Treatment Of Acute Heart Failure Research Articles

Unlocking the Potential of Acetazolamide: A Literature Review of an Adjunctive Approach in Heart Failure Management.

Background: Heart failure (HF) patients often experience persistent fluid overload despite standard diuretic therapy. The adjunctive use of acetazolamide, a carbonic anhydrase inhibitor, in combination with loop diuretics has shown promise in improving decongestion and diuretic efficacy. This literature review aims to analyze six studies evaluating the effectiveness of acetazolamide as an additive treatment for acute decompensated heart failure (ADHF) and its impact on various outcomes. Methods: We searched the PubMed database using the terms "acetazolamide heart failure". We refined our search with specific filters (as shown our PRISMA flow diagram) and exclusion criteria, narrowing down our results to five studies. We included an extra study via expert recommendation, ultimately including six studies for comprehensive analysis. Results: The review highlights the positive effects of acetazolamide on decongestion, natriuresis, and diuresis in HF patients. However, it also showcases the limitations of these trials. Discussion: While the reviewed studies demonstrate the potential benefits of acetazolamide in enhancing decongestion and diuretic efficiency, there are limitations to consider, including small sample sizes, lack of blinding, and limited external validity. Further research is needed to confirm these findings, compare acetazolamide with other diuretic combinations, and explore its effects in a broader population of heart failure patients, including those in the United States. The use of acetazolamide in HF management warrants continued investigation to optimize its role in improving decongestion and patient outcomes.

Network Meta-analysis of different Chinese medicine injections combined with conventional western medicine in treatment of acute heart failure

This study aims to evaluate the efficacy and safety of Chinese medicine injection in the treatment of acute heart failure. PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, Wanfang, and SinoMed were searched for the randomized controlled trial(RCT) of Chinese medicine injection combined with conventional western medicines in the treatment of acute heart failure with the time interval from the inception to July 10, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata 15.1 was used to perform network Meta-analysis. A total of 117 RCTs were included, involving 10 529 patients and 7 Chinese medicine injections: Shenfu Injection, Shenmai Injection, Danhong Injection, Puera-rin Injection, Xinmailong Injection, Shengmai Injection, and Yiqi Fumai Injection. Network Meta-analysis yielded the following results.(1) In terms of improving the total response rate, the surface under the cumulative ranking curve(SUCRA) ranking was Shengmai Injection + conventional western medicine > Danhong Injection + conventional western medicine > Shenmai Injection + conventio-nal western medicine > Shenfu Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Puerarin Injection + conventional western medicine > conventional western medicine.(2)In terms of reducing brain natriuretic peptide(BNP), the SUCRA ranking was Danhong Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Puerarin Injection + conventional wes-tern medicine > Shengmai Injection + conventional western medicine > conventional western medicine.(3)In terms of reducing N-terminal pro-brain natriuretic peptide(NT-proBNP), the SUCRA ranking was Shenmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Puerarin Injection + conventional western medicine > Danhong Injection + conventional western medicine > conventional western medicine.(4) In terms of improving the left ventricular ejection fraction(LVEF), the SUCRA ranking was Shenmai Injection + conventional western medicine > Xinmailong Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > Puerarin Injection + conventional western medicine > Danhong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > conventional western medicine.(5) In terms of decreasing the left ventricular end-diastolic diameter(LVEDD), the SUCRA ranking was Shenmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine=Xinmailong Injection + conventional western medicine > Shengmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > conventional western medicine > Puerarin Injection + conventional western medicine.(6) In terms of increasing the 6-min walk trail(6MWT), the SUCRA ranking was Xinmailong Injection + conventional western medicine > Shenfu Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Yiqi Fumai Injection + conventional western medicine > conventional western medicine.(7) In terms of reducing the Minnesota heart failure quality of life scale(MLHFQ) scores, the SUCRA ranking was Xinmailong Injection + conventional western medicine > Shenmai Injection + conventional western medicine > Shenfu Injection + conventional western medicine > conventional western medicine.(8)In terms of safety, the group of Chinese medicine injection combined with conventional western medicine had lower incidence of adverse reactions than the control group. The current evidence shows that combining Chinese medicine injection with conventional western medicine treatment can improve the therapeutic effect on acute heart failure, with high safety. Due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC.

