scholarly journals Differences in medical treatment and clinical characteristics between men and women with heart failure – a single-centre multivariable analysis

2020 ◽  
Vol 76 (4) ◽  
pp. 539-546 ◽  
Author(s):  
Helena Norberg ◽  
Veronica Pranic ◽  
Ellinor Bergdahl ◽  
Krister Lindmark
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Body Weight ◽  
Ejection Fraction ◽  
Associated Factors ◽  
Lower Body ◽  
Reduced Ejection Fraction ◽  
Lower Body Weight

Abstract Purpose The aims of this study were to examine sex differences in a heart failure population with regards to treatment and patient characteristics and to investigate the impact of sex on achieved doses of heart failure medications. Methods and results A total of 1924 patients with heart failure in a regional hospital were analysed, 622 patients had ejection fraction ≤ 40% of which 30% were women. In patients with reduced ejection fraction, women were older (79 ± 11 vs. 74 ± 12 years, P < 0.001), had lower body weight (70 ± 17 vs. 86 ± 18 kg, P < 0.001), lower estimated glomerular filtration rate (eGFR) (49 ± 24 vs. 71 ± 30 ml/min, P < 0.001) and received lower doses of heart failure medications than men. Multivariable linear regression on patients with reduced ejection fraction showed that sex was not associated with achieved dose of any heart failure medication. For angiotensin-converting enzyme inhibitors and angiotensin receptor blockers associated factors were eGFR, systolic blood pressure, age, ejection fraction, and heart rate. For beta-blockers associated factors were body weight, atrial fibrillation and age. For mineralocorticoid receptor antagonists associated factors were eGFR, serum potassium, age, systolic blood pressure, ejection fraction and heart rate. Conclusion Women with heart failure and reduced ejection fraction were prescribed lower doses of heart failure medications, were older, had worse renal function, and lower body weight than men. Sex was not independently associated with achieved doses of heart failure medications, instead age, renal function and body weight explained the differences in treatment.

scholarly journals Telemonitoring in subjects with newly diagnosed heart failure with reduced ejection fraction: From clinical research to everyday practice

2018 ◽  
Vol 25 (3) ◽  
pp. 167-171 ◽  
Author(s):  
G Koulaouzidis ◽  
D Barrett ◽  
K Mohee ◽  
AL Clark
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Electronic Devices ◽  
Newly Diagnosed ◽  
Online Database ◽  
Reduced Ejection Fraction ◽  
Real World Setting

Introduction Heart failure is increasingly common, and characterised by frequent admissions to hospital. To try and reduce the risk of hospitalisation, techniques such as telemonitoring (TM) may have a role. We wanted to determine if TM in patients with newly diagnosed heart failure and ejection fraction <40% reduces the risk of readmission or death from any cause in a ‘real-world’ setting. Methods This is a retrospective study of 124 patients (78.2% male; 68.6 ± 12.6 years) who underwent TM and 345 patients (68.5% male; 70.2 ± 10.7 years) who underwent the usual care (UC). The TM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. Follow-up was 12 months. Results Death from any cause occurred in 8.1% of the TM group and 19% of the UC group ( p = 0.002). There was no difference between the two groups in all-cause hospitalisation, either in the number of subjects hospitalised ( p = 0.7) or in the number of admissions per patient ( p = 0.6). There was no difference in the number of heart-failure-related readmissions per person between the two groups ( p = 0.5), but the number of days in hospital per person was higher in the UC group ( p = 0.03). Also, there were a significantly greater number of days alive and out of hospital for the patients in the TM group compared with the UC group ( p = 0.0001). Discussion TM is associated with lower any-cause mortality and also has the potential to reduce the number of days lost to hospitalisation and death.

scholarly journals Association of Blood Pressure and Heart Rate Responses to Submaximal Exercise With Incident Heart Failure: The Framingham Heart Study

2021 ◽  
Author(s):  
Herman A. Carneiro ◽  
Rebecca J. Song ◽  
Joowon Lee ◽  
Brian Schwartz ◽  
Ramachandran S. Vasan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Pulse Pressure ◽  
Framingham Heart Study ◽  
Submaximal Exercise ◽  
Exercise Stress ◽  
Reduced Ejection Fraction ◽  
Heart Study

