RCTs comprising 1055 patients were included, of whom 530 (50.2%) were randomized to CA. Compared with medical therapy, CA was associated with a significant reduction in heart failure (HF) hospitalization (RR 0.57; 95% CI 0.45–0.72; P < .01), cardiovascular mortality (RR 0.46; 95% CI 0.31–0.70; P < .01), all-cause mortality (RR 0.53; 95% CI 0.36–0.78; P < .01), and AF burden (MD –29.8%; 95% CI –43.73% to –15.90%; P < .01). Also, there was a significant improvement in LVEF (MD 3.8%; 95% CI 1.6%–6.0%; P < .01) and quality of life (Minnesota Living with Heart Failure Questionnaire; MD –4.92 points; 95% CI –8.61 to –1.22 points; P < .01) in the ablation group. ConclusionIn this meta-analysis of RCTs of patients with AF and HFrEF, CA was associated with a reduction in HF hospitalization, cardiovascular mortality, and all-cause mortality as well as a significant improvement in LVEF and quality of life.

A Systematic Review and Meta-Analysis of Randomised Controlled Trials Assessing Clinical and Haemodynamic Outcomes of Ivabradine in Heart Failure With Reduced Ejection Fraction Patients

Ivabradine, a pure bradycardic agent, can be given to heart failure reduced ejection fraction (HFrEF) patients with a sinus rhythm of ≥70 bpm on a maximum beta blocker dose, or when beta blockers are contraindicated. This study aimed to see how ivabradine affects the clinical and haemodynamic outcomes of HFrEF patients. This systematic review and meta-analysis searched ClinicalTrials.gov, OpenMD, ProQuest, PubMed, and ScienceDirect for potential articles. All relevant data were extracted. For all pooled effects, the random effect model was applied. A total of 18,972 heart failure (HF) patients from nine randomised clinical trials (RCTs) were involved in this study. Ivabradine decreased the risk of HF mortality (RR 0.79; 95% CI 0.64-0.98; p=0.03) and HF hospitalisation (RR 0.80; 95% CI 0.65-0.97; p=0.03). Ivabradine was related to a greater reduction in heart rate (MD -12.21; 95% CI -15.47 - -8.96; p<0.01) and left ventricular ejection fraction (LVEF) improvement (MD 3.24; 95% CI 2.17-4.31; p <0.01) compared with placebo. Asymptomatic bradycardia (RR 4.25; 95% CI 3.36-5.39; p<0.01) and symptomatic bradycardia (RR 3.99; 95% CI 3.17-5.03; p<0.01) were higher in the ivabradine group. Ivabradine can reduce the risk of HF mortality and HF hospitalisation in HFrEF patients. Ivabradine also effectively reduces resting heart rate and improves LVEF. However, ivabradine is associated with a greater risk of symptomatic and asymptomatic bradycardia.

THE RATE AND OUTCOMES OF REDUCING RE-HOSPITALIZATIONS WITH A TREATMENT REGIMEN INCLUDING DAPAGLIFLOZIN IN HEART FAILURE WITH REDUCED EJECTION FRACTION WITHOUT DIABETES PATIENTS

Background: Heart failure, a cardiovascular disease with a substantial disease burden, often leads to frequent hospitalizations for acute episodes. The readmission rate is estimated to be around 30-50%, resulting in high costs for both pharmacological and non-pharmacological treatments. Additionally, heart failure is associated with a considerable mortality rate, ranging from 48-57%. Objectives: To describe the rate and outcomes of reducing hospital readmissions for heart failure in non-diabetes patients and with heart failure featuring reduced ejection fraction, through the use of Dapagliflozin at Can Tho University of Medicine and Pharmacy Hospital. Materials and methods: A cross-sectional descriptive study was conducted 44 non-diabetes and heart failure with reduced ejection fraction patients who were examined and treated at Can Tho University of Medicine and Pharmacy Hospital. Results: The average age of patients was 67.3 ± 13, with male patients representing 65.9%. Shortness of breath was the most common symptom (77.3%). Other frequently observed symptoms included distended neck veins, peripheral edema, and rales in the lungs. The average ejection fraction was 36.65 ± 8.16%. In terms of functional classification, NYHA III represents the highest proportion at 54.5%. The median NT-proBNP concentration was 8757 pg/mL (ranging from a minimum of 604 pg/mL to a maximum of 35.000 pg/mL). The observed improvement rate in NYHA classification after treatment was 13.6%. The rate of rehospitalization for heart failure before treatment was 27.3%, decreasing to 11.4% after treatment (p=0.118 but the analysis suggests that there were no independent risk factors contributing to rehospitalization for heart failure in patients with reduced ejection fraction without diabetes.Conclusions: Dyspnea was the most common symptom in patients with heart failure with reduced ejection fraction and nondiabetes. The rate of rehospitalization for heart failure after 12 weeks of Dapagliflozin treatment was lower than before treatment, but this difference was not statistically significant.