Document Reviewers: Rudolf A. de Boer (CPG Review Co-ordinator) (Netherlands), P. Christian Schulze (CPG Review Co-ordinator) (Germany), Elena Arbelo (Spain), Jozef Bartunek (Belgium), Johann Bauersachs (Germany), Michael A. Borger (Germany), Sergio Buccheri (Sweden), Elisabetta Cerbai (Italy), Erwan Donal (France), Frank Edelmann (Germany), Gloria Färber (Germany), Bettina Heidecker (Germany), Borja Ibanez (Spain), Stefan James (Sweden), Lars Køber (Denmark), Konstantinos C. Koskinas (Switzerland), Josep Masip (Spain), John William McEvoy (Ireland), Robert Mentz (United States of America), Borislava Mihaylova (United Kingdom), Jacob Eifer Møller (Denmark), Wilfried Mullens (Belgium), Lis Neubeck (United Kingdom), Jens Cosedis Nielsen (Denmark), Agnes A. Pasquet (Belgium), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Bianca Rocca (Italy), Xavier Rossello (Spain), Leyla Elif Sade (United States of America/Türkiye), Hannah Schaubroeck (Belgium), Elena Tessitore (Switzerland), Mariya Tokmakova (Bulgaria), Peter van der Meer (Netherlands), Isabelle C. Van Gelder (Netherlands), Mattias Van Heetvelde (Belgium), Christiaan Vrints (Belgium), Matthias Wilhelm (Switzerland), Adam Witkowski (Poland), and Katja Zeppenfeld (Netherlands) All experts involved in the development of this Focused Update have submitted declarations of interest. These have been compiled in a report and simultaneously published in a supplementary document to the Focused Update. The report is also available on the ESC website www.escardio.org/guidelines See the European Heart Journal online for supplementary documents that include evidence tables.

Cardiogenic pulmonary edema - is it lone cardiogenic? "Missing link" between hemodynamic and other existing mechanisms.

The current traditional pathophysiologic concept of pulmonary edema of cardiogenic origin explains its development by a hydrostatic effect due to increased pulmonary capillary pressure resulting in fluid flux to alveolar and interstitial areas from capillaries. However, several experimental studies and clinical data of poor response to hemodynamic and diuretic treatment in many scenarios provide further evidence of the involvement of several other contributing factors to the development of cardiogenic pulmonary edema. Several experimental and clinical studies have found that sympathetic overactivity with elevated plasma catecholamine concentrations may play an important role in the development of cardiovascular-associated pulmonary edema. Catecholamine-induced pulmonary injury may be one of the key mechanisms in acute cardiogenic pulmonary edema triggering proinflammatory cytokine overactivation, oxidative stress and myocardial injury. In the everyday treatment of acute heart failure, physicians should consider the possibility of other noncardiogenic mechanisms involved in the progression of acute pulmonary edema, particularly catecholamine overactivity, lymphatic drainage, inflammatory and oxidative stress, high surfactant protein. The classic, hemodynamic treatment approach in pulmonary edema with the coexistence of other contributing factors may not provide adequate clinical benefit during treatment.

Clinical Efficacy of Non-Invasive Ventilator-Assisted Ventilation Combined with Morphine in the Treatment of Acute Heart Failure

Clinical Efficacy of Non-Invasive Ventilator-Assisted Ventilation Combined with Morphine in the Treatment of Acute Heart Failure

Efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with acute heart failure: a systematic review and meta-analysis.

