Role In Management Of Heart Failure Research Articles

The role of miR-128 and MDFI in cardiac hypertrophy and heart failure: Mechanistic.

Heart failure (HF) prognosis depends on various regulatory factors; microRNA-128 (miR-128) is identified as a regulator of cardiac fibrosis, contributing to HF. MyoD family inhibitor (MDFI), which is reported to be related with Wnt/β-catenin pathway, is supposed to be regulated by miR-128. This study investigates the interaction between miR-128 and MDFI in cardiomyocyte development and elucidates its role in heart injury. Gene expression profiling assessed miR-128's effect on MDFI expression in HF using qPCR and Western blot analysis. Luciferase assays studied the direct interaction between miR-128 and MDFI. MTT, transwell, and immunohistochemistry evaluated the effects of miR-128 and MDFI on myocardial cells in mice HF. Genescan and luciferase assays validated the interaction between miR-128 and MDFI sequences. miR-128 mimics significantly reduced MDFI expression at mRNA and protein levels with decrease rate of 55%. Overexpression of miR-128 promoted apoptosis with the increase rate 65% and attenuated cardiomyocyte proliferation, while MDFI upregulation significantly enhanced proliferation. Elevated miR-128 levels upregulated Wnt1 and β-catenin expression, whereas increased MDFI levels inhibited these expressions. Histological analysis with haematoxylin and eosin staining revealed that miR-128 absorption reduced MDFI expression, hindering cell proliferation and cardiac repair, with echocardiography showing corresponding improvements in cardiac function. Our findings suggest miR-128 interacts with MDFI, playing a crucial role in HF management by modulating the Wnt1/β-catenin pathway. Suppression of miR-128 could promote cardiomyocyte proliferation, highlighting the potential value of the miR-128/MDFI interplay in HF treatment.

Association between early central venous pressure measurement and all-cause mortality in critically ill patients with heart failure: A cohort of 11,241 patients

BackgroundThe timing of central venous pressure (CVP) measurement may play a crucial role in heart failure management, yet no studies have explored this aspect. MethodsClinical information pertaining to patients in critical condition with a diagnosis of heart failure was retrieved from the MIMIC-IV database. The association between initial measurements of central venous pressure (CVP) and the incidence of mortality from all causes was analyzed using the Cox proportional hazards approach. Subgroup analysis and propensity score matching were conducted for sensitivity analyses. ResultsThis study included 11,241 participants (median age, 75 years; 44.70 % female). Utilizing restricted cubic spline and Kaplan–Meier survival analyses, it was determined that prognostic outcomes were better when CVP was measured within the initial 5-h window. Multivariate-adjusted 1-year (HR: 0.69; 95 % CI: 0.61–0.77), 90-day (HR: 0.70; 95 % CI: 0.62–0.80), and 30-day (HR: 0.67; 95 % CI: 0.57–0.78) all-cause mortalities were significantly lower in patients with early CVP measurement, which was proved robustly in subgroup analysis. Subsequent to the application of propensity score matching, a cohort of 1536 matched pairs was established, with the observed mortality rates continuing to be significantly lower among participants who underwent early CVP assessment. ConclusionsEarly CVP measurement (within 5 h) demonstrated an independent correlation with a decrease in both immediate and extended all-cause mortality rates among patients in critical condition suffering from heart failure.

Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Heart failure (HF) patients frequently present with comorbidities such as atrial fibrillation (AF) or other cardiovascular conditions, elevating their risk of thromboembolic events. Consequently, anticoagulation therapy is often considered for thromboprophylaxis, although its initiation in HF patients is complicated by concomitant bleeding risk factors. This review explores the paradoxical relationship between HF, increased bleeding risk, and the potential benefits of anticoagulation. Through an examination of existing evidence from clinical trials, observational studies, and meta-analyses, we aim to elucidate the role of anticoagulation in HF patients with increased bleeding risk. Despite guidelines recommending anticoagulation for certain HF patients with AF or other thromboembolic risk factors, uncertainty persists regarding the optimal management strategy for those at heightened risk of bleeding. The review discusses the pathophysiological mechanisms linking HF and thrombosis, challenges in bleeding risk assessment, and strategies to minimize bleeding risk while optimizing thromboprophylaxis.Shared decision-making between clinicians and patients is emphasized as essential for individualized treatment plans that balance the potential benefits of anticoagulation against the risk of bleeding complications. Furthermore, it examines emerging anticoagulant agents and their potential role in HF management, highlighting the need for further research to delineate optimal management strategies and inform evidence-based practice. In conclusion, while anticoagulation holds promise for improving outcomes in HF patients, careful consideration of patient-specific factors and ongoing research efforts are essential to optimize therapeutic strategies in this population.