O163: CABG versus PCI in Heart Failure with Reduced Ejection Fraction Patients: A Systematic Review &amp; Meta-analysis Stratified by Left Ventricular Ejection Fraction

Abstract Background Comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with heart failure with reduced ejection fraction (HFrEF) remains controversial within the literature. The current meta-analysis aimed to compare CABG and PCI in HFrEF patients regarding mortality and long-term survival, repeat revascularization, new postoperative myocardial infarction (MI) and stroke, stratified by the degree of LVEF reduction. Methods In a systematic review, a comprehensive literature search was conducted on multiple electronic databases using strict search terms. Twenty studies met the set inclusion/exclusion criteria. Meta-analysis of extracted data was conducted using the R-studio and STATA software. Furthermore, the aforementioned study endpoints were stratified by the degree of left ventricular ejection fraction (LVEF) reduction into severe (&amp;lt;35%), moderate (&amp;lt;40%) and mild (&amp;lt;50%). Results Data from 25,031 HFrEF patients was analysed, out of which 12,957 (52%) underwent CABG and 12,074 (48%) received PCI. Long-term survival was significantly higher in the severe (&amp;lt;35%) and mildly (&amp;lt;50%) reduced LVEF groups, with no significant different found in the moderately (&amp;lt;40%) reduced LVEF cohort. However, all 3 groups significantly favoured CABG in terms of need for revascularization, but no difference in stroke incidence was found. As for postoperative MI, this followed the same trend as survival. No evidence of significant heterogeneity or publication bias was found. Conclusion CABG yields more favourable results than PCI in HFrEF patients. Further stratifying the clinical outcomes measured by the degree of LVEF reduction sheds light on the importance of risk stratification of patients to optimise results.

Reduced mitochondrial pyruvate carrier expression in hearts with heart failure and reduced ejection fraction patients: ischemic vs. non-ischemic origin.

Mitochondrial pyruvate carrier (MPC) mediates the entry of pyruvate into mitochondria, determining whether pyruvate is incorporated into the Krebs cycle or metabolized in the cytosol. In heart failure (HF), a large amount of pyruvate is metabolized to lactate in the cytosol rather than being oxidized inside the mitochondria. Thus, MPC activity or expression might play a key role in the fate of pyruvate during HF. The purpose of this work was to study the levels of the two subunits of this carrier, named MPC1 and MPC2, in human hearts with HF of different etiologies. Protein and mRNA expression analyses were conducted in cardiac tissues from three donor groups: patients with HF with reduced ejection fraction (HFrEF) with ischemic cardiomyopathy (ICM) or idiopathic dilated cardiomyopathy (IDC), and donors without cardiac pathology (Control). MPC2 plasma levels were determined by ELISA. Significant reductions in the levels of MPC1, MPC2, and Sirtuin 3 (SIRT3) were observed in ICM patients compared with the levels in the Control group. However, no statistically significant differences were revealed in the analysis of MPC1 and MPC2 gene expression among the groups. Interestingly, Pyruvate dehydrogenase complex (PDH) subunits expression were increased in the ICM patients. In the case of IDC patients, a significant decrease in MPC1 was observed only when compared with the Control group. Notably, plasma MPC2 levels were found to be elevated in both disease groups compared with that in the Control group. Decreases in MPC1 and/or MPC2 levels were detected in the cardiac tissues of HFrEF patients, with ischemic or idiopatic origen, indicating a potential reduction in mitochondrial pyruvate uptake in the heart, which could be linked to unfavorable clinical features.

Temporal evolution of liver function parameters predicts clinical outcome in chronic heart failure patients (Bio-SHiFT study).