The effectiveness and safety of a novel class of hypoglycemic medications known as sodium-glucose cotransporter 2 (SGLT2) inhibitors have not been completely established in relation to acute heart failure (AHF). Consequently, we sought to compare the prognostic and safety outcomes of patients administered SGLT2 inhibitors for the treatment of AHF. An extensive search of the Web of Science, PubMed, and EMBASE was conducted for randomized controlled trials and observational studies that have evaluated the use of SGLT2 inhibitors in AHF from the inception of these drugs to the present. We compiled data related to cardiovascular safety and prognosis. Aggregated risk ratios (RR), mean differences (MD), or standardized mean differences (SMD) were generated for all outcomes, with 95% confidence intervals (CIs), to evaluate the predictive significance of SGLT2 inhibitors in patients with AHF. We identified 4,053 patients from 13 studies. Patients experienced a substantial reduction in all-cause mortality (RR = 0.82, 95% CI: 0.70-0.96, P = 0.01), readmission rates (RR = 0.85, 95% CI: 0.74-0.98, P = 0.02), the number of heart failure exacerbation events (RR = 0.69, 95% CI: 0.50-0.95, P = 0.02), and the number of rehospitalization events due to heart failure (RR = 0.71, 95% CI: 0.58-0.86, P < 0.05) in the SGLT2 inhibitors-treatment group compared to a placebo or standard care (control group). SGLT2 inhibitors improved patient quality of life (SMD = -0.24, 95% CI: -0.40 to -0.09, P = 0.002). SGLT2 inhibitors were associated with enhanced diuresis in patients with AHF (MD = 2.83, 95% CI: 1.36-4.29, P < 0.05). Overall, treatment with SGLT2 inhibitors significantly reduced the level of serum NT-proBNP (MD = -497.62, 95% CI: -762.02 to -233.21, P < 0.05) and did not increase the incidence of adverse events (RR = 0.91, 95% CI: 0.82-1.01, P = 0.06). This meta-analysis suggests that treatment with SGLT2 inhibitors is associated with a better prognosis in patients with AHF than in patients not treated with SGLT2 inhibitors. It is safe and effective to initiate SGLT2 inhibitors in patients with AHF. https://www.doi.org/10.37766/inplasy2024.9.0015, identifier (INPLASY202490015).

Interpretation of 2023 ESC focused update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

Interpretation of 2023 ESC focused update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Istaroxime, an intravenous inotropic agent with a dual mechanism-increasing both cardiomyocyte contractility and relaxation-is a novel treatment for acute heart failure (AHF), the leading cause of morbidity and mortality in heart failure. We conducted a systematic review and meta-analysis that synthesized randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane until 24 April 2023. We used a fixed-effect or random-effect model-according to heterogeneity-to pool dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD), with a 95% confidence interval (CI). We included three RCTs with a total of 300 patients. Istaroxime was significantly associated with an increased left ventricular ejection fraction (mL) (MD: 1.06, 95% CI: 0.29, 1.82; p = 0.007), stroke volume index (MD: 3.04, 95% CI: 2.41, 3.67; p = 0.00001), and cardiac index (L/min/m2) (MD: 0.18, 95% CI: 0.11, 025; p = 0.00001). Also, istaroxime was significantly associated with a decreased E/A ratio (MD: -0.39, 95% CI: -0.58, -0.19; p = 0.0001) and pulmonary artery systolic pressure (mmHg) (MD: 2.30, 95% CI: 3.20, 1.40; p = 0.00001). Istaroxime was significantly associated with increased systolic blood pressure (mmHg) (MD: 5.32, 95% CI: 2.28, 8.37; p = 0.0006) and decreased heart rate (bpm) (MD: -3.05, 95% CI: -5.27, -0.82; p = 0.007). Since istaroxime improved hemodynamic and echocardiographic parameters, it constitutes a promising strategy for AHF management. However, the current literature is limited to a small number of RCTs, warranting further large-scale phase III trials before clinical endorsement.

Key messages to comprehend: 2023 Focused Update of the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure

Key messages to comprehend: 2023 Focused Update of the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure

Comments on the 2023 update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure

Comments on the 2023 update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure

Heart Failure Treatment in 2023: Is There a Place for Lipid Lowering Therapy?