Background Exercise stress tests are conventionally performed to assess risk of coronary artery disease. Using the FHS (Framingham Heart Study) Offspring cohort, we related blood pressure (BP) and heart rate responses during and after submaximal exercise to the incidence of heart failure (HF). Methods and Results We evaluated Framingham Offspring Study participants (n=2066; mean age, 58 years; 53% women) who completed 2 stages of an exercise test (Bruce protocol) at their seventh examination (1998–2002). We measured pulse pressure, systolic BP, diastolic BP, and heart rate responses during stage 2 exercise (2.5 mph at 12% grade). We calculated the changes in systolic BP, diastolic BP, and heart rate from stage 2 to recovery 3 minutes after exercise. We used Cox proportional hazards regression to relate each standardized exercise variable (during stage 2, and at 3 minutes of recovery) individually to HF incidence, adjusting for standard risk factors. On follow‐up (median, 16.8 years), 85 participants developed new‐onset HF. Higher exercise diastolic BP was associated with higher HF with reduced ejection fraction (ejection fraction <50%) risk (hazard ratio [HR] per SD increment, 1.26; 95% CI, 1.01–1.59). Lower stage 2 pulse pressure and rapid postexercise recovery of heart rate and systolic BP were associated with higher HF with reduced ejection fraction risk (HR per SD increment, 0.73 [95% CI, 0.57–0.94]; 0.52 [95% CI, 0.35–0.76]; and 0.63 [95% CI, 0.47–0.84], respectively). BP and heart rate responses to submaximal exercise were not associated with risk of HF with preserved ejection fraction (ejection fraction ≥50%). Conclusions Accentuated diastolic BP during exercise with slower systolic BP and heart rate recovery after exercise are markers of HF with reduced ejection fraction risk.

scholarly journals Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Kavita Sharma ◽  
Yejin Mok ◽  
Lucia Kwak ◽  
Sunil K. Agarwal ◽  
Patricia P. Chang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Ejection Fraction ◽  
Surveillance Study ◽  
Preserved Ejection Fraction ◽  
Predictors Of Mortality ◽  
Worsening Renal Function ◽  
Increased Risk

Background Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all‐cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. Methods and Results Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1‐year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [ P =0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [ P =0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. Conclusions In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex‐ and race‐based differences in predictors of mortality may help strategize targeted management of HFpEF.

scholarly journals Acute Hemodynamic Effects and Tolerability of Phosphodiesterase-1 Inhibition With ITI-214 in Human Systolic Heart Failure

2021 ◽  
Author(s):  
Nisha A. Gilotra ◽  
Adam D. DeVore ◽  
Thomas J. Povsic ◽  
Allison G. Hays ◽  
Virginia S. Hahn ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Single Dose ◽  
Adverse Events ◽  
Ejection Fraction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Guanosine Monophosphate ◽  
Reduced Ejection Fraction

Background: PDE1 (phosphodiesterase type 1) hydrolyzes cyclic adenosine and guanosine monophosphate. ITI-214 is a highly selective PDE1 inhibitor that induces arterial vasodilation and positive inotropy in larger mammals. Here, we assessed pharmacokinetics, hemodynamics, and tolerability of single-dose ITI-214 in humans with stable heart failure with reduced ejection fraction. Methods: Patients with heart failure with reduced ejection fraction were randomized 3:1 to 10, 30, or 90 mg ITI-214 single oral dose or placebo (n=9/group). Vital signs and electrocardiography were monitored predose to 5 hours postdose and transthoracic echoDoppler cardiography predose and 2-hours postdose. Results: Patient age averaged 54 years; 42% female, and 60% Black. Mean systolic blood pressure decreased 3 to 8 mm Hg ( P <0.001) and heart rate increased 5 to 9 bpm ( P ≤0.001 for 10, 30 mg doses, RM-ANCOVA). After 4 hours, neither blood pressure or heart rate significantly differed among cohorts (supine or standing). ITI-214 increased mean left ventricular power index, a relatively load-insensitive inotropic index, by 0.143 Watts/mL 2 ·10 4 ( P =0.03, a +41% rise; 5–71 CI) and cardiac output by 0.83 L/min ( P =0.002, +31%, 13–49 CI) both at the 30 mg dose. Systemic vascular resistance declined with 30 mg (–564 dynes·s/cm– 5 , P <0.001) and 90 mg (–370, P =0.016). Diastolic changes were minimal, and no parameters were significantly altered with placebo. ITI-214 was well-tolerated. Five patients had mild-moderate hypotension or orthostatic hypotension recorded adverse events. There were no significant changes in arrhythmia outcome and no serious adverse events. Conclusions: Single-dose ITI-214 is well-tolerated and confers inodilator effects in humans with heart failure with reduced ejection fraction. Further investigations of its therapeutic utility are warranted. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03387215.