Abstract 15572: Assessing the Impact of Renal Denervation on Heart Failure: Results From the Pooled Analysis of Randomized Controlled Trials

Introduction: Renal denervation (RDN), first developed for hypertension management, is currently being investigated as a potential treatment for heart failure (HF). However, its efficacy and safety for these patients necessitate further investigation. Hypothesis: This study aimed to assess the impact of renal denervation on various clinical and hemodynamic parameters in heart failure patients. Methods: A comprehensive search of PubMed, Cochrane Library, and Embase databases was performed for randomized controlled trials (RCTs) comparing RDN with standard care or placebo in HF patients, published until January 2023. Data were pooled using a random-effects model, and results were reported as Mean Differences (MD) with a 95% confidence interval (CI). All statistical analyses were performed using R software (version 4.0.3) with the metafor and meta packages. Results: The search identified five RCTs involving 208 patients (103 in the RDN group and 105 in the control group). RDN was associated with significant improvements in left ventricular ejection fraction (MD: 4.48%, 95% CI: 0.57-8.4%, P=0.02, I2=77%), 6-minute walk distance (MD: 78.71 meters, 95% CI: 47.01-110.41 meters, P<0.01, I2=0%), left ventricular end-systolic diameter (MD: -3.18 mm, 95% CI: -5.64 to -0.72 mm, P=0.01, I2=24%), and left ventricular end-diastolic diameter (MD: -4.16 mm, 95% CI: -6.04 to -2.29 mm, P<0.01, I2=0%). However, no significant changes were noted in left atrial diameter (MD: -4.49 mm, 95% CI: -9.19 to 0.20 mm, P=0.06, I2=79%), New York Heart Association class (MD: -0.71, 95% CI: -1.65 to 0.24, P=0.14, I2=96%), heart rate (MD: -3.71 beats per minute, 95% CI: -8.45 to 1.03 beats per minute, P=0.12, I2=62%), systolic blood pressure (MD: -0.35 mmHg, 95% CI: -11.51 to 10.79 mmHg, P=0.95, I2=88%), and diastolic blood pressure (MD: -1.46 mmHg, 95% CI: -7.12 to 4.19 mmHg, P=0.61, I2=79%). Conclusions: RDN has shown the potential to improve left ventricular function and exercise capacity in managing heart failure. The results, marked by high heterogeneity in some outcomes and constrained by the limited number of trials and patients, necessitate larger multicenter trials for validation and further exploration of renal denervation's role in heart failure management.

Diuretics in the management of chronic heart failure: when and how.

Heart failure is an increasingly prevalent condition resulting in recurrent hospitalisations and significant mortality and morbidity. The management of heart failure has evolved, and multiple drugs have an established mortality benefit in heart failure with reduced ejection fraction. Although the focus should be on ensuring that patients are treated with the maximum tolerated doses of these guideline-directed therapies, diuretics continue to play a key role in the management of clinical congestion in all forms of heart failure. Clinicians play a key role in heart failure management. Familiarity with the role of diuretics and their dosing and monitoring is critical.

An Artificial Intelligence Approach to Guiding the Management of Heart Failure Patients Using Predictive Models: A Systematic Review.