An evidence for lipid lowering therapy in heart failure is briefly summarized in this review. Heart failure therapy is based on recent guidelines for diagnosis and treatment of acute and chronic heart failure. The question of the importance of hypolipidemic treatment in heart failure remains insufficiently answered. We still rely only on results of two randomized controlled trials that did not show significant benefit of statins on mortality in these patients. In contrast, some meta-analysis, prospective or retrospective cohorts, found some positive effects of this therapy. Recently, the role of inflammation and the possibility of its influence by hypolipidemics have been discussed. PCSK9 inhibitors, new lipid lowering drugs, are very effective in LDL-cholesterol lowering and atherosclerotic cardiovascular diseases prevention. The role of PCSK9 inhibitors in heart failure treatment is investigated. Based on current knowledge, hypolipidemics are not generally recommended in heart failure therapy, unless there is another indication for their use.

Clinical effect of Shenfu injection combined with glucocorticoid on patients with acute left heart failure complicated with bronchospasm

To investigate the clinical effect of Shenfu injection combined with glucocorticoid in the treatment of acute left heart failure complicated with bronchospasm. A prospective study was conducted.Ninety patients with acute left heart failure complicated with bronchospasm admitted to Huai'an Second People's Hospital from January 2021 to July 2022 were selected and divided into conventional treatment group, hormone therapy group and combined treatment group according to random number table method, with 30 cases in each group. All patients in the 3 groups received basic Western medicine treatment. On this basis, the conventional treatment group was given 0.25-0.50 g aminophylline injection plus 5% glucose injection or 0.9% sodium chloride injection (diabetes patients) 100 mL slow intravenous infusion, 1-2 times a day. In the hormone treatment group, 1 mg of budesonide suspension for inhalation was diluted to 2 mL by 0.9% sodium chloride injection, twice a day, and applied until 48 hours after the pulmonary wheezing disappeared. The combined treatment group was given glucocorticoid combined with Shenfu injection 80 mL plus 5% glucose injection or 0.9% sodium chloride injection (diabetes patients) 250 mL intravenously, once a day. All treated for 1 week. The general data, traditional Chinese medicine (TCM) syndrome score, TCM syndrone efficacy index, acute left heart failure efficacy, bronchospasm efficacy, systolic blood pressure (SBP), mean arterial pressure (MAP), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level and safety of the 3 groups were compared. The patients were followed up for 6 months, and the mortality and re-hospitalization rate of the 3 groups were recorded. Among the 90 patients, a total of 83 patients completed the study, excluding the cases dropped due to death and other reasons. There were 29 cases in the combined treatment group, 25 cases in the hormone therapy group and 29 cases in the conventional treatment group. There were no significant differences in age, gender, course of disease, and previous history (history of diabetes, history of hypertension, history of hyperlipidemia) among the 3 groups. Therefore, they were comparable. The difference of TCM syndrome score before and after treatment, TCM syndrome efficacy index of combined treatment group and hormone therapy group were higher than those of conventional treatment group [difference of TCM syndrome score: 15.14±5.74, 13.24±5.75 vs. 10.62±5.87, TCM syndrome efficacy index: (67.84±14.31)%, (59.94±14.26)% vs. (48.92±16.74)%, all P < 0.05], and the difference of TCM syndrome score and TCM syndrome efficacy index of combined treatment group were higher than those of hormone treatment group (both P < 0.05). The total effective rate of acute left heart failure and bronchospasm in the combined treatment group was significantly higher than that in the conventional treatment group (total effective rate of acute left heart failure: 96.55% vs. 75.86%, total effective rate of bronchospasm: 93.10% vs. 65.52%, both P < 0.05). The difference of serum NT-proBNP before and after treatment in combination therapy group and hormone therapy group was significantly higher than that in conventional treatment group (ng/L: 7 922.86±5 220.31, 7 314.92±4 450.28 vs. 4 644.79±3 388.23, all P < 0.05), and the difference of serum NT-proBNP before and after treatment in the combined treatment group was significantly higher than that in the hormone treatment group (P < 0.05). There were no significant differences in SBP difference, MAP difference, mortality and re-hospitalization rate among the 3 groups. No adverse reactions occurred in the 3 groups during treatment. Shenfu injection combined with glucocorticoid is effective in the treatment of patients with acute left heart failure complicated with bronchospasm. It is superior to glucocorticoid and aminophylline in relieving bronchospasm, reducing NT-proBNP level and improving total effective rate, and has good prognosis and safety.