scholarly journals Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cze-Ci Chan ◽  
Kuang-Tso Lee ◽  
Wan-Jing Ho ◽  
Yi-Hsin Chan ◽  
Pao-Hsien Chu
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Cardiac Care ◽  
Chang Gung Memorial Hospital ◽  
Research Database ◽  
Cohort Entry ◽  
Reduced Ejection Fraction ◽  
Abnormal Renal Function

Abstract Background Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan. Methods We performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date. Results There were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 or on dialysis. The results were consistent before and after propensity score matching. Conclusions Levosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m2 was not necessarily considered a contraindication for levosimendan in these patients.

scholarly journals Heart rate reduction and exercise performance in recent onset heart failure with reduced ejection fraction: arguments for beta-blocker hypo-response

2015 ◽  
Vol 70 (5) ◽  
pp. 565-572
Author(s):  
Frederik H. Verbrugge ◽  
Jeroen Vrijsen ◽  
Jan Vercammen ◽  
Lars Grieten ◽  
Matthias Dupont ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Exercise Performance ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Reduced Ejection Fraction ◽  
Recent Onset

Abstract 15566: Autonomic Modulation by Cardiopulmonary Rehabilitation in Heart Failure With Reduced Ejection Fraction: Who Benefits?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Catherine F Notarius ◽  
Daniel A Keir ◽  
Mark B Badrov ◽  
Philip J Millar ◽  
Paul Oh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Perceived Exertion ◽  
Group Interaction ◽  
Moderate Intensity ◽  
Autonomic Modulation ◽  
Reduced Ejection Fraction ◽  
Leg Cycling

Introduction: Elevated muscle sympathetic nerve activity (MSNA) both at rest and during dynamic cycling relates inversely to peak oxygen uptake (VO 2peak ) in patients with heart failure due to a reduced ejection fraction (HFrEF). We observed a drop in MSNA both rest (-6±2 bursts/min) and mild exercise (-4±2) in HFrEF patients after 6 months of cardiac rehabilitation. Hypothesis: We hypothesized that after training those HFrEF patients with LOW VO2peak (less than median 74% of age predicted) would have a larger decrease in MSNA during dynamic exercise than those with HIGH VO2peak (over 74%). Methods: In 21 optimally treated HFrEF patients (5 Female) (13 HIGH: mean VO 2peak =26 ml·kg/min; 98% of predicted; 8 LOW VO 2peak =12; 50%) we assessed VO 2peak (open-circuit spirometry), heart rate variability (HRV) and fibular MSNA (microneurography) at rest, during 1-leg cycling (2 min each of mild and moderate intensity upright 1-leg cycling, n=19) and recovery before and after 6 months of exercise training (45 min aerobic exercise, 5 days/ wk at 60-70 % of VO 2peak; and resistance training 2 days/wk). Results: HIGH and LOW groups had similar age (63±3 vs 63±4 years) , LVEF (30±2 vs 28±3%), BMI, resting heart rate (HR), blood pressure and MSNA (52±3 vs 50±3 bursts/min). Training increased VO 2peak in both groups (main effect P=0.009), with no group difference in HR response or ratings of perceived exertion. MSNA at rest tended to decrease after training in the HIGH but not LOW group (interaction P=0.08). MSNA during cycling increased in both HIGH (P=0.04) and LOW (P<0.001) groups but was blunted post-training in the HIGH group only (P=0.04 vs. 0.90 in LOW). Training-induced sympatho-inhibition during exercise recovery occurred in the HIGH but not LOW group (interaction P=0.01). In contrast, HRV was not improved by training in either group. Conclusions: Contrary to our hypothesis, the sympatho-inhibitory effect of 6 months of exercise-based cardiac rehabilitation favours HFrEF patients with an already normal VO 2peak . This suggests that increasing initially low VO 2peak may be insufficient to trigger beneficial exercise and recovery autonomic modulation and altered training paradigms may be required in such patients. Funded by Canadian Institutes for Health Research (CIHR)