Liver dysfunction contributes to worse clinical outcomes in heart failure (HF) patients. However, studies exploring temporal evolutions of liver function parameters in chronic HF (CHF) pa- tients, and their associations with clinical outcome, are scarce. Detailed temporal patterns of alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGTP), total bilirubin (TBIL) and albumin (ALB) were investigated, and their relation with clinical outcome, in patients with stable CHF with reduced ejection fraction. Tri-monthly plasma samples were collected from 250 patients during 2.2 (1.4-2.5) years of follow-up. ALP, GGTP, ALB, and TBIL were measured in 749 selected samples and the relationship between repeatedly measured biomarker levels and the primary endpoint (PEP; composite of cardiovas- cular death, heart transplantation, left ventricular assist device implantation, and hospitalization for worsened HF) was evaluated by joint models. Mean age was 66 ± 13 years; 74% were men, 25% in New York Heart Association class III-IV. 66 (26%) patients reached the PEP. Repeatedly measured levels of TBIL, ALP, GGTP, and ALB were associated with the PEP after adjustment for N-terminal prohormone B-type natriuretic peptide and high sensitivity troponin T (hazard ratio [95% confidence interval] per doubling of biomarker level: 1.98 [1.32; 2.95], p = 0.002; 1.84 [1.09; 3.05], p = 0.018, 1.33 [1.08; 1.63], p = 0.006 and 1.14 [1.09; 1.20], p < 0.001, respectively). Serial levels of ALP and GGTP, and slopes of the temporal evolutions of ALB and TBIL, adjusted for clinical variables, were also significantly associated with the PEP. Changes in serum levels of TBIL, ALP, GGTP, and ALB precede adverse cardiovascular events in patients with CHF. These routine liver function parameters may provide additional prognostic information in heart failure with reduced ejection fraction patients in clinical practice.

Hemodynamic Response to Exercise Training in Heart Failure With Reduced Ejection Fraction Patients.

Supervised exercise training decreases total and cardiac mortality and increases quality of life of heart failure with reduced ejection fraction (HFrEF) patients. However, response to training is variable from one patient to another and factors responsible for a positive response to training remain unclear. The aims of the study were to compare cardiac hemodynamic changes after an exercise training program in responders (R) versus non-responders (NR) HFrEF patients, and to compare different discriminators used to assess response to training. Seventy-six HFrEF patients (86% males, 57 ± 12 years) completed an exercise training program for 4 weeks. Patients underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer before and after training. Cardiac hemodynamics were measured by impedance cardiography during CPET. The R and NR groups were classified using the median change in peak oxygen uptake (V̇O2peak). There were statistically significant differences in V̇O2peak (+35% vs. -1%, P < 0.0001) and in peaks of ventilation (+30% vs. +2%, P < 0.0001), cardiac output (COpeak) (+25% vs. +4%, P < 0.01), systolic blood pressure (+12% vs. +2%, P < 0.05), diastolic blood pressure (+9% vs. +4%, P < 0.05) and heart rate (+8% vs. +1%, P < 0.01) between R and NR after the training program. V̇O2peak was the best discriminator between R and NR (receiver operating characteristic (ROC) area under the curve (AUC) = 0.83, P < 0.0001), followed by COpeak (ROC AUC = 0.77, P < 0.0001). V̇O2peak is the best discriminator between HFrEF R and NR patients after the training program. Responders showed improvements in peak hemodynamic parameters. These results pave the way for other studies to determine how the individualization of exercise training programs and peak hemodynamic parameters potentially linked to a better positive response status.

Health-related quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Hospital, Ethiopia.

Living with heart failure poses challenges due to its poor prognosis and impact on quality of life, making it crucial to assess how it affects patients for better patient-centered management. This study aimed to assess quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Comprehensive Specialized Hospital in Ethiopia, 2023. An "institution-based" cross-sectional study was conducted at the University of Gondar Comprehensive Specialised Hospital. The data were collected using an interviewer-administered questionnaire. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Sociodemographic, behavioral, clinical, biochemical, and echocardiographic characteristics were included in the questionnaire. The collected data were entered into EpiData version 4.6 and exported into SPSS version 25 for analysis. Multiple linear regression analysis (p < 0.05) was used to measure the degree of association between quality of life and independent variables. A total of 240 patients with heart failure and reduced ejection fraction participated in the study. The health-related quality of life scores for the physical, emotional, and total were 17.60 ± 10.33, 10.58 ± 6.33 and 46.12 ± 26.06, respectively. Health-related quality of life was significantly associated with age, marital status, occupation, income, heart failure duration, recent hospitalization, New York Heart Association functional class, heart failure etiology, atrial fibrillation comorbidity, systolic blood pressure, heart rate, heart failure medications, severe left ventricular systolic dysfunction, and severe or moderate pulmonary hypertension. This study found that patients with heart failure and reduced ejection fraction had poor health-related quality of life, influenced by identified factors. These findings aid professionals in assessing and identifying interventions that improve these patients' quality of life.