Timing for combined diuretic therapy in acute heart failure: should we continue waiting for the poor response?

Decongestion is an important primary goal in acute heart failure treatment. Loop diuretics remain a fundamental role in congestion management and symptom improvement in patients with acute heart failure. Diuretic combination contributes to achieving better diuretic efficacy. However, the optimal timing for diuretic combination in clinical practice has not been distinctly recommended in current guidelines.

Comparative analysis of diuretic therapy and ultrafiltration in the efficacy of acute heart failure treatment

This article examines the role of furosemide and ultrafiltration in the treatment of acute heart failure. Furosemide, a loop diuretic, is successfully employed to reduce circulating blood volume and arterial pressure while increasing urea and uric acid excretion. The study compares two methods of furosemide administration: continuous infusion and intermittent injections, highlighting their advantages and limitations. Ultrafiltration, a method for removing excess fluid from the body, presents a promising alternative to diuretic therapy in the treatment of acute heart failure. This method allows for more precise fluid removal, preservation of kidney function, reduction of patient deterioration risks, improvement in their quality of life, and a decrease in diuretic dosages. Data analysis underscores the efficacy of ultrafiltration in managing acute heart failure with fluid overload and offers a perspective for future therapeutic practices.

Fractional excretion of urea nitrogen can identify true worsening renal function in patients with acute heart failure

Abstract Background Worsening renal function (WRF) often occurs during decongestive treatment in acute heart failure (AHF). Although WRF has previously been associated with worse prognosis, recent studies have revealed that it may not contribute to an unfavorable outcome in the setting of adequate decongestion achieved. Therefore, there is growing interest to identify patients who develop "true WRF" with poor outcomes. Purpose Fractional excretion of urea nitrogen (FEUN), which is used to differentiate causes of renal failure, has emerged as a surrogate marker of volume status in patients with AHF complicated by renal dysfunction. Recent study has reported that a low FEUN value (FEUN ≤32.1%) represents intravascular dehydration, whereas a high FEUN value (FEUN &amp;gt;38.0%) reflects intravascular congestion, both being independent adverse prognostic factors. Therefore, we hypothesized that FEUN could identify "true WRF" in patients with AHF. Methods We examined 801 hospitalized patients with AHF and renal dysfunction (defined as discharge estimated glomerular filtration rate &amp;lt;60 mL/min/1.73 m²) whose FEUN was measured at discharge. The patients were divided into four groups as follows: no WRF (n=683); WRF with low FEUN (≤32.1%) (n=36); WRF with medium FEUN (&amp;gt;32.1% and ≤38.0%) (n=25); and WRF with high FEUN (&amp;gt;38.0%) (n=57). WRF was defined as an increase in serum creatinine ≥0.3 mg from admission to discharge. FEUN was calculated by the following formula: (urinary urea × serum creatinine) × 100 / (serum urea × urinary creatinine). The primary endpoint was the composite of all-cause death and heart failure (HF) readmission within 1-year after discharge. Results Regarding baseline characteristics, the WRF with low FEUN group had lower left ventricular ejection fraction, whereas the WRF with high FEUN group had poorer renal function. During the median follow-up period of 300 days, 18 all-cause deaths and 165 HF readmissions occurred. Kaplan–Meier analysis showed that patients without WRF had a significantly higher event-free survival rate than those with WRF. In addition, the WRF with medium FEUN group had a significantly higher event-free survival rate similar to that of the no WRF group, whereas the WRF with low FEUN and WRF with high FEUN groups had lower event-free survival rates. In multivariable Cox regression analysis, the WRF with low FEUN (hazard ratio, 1.91; 95% confidence interval, 1.02–3.57; P=0.043) and WRF with high FEUN (hazard ratio, 1.71; 95% confidence interval, 1.02–2.89; P=0.043) groups were independently associated with poor outcomes, even after adjusting for confounders. Conclusion Our study suggests that FEUN can identify prognostically relevant WRF and may be a useful marker for guiding decongestive therapy in patients with AHF complicated by WRF.Table 1Figure 1