scholarly journals Целевой уровень артериального давления при лечении артериальной гипертензии у пациентов пожилого возраста с хронической сердечной недостаточностью

2019 ◽  
pp. 8-16
Author(s):  
M.S. CHERNIAEVA ◽  
O.D. OSTROUMOVA
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Target Blood Pressure ◽  
Lower Systolic Blood Pressure ◽  
Reduced Ejection Fraction ◽  
Increased Risk

Высокая распространенность хронической сердечной недостаточности (ХСН) в популяции пожилых пациентов наряду с устойчивым ро- стом численности пожилого населения как в России, так и в западных странах все больше привлекает внимание врачей к проблеме, связан- ной с ведением данного заболевания. Известно, что ведущим фактором риска развития ХСН является повышенное артериальное давление (АД) и большинство пациентов с ХСН имеют в анамнезе артериальную гипертонию (АГ), поэтому лечение пациентов пожилого возраста c АГ и ХСН является одним из важных направлений в профилактике прогрессирования ХСН, снижения количества госпитализаций и смерт- ности. Лечение АГ у пожилых имеет свои особенности, связанные с функциональным статусом пациентов и их способностью переносить лечение. В европейских рекомендациях (2018) пересмотрены целевые цифры АД при лечении АГ у пожилых, однако данные по целевым цифрам АД для лечения АГ у пациентов с ХСН опираются лишь на исследования, проводившиеся у больных без ХСН. Данные об оптималь- ном целевом уровне у пациентов с АГ и ХСН представлены в единичных исследованиях. В настоящей статье проанализирована взаимосвязь уровня АД и сердечно-сосудистых событий и смертности отдельно для пациентов с АГ и сердечной недостаточностью с низкой фракцией выброса левого желудочка и с сохраненной фракцией выброса левого желудочка. Результаты многих исследований показывают, что более низкий уровень систолического АД (120 мм рт. ст.) и диастолического АД (80 мм рт. ст.) ассоциирован с развитием неблагоприятных сердечно-сосудистых событий, особенно у пациентов с сердечной недостаточностью с низкой фракцией выброса левого желудочка.The high prevalence of chronic heart failure (CHF) in the elderly patients, along with the steady growth of the elderly population, both in Russia and in Western countries, is increasingly attracting the attention of doctors to the problem associated with the management of this disease. It is known that the leading risk factor for CHF is high blood pressure (BP) and most patients with CHF have a history of hypertension (H), so the treatment of elderly patients with H and CHF is the major focus in the slowing CHF progression, reducing the heart failure hospitalisation and mortality. Treatment of hypertension in the elderly has some specific features associated with the functional status of patients and their ability to tolerate treatment. The European recommendations (2018) revised target blood pressure levels in the elderly patients, however, data on target blood pressure levels in patients with CHF are based only on studies conducted in patients without CHF, data on the optimal target blood pressure levels in patients with hypertension and CHF are presented in single studies. In this article we analyze the relationship between blood pressure levels and cardiovascular events and mortality separately for patients with hypertension and heart failure with reduced ejection fraction and with preserved ejection fraction. Several studies show that lower systolic blood pressure (120 mm Hg) and diastolic blood pressure (80 mm Hg) is associated with the increased risk of cardiovascular events, especially in patients with heart failure with reduced ejection fraction.

Sign in / Sign up

Export Citation Format

Share Document