Heart failure (HF) is one of the leading causes of mortality and hospitalization worldwide. The accurate prediction of mortality and readmission risk provides crucial information for guiding decision making. Unfortunately, traditional predictive models reached modest accuracy in HF populations. We therefore aimed to present predictive models based on machine learning (ML) techniques in HF patients that were externally validated. We searched four databases and the reference lists of the included papers to identify studies in which HF patient data were used to create a predictive model. Literature screening was conducted in Academic Search Ultimate, ERIC, Health Source Nursing/Academic Edition and MEDLINE. The protocol of the current systematic review was registered in the PROSPERO database with the registration number CRD42022344855. We considered all types of outcomes: mortality, rehospitalization, response to treatment and medication adherence. The area under the receiver operating characteristic curve (AUC) was used as the comparator parameter. The literature search yielded 1649 studies, of which 9 were included in the final analysis. The AUCs for the machine learning models ranged from 0.6494 to 0.913 in independent datasets, whereas the AUCs for statistical predictive scores ranged from 0.622 to 0.806. Our study showed an increasing number of ML predictive models concerning HF populations, although external validation remains infrequent. However, our findings revealed that ML approaches can outperform conventional risk scores and may play important role in HF management.

Využití telemedicíny u pacientů se srdečním selháním

Chronic heart failure (HF), like any chronic disease, is a medical and socioeconomic burden. The number of patients with HF is increasing and our effort is to apply the most effective way of care in practice, preferably together with using telemedicine. Early diagnosis, therapy establishment and reduction of rehospitalizations play the key role in HF management. For patients for whom we add telemedicine (telephone consultation, physiological data transfer, data transfer from implantable devices, teleconsultation) and especially if we are able to provide the background of a well-functioning telemedicine center that is able to respond promptly to the data, we can recognize and respond to the deterioration in health status in a timely manner. Telemedicine has benefit in all aspects of care mentioned above, but mostly in the reduction of re-hospitalizations, which is related to the reduction of morbidity and mortality. Telemedicine in HF is also cost-effective.

Vericiguat for the treatment of heart failure: mechanism of action and pharmacological properties compared with other emerging therapeutic options

ABSTRACT Introduction The significant morbidity and mortality in patients with heart failure (HF), notably in the most advanced forms of the disease, justify the need for novel therapeutic options. In the last year, the soluble guanylate cyclase (sGC) stimulator, vericiguat, has drawn the attention of the medical community following the report of reduced clinical outcomes in patients with worsening chronic HF (WCHF). Areas Covered The authors review the available data on the mechanism of action of vericiguat (cyclic guanosine monophosphate (cGMP) pathway), its clinical development program, its role in HF management, and its future positioning in the therapeutic recommendations. Expert opinion cGMP deficiency has deleterious effects on the heart and contributes to the progression of HF. Different molecules, including nitric oxide (NO) donors, phosphodiesterase inhibitors, and natriuretic peptides analogues, target the NO-sCG-cGMP pathway but have yielded conflicting results in HF patients. Vericiguat acts as a sGC stimulator thus targeting the NO-sGC-cGMP pathway by a different mechanism that complements the current pharmacotherapy for HF. Vericiguat has shown an additional statistical add-on therapy efficacy by reducing morbi-mortality in patients with WCHF. A better evaluation of HF severity might be an important determinant to guide the use of vericiguat among the available therapies.

Stem cell therapy for heart failure: Medical breakthrough, or dead end?

Heart failure continues to be one of the leading causes of morbidity and mortality worldwide. Myocardial infarction is the primary causative agent of chronic heart failure resulting in cardiomyocyte necrosis and the subsequent formation of fibrotic scar tissue. Current pharmacological and non-pharmacological therapies focus on managing symptoms of heart failure yet remain unable to reverse the underlying pathology. Heart transplantation usually cannot be relied on, as there is a major discrepancy between the availability of donors and recipients. As a result, heart failure carries a poor prognosis and high mortality rate. As the heart lacks significant endogenous regeneration potential, novel therapeutic approaches have incorporated the use of stem cells as a vehicle to treat heart failure as they possess the ability to self-renew and differentiate into multiple cell lineages and tissues. This review will discuss past, present, and future clinical trials, factors that influence stem cell therapy outcomes as well as ethical and safety considerations. Preclinical and clinical studies have shown a wide spectrum of outcomes when applying stem cells to improve cardiac function. This may reflect the infancy of clinical trials and the limited knowledge on the optimal cell type, dosing, route of administration, patient parameters and other important variables that contribute to successful stem cell therapy. Nonetheless, the field of stem cell therapeutics continues to advance at an unprecedented pace. We remain cautiously optimistic that stem cells will play a role in heart failure management in years to come.