Safety of sodium-glucose cotransporter 2 inhibitors drugs among heart failure patients: a systematic review and meta-analysis.

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce morbidity and mortality for heart failure (HF) patients and are recommended as cornerstones for their medical therapy. Utilization in clinical practice remains low for multiple reasons, one of which may be adverse events. We investigated the incidence of these events to see if they are associated with SGLT2i use. A systematic search was performed in databases, including PubMed, Embase, Cochrane Library, Clinicaltrials.gov, and WHO's International Clinical Trials Registry Platform. Relevant randomized controlled trial studies assessing the safety outcomes of SGLT2i in HF patients were included in this study. We conducted the common-effect meta-analysis to estimate the relative risk (RR) and 95% confidence interval (CI) of safety outcomes in SGLT2i compared with placebo. Eighteen studies were included in the meta-analysis composed of 12925 HF patients taking an SGLT2i and 12747 taking a placebo. The meta-analysis indicated that the all-cause mortality and serious adverse events (SAEs) were lower in the SGLT2i group (RR, 0.91; 95% CI, 0.85-0.97; P=0.005, I2=0%; and RR, 0.92; 95% CI, 0.90-0.95; P<0.001, I2=43%, respectively). Volume depletion and genitourinary infections were more prevalent in the SGLT2i group (RR, 1.17; 95% CI, 1.06-1.28; P=0.001, I2=0%; and RR, 1.27; 95% CI, 1.13-1.43; P<0.001, I2=17%, respectively). Our meta-analysis demonstrated that using SGLT2is in HF patients was correlated with reduced mortality and SAEs, with a more prominent effect in HF with reduced ejection fraction patients and those taking dapagliflozin.

Prognostic impact of lung ultrasound detected B-lines on hospitalised ischaemic heart failure with mildly reduced ejection fraction patients

ObjectivesPrognostic impact of lung ultrasound-derived B-lines (LUS-BL) in heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) patients remains elusive. We evaluated the correlation between LUS-BL and prognosis in...

Abstract 16337: Guideline-Directed Medical Therapy Use and Association With Outcomes Among Hospitalized Heart Failure With Reduced Ejection Fraction Patients During COVID-19

Background: The association of prior to admission guideline-directed medical therapy (GDMT) with outcomes among patients hospitalized with Heart Failure with Reduced Ejection Fraction (HFrEF) and COVID-19, as well as overall GDMT prescription patterns during the pandemic, is not well known. Methods: HFrEF patients (left ventricular ejection fraction ≤40%) admitted with acute decompensated heart failure (ADHF) were identified from the American Heart Association’s Get With The Guidelines Heart Failure Registry. We analyzed the association of prior to admission GDMT use with odds of in-hospital mortality, and with odds of severe COVID-19, using adjusted logistic regression models. GDMT was defined as prescription of angiotensin converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEI/ARB/ARNI), beta blocker (BB), or mineralocorticoid receptor antagonist (MRA). We further evaluated GDMT prescription trends during the pandemic. Results: We identified 23,899 HFrEF patients admitted with ADHF (2/16/20-3/24/21) during the pandemic, of which 333 had a diagnosis of COVID-19. We also identified 26,459 HFrEF patients admitted with ADHF in the year prior to the pandemic (2/16/19-2/15/20). Prior to admission ACEI/ARB/ARNI, BB, or MRA use was not associated with odds of in-hospital mortality or severe COVID-19. Among all HFrEF patients, prior to admission ACEI/ARB/ARNI and BB use was lower during the pandemic compared to the year prior (Figure 1, Panel A). Prior to discharge prescription of ACEI/ARB/ARNI, MRA, and triple therapy (ACEI + BB + MRA) was higher during the pandemic compared to the year prior (Figure 1, Panel B). Conclusion: Among patients with HFrEF admitted with ADHF and COVID-19, prior to admission GDMT use was not associated with in-hospital mortality or severe COVID-19. GDMT prescription rates at discharge were similar to or improved during the pandemic compared with the preceding year.