Abstract 17404: Heart Failure Hospitalization Readmissions and Mortality on Cardiology versus Non-Cardiology Services in a U.S. Hospital System

Introduction: With the number of patients diagnosed with heart failure (HF) in the U.S. exceeding the number of cardiologists specialized to care for them, there is increasing reliance on non-cardiologists for treatment of acute decompensated heart failure (ADHF). Based on prior studies, there is concern that outcomes may be inferior under this circumstance. Hypothesis: Patients admitted with ADHF have lower 30-day readmissions when admitted to cardiology versus non-cardiology services. Methods: This was an observational, retrospective cohort study of 6885 patients with a primary diagnosis of ADHF based on ICD diagnosis-codes from 2015 to 2020. Data were retrieved from an EPIC-based registry with patients admitted to any of five network hospitals in a single health system. The registries were constructed through Clarity. Logistic regression adjusted for age, race, and gender was employed to distinguish differences in 30-day readmissions in those admitted with ADHF to cardiology vs. non-cardiology services. Results: Of the 6885 patients, 14% were admitted to cardiology, and 86% under non-cardiology services. The total cohort’s mean age was 69 (±15). The majority were White (71%) and male (54%). There was a statistically significant difference in mean age between cardiology services (68 [±14]) and non-cardiology services (69 [±15]) (p= 0.013). Black patients represented 15% of patients on cardiology services and 28% on non-cardiology services (p &lt;0.0001). There were more male patients on the cardiology services (64%) than the non-cardiology services (52%) (p &lt;0.0001). Unadjusted 30-day readmissions were lower for those admitted to cardiology vs. non-cardiology services (odds ratio 0.82 [95%CI: 0.67, 0.99, p=0.041]). Adjusted 30-day readmissions for those admitted to cardiology vs non-cardiology services were also lower (odds ratio 0.79 [95%CI: 0.65, 0.97, p=0.022). Conclusion: In this institutional electronic health record-based study, 30-day HF readmissions were found to be significantly lower in those admitted to cardiology vs. non-cardiology services. A future study to explore the variables contributing to these outcomes and to validate this data in a larger population is required.

Hydralazine combined with conventional therapy improved outcomes in severe systolic dysfunction and mitral regurgitation.

Patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF) accompanied by significant mitral regurgitation (MR) had poor outcome. Several vasodilator trials showed neutral results. We aimed to investigate the effect of early up-titration of hydralazine combined with conventional treatment in acute HF with severe systolic dysfunction and significant MR. The study was open-labelled, one-to-one ratio randomized designed. Consecutively hospitalized patients with decompensated HF symptoms, LVEF<35%, and MR more than moderate severity were enrolled after exclusion. All participants with inadequate preload should have intake promotion with/without fluid supply. Patients receiving evidence-based medications (EBMs) as conventional treatment served as the control. Hydralazine+conventional treatment group received up-titration of hydralazine at Days 1-5 of the index admission combined with EBMs and throughout the course of follow-up. The endpoints included cardiovascular (CV) death and HF rehospitalization. Totally, 408 patients were enrolled (203 in conventional treatment and 205 in hydralazine+conventional treatment). The mean follow-up period was 3.5years. The mean dose of hydralazine was 191mg at index admission and 264mg at study end in hydralazine+conventional treatment group. Both groups did not significantly differ in prescription rates and dosages of EBMs (all P>0.05) at study end. Side effects did not differ between the two groups. Finally, 51% (104 out of 203 cases) reached endpoints in conventional group and 34.6% (71 out of 205 cases) in hydralazine+conventional treatment group, which had a significant reduction in CV events (hazard ratio 0.613, 95% confidence interval 0.427-0.877, P<0.001). In-hospital death during the index admission was significantly higher in conventional group (5.4% vs. 0.5%, respectively; P=0.001). When administered without inadequate preload, combining early up-titration of hydralazine with EBMs improves outcome in patients with severe systolic dysfunction and significant MR, and it is safe and well tolerated.