Abstract 16: Home Care Workers Who Care for Adults With Heart Failure: A Community-Partnered Qualitative Study

Background: Paid home care workers (HCWs) represent one of the fastest growing sectors of the US workforce and healthcare industry. They are increasingly utilized by home-dwelling adults with heart failure (HF) for long term assistance and post-acute care. Yet, little is known about the perspectives of HCWs regarding their role in HF management and as part of the healthcare team. Objective: We sought to understand the perspectives of HCWs who take care of adults with HF as the foundation for the development of future intervention(s). Methods: We conducted 8 focus groups with English and Spanish-speaking HCWs at the 1199SEIU’s Home Care Industry Education Fund, a non-profit organization that oversees the training of 65,000 HCWs from 50 home care agencies across NYC. Eligibility criteria included taking care of a client with HF within the last year and being a HCW for at least 2 years. Purposeful sampling ensured equal representation of English and Spanish speaking HCWs. Focus groups were audio recorded and professionally transcribed. Data were organized using qualitative software and analyzed using grounded theory. Results: The 46 participants were mean age of 49 years (SD 10), 45 (98%) were female, 17 (37%) were Black, 25 (54%) were Hispanic, and 42 (91%) had at least a high school education. Participants had been HCWs for 16 years (8.4 SD) and spent 3.5 days per week (1.8 SD) with HF clients. Seven major themes emerged: 1. HF has an unpredictable disease course, which is frightening to HCWs. “One minute we’re watching TV and the next, he crumps.” 2. HCWs often assist with HF management , although most have not received HF training. “Over time, you pick up on the symptoms - the shortness of breath, the swollen legs. But, I’ve never received HF training.” 3. Communication is fragmented. ?No one at the agency picks up the phone, so I just take him to the emergency room instead.? 4. HCWs are ignored by the healthcare team. “We’re with the clients all day, more than anyone else. So why aren’t we included in the conversation?” 5. Role definition is lacking . “The agency doesn’t make clear who we are or what we do. We aren’t just the help!” 6. Delicate family dynamics. “I’m always in the middle and I can’t afford to lose my job.” 7. Social isolation and burnout. “I’m with her all day, and she has Dementia too. It’s hard -- I’ve literally got nobody to talk to.” Conclusions and Implications: Our findings suggest that while HCWs are frequently involved in their clients’ HF management, most have not received formal HF training or resources. Additionally, despite spending so much time caring for their clients, they often feel invisible to healthcare providers. HF-specific training, as well as interventions that aim to integrate HCWs into the healthcare team, may improve HCWs’ HF knowledge and the quality of care delivered to adults with HF.

Nurse Practitioner Led Cardiac Gym Clinic for Heart Failure Patients; A New Initiative

Objective: The onsite hospital cardiac gym provides patients of the Advanced Heart Failure Service with a safe environment to exercise. Benefits of exercise in heart failure (HF) have been well documented [[1]NHF&CSANZ Guidelines for the prevention, detection and management of chronic heart failure in Australia. 2011; Google Scholar]. The HF nurse practitioner (NP) initiated a NP gym clinic aiming to provide clinical support and prompt solutions to presenting problems combined with medication management. NPs have been proven to improve outcomes for HF patients [[2]Kaan A. Dunne J. Development of a Nurse Practitioner Role in Heart Failure Management: An Australian Experience.Prog Cardiovasc Nurs. 2001; 16: 33-34Crossref PubMed Scopus (3) Google Scholar]. Management of HF includes optimisation of angiotension receptor antagonists and betablockers [[1]NHF&CSANZ Guidelines for the prevention, detection and management of chronic heart failure in Australia. 2011; Google Scholar] Design: The NP is onsite at the cardiac gym 1 day per week. This retrospective study reviews data collected over 12 months. Method: NP reviewed 74 patients, 63 male for 322 episodes. Average age 52 years (SD 12.8) with varying aetiology of heart failure, ejection fraction 27.4% (SD 12.9). Results: NP initiated 62% of cases, 59% for routine follow up and 41% due to a symptom change. Of symptoms reported, 51% were shortness of breath + - fluid overload. Treatment included medication optimisation and blood work. Most cases were independently managed by the NP without consultation with medical staff. Improvement in EF on echocardiogram increased to 38.4% (SD 13.6). Patient satisfaction was positive on survey. Conclusion: The presence of an NP in the cardiac gym proved to be a valuable adjunct to exercise. Patients were uptitrated to maximal doses of HF medications where tolerated. Improvement in EF on echo was statistically significant.