Associations between baseline heart rate and blood pressure and time to events in HFrEF patients: data from the QUALIFY international registry.

A high resting heart rate (RHR) and low systolic blood pressure (SBP) are a risk factor and a risk indicator, respectively, for poor heart failure (HF) outcomes. This analysis evaluates the associations between baseline RHR and SBP with outcomes and treatment patterns in HF patients with reduced ejection fraction (HFrEF) in the QUALIFY international registry. Between September 2013 and December 2014, 7317 HFrEF patients with a previous HF hospitalization within 1-15 months were enrolled in the QUALIFY registry (Quality of Adherence to Guideline Recommendations for Life-Saving Treatment in Heart Failure Survey). Complete follow-up data were available for 5138 patients. The relationships between RHR and SBP and outcomes were assessed using a Cox proportional hazards model and were analyzed according to baseline values as high RHR (H-RHR) ≥ 75 vs. low RHR (L-RHR) < 75 bpm) and high SBP (H-SBP): ≥ 110 vs. low SBP (L-SBP): <110 mmHg and analyzed according to each of the following 4 phenotypes: (H-RHR/L-SBP, L-RHR/L-SBP, H-RHR/H-SBP and L-RHR/H-SBP (reference group). Compared to the reference group, H-RHR/L-SBP was associated with the worst outcomes for the combined primary endpoint of CV death and HF hospitalization (HR 1.83, CI 1.51-2.21, p<0.001), CV death (HR 2.7, CI 1.69-4.33, p <0.001), and HF hospitalization (HR 1.62, CI 1.30-2.01, p<0.001). Low-risk patients with L-RHR/H-SBP achieved more frequently >=50% of target doses of ACEIs and BBs than the other groups. However, 48% and 46% of low-risk patients were not well treated with ACEIs and BBs, respectively (<=50% of target dose or no treatment). In patients with HFrEF and recent hospitalisation, elevated RHR and lower SBP identify patients at increased risk for CV endpoints. While SBP and RHR are often recognized as barriers that deter physicians from treating with high doses of recommended drugs, they are not the only reason leaving many patients suboptimally treated. This article is protected by copyright. All rights reserved.

Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India.

Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides β-blockers, Ivabradine is a wellestablished heart rate modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed β-blocker dosing or having contraindication/intolerance to β-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/β-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed for further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and β-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.

Telmisartan versus EnalapRil In heart failure with redUced ejection fraction patients with Moderately impaired kidney Functions; randomized controlled trial: “TRIUMF trial”

BackgroundWhen heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) co-exist, Renin angiotensin-aldosterone system inhibitors (RAASi) are often underutilized for the fear of worsening renal function (WRF). Telmisartan is a RAASi characteristic for a favorable renal profile, although data on its utility in HFrEF is limited. This study aimed to compare efficacy and tolerability of Telmisartan versus Enalapril in patients with HFrEF and CKD.ResultsThis study randomized 107 patients with HFrEF and CKD to either Telmisartan (10–80 mg) or Enalapril (5–40 mg) daily. The achieved RAASi dose, dose reductions (DR) or dis-continuation (DC), death/Heart failure rehospitalization (HFH), NYHA class and 6MWT were compared at 3- and 6-months. At 3- and 6-months, 93.5% versus 68.6% and 95.2% versus 72.9% were maintaining ≥ 50% of the target dose in the Telmisartan- versus Enalapril-group, respectively. Despite the higher achieved dose by 3- and 6-months, Telmisartan versus Enalapril was associated with less WRF (6.4% vs. 22.9%, p = 0.022 and 7.3% vs. 13.6%, p = 0.28) and fewer episodes of DR-DC (31.9% vs. 55.1%, p = 0.018 and 35.7% vs. 56.5%, p = 0.041), respectively. By the end of the study, there were 5 deaths in each group, yet, HFH occurred in 34.1% versus 55.3%, p = 0.035, and NYHA class changed by − 1 [− 2, 0] versus 0 [− 1, 1], p = 0.017 in Telmisartan- versus Enalapril patients, respectively. Within-group results showed improvement in 6MWT in Telmisartan-, and increase in diuretic requirements in Enalapril-group.ConclusionsIn patients with HFrEF and CKD, Telmisartan was better tolerated to uptitrate, caused less WRF, less HFH and showed better functional improvement compared to Enalapril.Clinical trial registration This study was prospectively registered on clinicaltrials.gov, with registration number (NCT04736329).