Troponin-Guided Heart Failure Therapy: Are We There Yet?

Biomarkers are widely used in medicine and the natriuretic peptides are the prototypical biomarker for heart failure aiding in diagnosis, prognosis, and biomarker-guided therapy. Cardiac troponins are mostly known for their role in diagnosing acute coronary syndrome, but they also play an important role in heart failure management. Current guidelines support using troponin for diagnosing ischemia as the cause of heart failure decompensation and prognosticating the risk for morbidity and mortality in acute and chronic heart failure. Recently, novel heart failure therapies have been shown to reduce troponin levels with a concurrent reduction in morbidity and mortality suggesting serial troponin measurements can be used as a surrogate for effectiveness of therapy. Troponin is prognostic for morbidity and mortality in heart failure and may provide a means for assessing the effectiveness of therapies. Recent studies suggest troponin could be used for guiding heart failure therapy, but further studies are needed specifically testing this role.

Can we engage caregiver spouses of patients with heart failure with a low-intensity, symptom-guided intervention?

ObjectiveEvaluate a pilot intervention to engage caregivers in management of heart failure (HF) patient symptoms. BackgroundHF impairs quality of life; caregivers provide an important role in HF management. MethodsWe developed modules to help patients report and caregivers alleviate symptoms of depression, pain, dyspnea, and fatigue. Semi-structured interviews followed by a mixed inductive and deductive, team-based analysis were used to evaluate acceptability and feasibility in patients with HF and their caregivers. ResultsParticipants (n = 22) expressed significant interest but few used the modules in follow-up. We identified three barriers to acceptability and feasibility: the quality of dyadic relationship, the timing and structure of the intervention, and the patient's perceived control over their illness. ConclusionsFuture interventions should evaluate dyadic relationship dynamics, match the timing and content of the intervention to the patient population, and enroll patients with perceived control over their illness to maximize intervention acceptability and feasibility.

New biomarkers in heart failure

Biomarkers are widely utilized in clinical medicine for their representation of numerous biological processes by means of measurable variables. In heart failure, biomarkers such as natriuretic peptides and troponins have been used to indicate severity of cardiac disease, but as more information emerges from research into new biomarkers and their adjuvant use, it is becoming clear that biomarkers offer a far wider range of functional uses including risk stratification, prognostic indication and calculation of targeted therapeutic strategies. To date the majority of information available regarding the use and potential of biomarkers in heart failure has been related to adults but here we discuss the relevance to the pediatric population. With the clinical and economic worldwide significance of heart failure both in adult and pediatric populations, biomarkers have an evolving role in heart failure management.

Imaging Heart Failure in 2010

Heart failure is a common and serious public health problem in industrialized countries. The epidemics of diabetes, obesity, hypertension, and coronary disease are contributing to the increasing prevalence of heart failure. The diagnosis of heart failure is based on a detailed history and a thorough physical examination. Echocardiography plays a central role in aiding in the diagnosis and characterization of heart failure and in directing its management. This review highlights recent advances in echocardiography in relation to heart failure. Three-dimensional echocardiography, tissue Doppler imaging, and speckle tracking echocardiography represent recent developments in echocardiography relevant to heart failure and as such are emphasized in this review. Advanced cardiac imaging includes nuclear cardiac imaging, cardiac CT, and cardiac MRI, and they also play an important role in heart failure management; in this review we emphasize their application in heart failure secondary to ischemic heart disease.

Diuretic Management in Heart Failure

Many of the primary clinical manifestations of heart failure are due to fluid retention and congestion, and therefore treatments targeting congestion play a central role in heart failure management. Diuretic therapy remains the cornerstone of congestion treatment, and diuretics are prescribed to the majority of heart failure patients. Despite this ubiquitous use, there is limited evidence from prospective randomized studies to guide the use of diuretics. Some observational data have suggested that diuretics may actually be harmful in heart failure, potentially contributing to worsening renal function, neurohormonal activation, and even heart failure progression. Recent clinical trial data have provided new insights into the balance of risks and benefits from diuretics. This review describes the mechanism of action of available diuretic classes, reviews their clinical use based on current guidelines, and briefly discusses evolving alternatives to diuretic therapy in the management of congestion in heart failure patients.

How to use diuretics in heart failure

Systemic and pulmonary congestion is a central aspect of both acute and chronic heart failure and directly leads to many of the clinical manifestations of these syndromes. Therefore, diuretic therapy to treat congestion plays a fundamental role in heart failure management. However, although diuretics are the most common drugs prescribed for heart failure, there is limited quality evidence to guide their use. Unlike other components of the heart failure armamentarium, such as beta-blockers and angiotensin-converting enzyme inhibitors, diuretics (with the exception of aldosterone antagonists) have not been shown to decrease heart failure progression or improve mortality. Additionally, some observational data suggest that diuretics may actually be harmful in heart failure, contributing to neurohormonal activation, renal dysfunction, and potentially mortality. Despite these concerns, diuretics remain ubiquitous in heart failure management because of the need to address symptoms of congestion and the lack of alternative strategies. Recently, the development of a variety of potential adjuncts or alternatives to diuretic therapy has suggested the need for an active reappraisal of diuretic therapy for heart failure. The main classes of diuretics are the loop diuretics, potassium-sparing diuretics, and thiazides. Loop diuretics, the mainstay of acute and chronic therapy for heart failure, are "threshold drugs"; therefore, an adequate dose to achieve a pharmacodynamic effect (ie, to increase urine output) must be prescribed for effective therapy. The minimum dose to achieve diuresis and manage congestion should be used to minimize adverse effects. For patients refractory to initial dosing of intravenous diuretics, options include dose escalation, use of continuous infusion rather than intermittent boluses, or combination therapy with the addition of a thiazide or thiazide-like diuretic (eg, metolazone). Management of chronic heart failure often includes patient-directed titration of diuretics based on changes in symptoms or body weight in an attempt to decrease hospitalizations, although the efficacy of this strategy has not been tested in well-designed trials. Aldosterone antagonists, which are used primarily as neurohormonal agents rather than for their diuretic effects, are indicated for patients with systolic failure and moderate to severe symptoms, as long as renal function and serum potassium are stable and monitored closely. All diuretic therapy requires careful monitoring of electrolytes and renal function. Whether newer modalities for managing congestion (vasopressin antagonists, adenosine A(1) antagonists, and ultrafiltration therapy) will be an improvement over diuretic therapy will be determined by the results of multiple ongoing clinical trials.

Development of a nurse practitioner role in heart failure management: an Australian experience.

This paper describes the history of nurse practitioners and outlines the Australian experience in developing and implementing such a role. The legislative process and changes in introducing a nurse practitioner role are noted, and a trial to develop a framework for the nurse practitioner role in acute care in South Australia is highlighted.

2003: The year in heart failure*1

2003: The year in heart failure*1

A new treatment modality in heart failure enhanced external counterpulsation (EECP).

Heart failure remains a significant health problem in the United States and in the world. Despite a surfeit of recent diagnostic and therapeutic advances, patients with heart failure remain inadequately helped. The overwhelming need for new and better therapies continues to stimulate scientists to investigate new technologies. Over the past several years the use of enhanced external counterpulsation as a treatment for chronic angina has steadily increased. Recently, its potential role in heart failure management has been shown. We review the role of enhanced external counterpulsation in heart failure management as an emerging noninvasive outpatient therapy.