scholarly journals BLITZ-HF study: a nationwide initiative to assess and improve guidelines recommendations adherence in cardiology centers managing patients with acute and chronic heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Orso ◽  
A Di Lenarda ◽  
F Oliva ◽  
N Aspromonte ◽  
C Greco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Performance Indicators ◽  
High Performance ◽  
Phase 1 ◽  
Significant Rise ◽  
Prescription Rate ◽  
Private Company ◽  
Phase 3 ◽  
Funding Sources

Abstract Background Physicians adherence to heart failure (HF) guidelines is generally sub-optimal with consequent negative prognostic implications. Strategies to improve adherence to guideline recommendations are strongly needed. Aims To assess and improve adherence of Italian cardiology sites to guidelines recommendations on performance indicators in patients with acute (AHF) and chronic heart failure (CHF). Methods BLITZ-HF was a prospective study based on a web based recording system used during two enrollment periods (phase 1 and 3), interspersed by face-to-face macro-regional benchmark analysis and educational meetings (phase 2). Both management (creatinine and echocardiographic evaluations or discharge follow-up planning) and treatment (according to ejection fraction categories, focusing on guidelines directed medical treatments - GDMTs) performance indicators were considered for patients in both settings. Results Overall, 7218 patients with acute and chronic HF were enrolled at 106 sites. During the enrollment phases, 3920 and 3298 patients were included respectively, 84% with CHF and 16% with AHF in phase 1, 74% with CHF and 26% with AHF in phase 3. In Figure 1 we report adherence to management and treatment indicators in the two enrollment phases. Among AHF patients improvement was obtained in two of seven indicators. A significant rise in echocardiographic evaluation was observed, while discharge schedule of a cardiology ambulatory evaluation within four weeks was overall poor (less than 50%) and did not improve in the 3 phase. Overall GDMTs prescription rate in HFrEF was good and we observed a nominal increase in betablockers prescription rate in Phase 3. Among CHF patients with HFpEF and HFmrEF we observed a performance increase in two of three indicators: creatinine end echocardiographic evaluations, while oral anticoagulation in atrial fibrillation remained stably high. Performance measures in CHF HFrEF patients improved in six of nine indicators although significantly only in two. Prescription rate of GDMTs was good already in phase 1 and a significant increase in ACE-I/ARB or ARNI prescription was reported, with a nominal increase in the use of one of these three drugs in combination with MRAs and a BB. Conclusions A structured multifaceted educational intervention can improve adherence to HF guidelines on several indicators in a context of an already elevated level of adherence to guideline recommendations. Extension of this approach to other non-cardiology health professional settings, in which patients with HF are generally managed, should be considered. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): The study was funded by Heart Care Foundation with a partial unrestricted support from Abbott, Daiichi Sankyo, Medtronic, Servier, Vifor.

scholarly journals Phase 3 DREAM-HF Trial of Mesenchymal Precursor Cells in Chronic Heart Failure

2019 ◽  
Vol 125 (3) ◽  
pp. 265-281 ◽  
Author(s):  
Kenneth M. Borow ◽  
Alex Yaroshinsky ◽  
Barry Greenberg ◽  
Emerson C. Perin
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Precursor Cells ◽  
Phase 3 ◽  
Mesenchymal Precursor Cells ◽  
Mesenchymal Precursor

Emerging Therapies for Acute and Chronic Heart Failure

2016 ◽  
Vol 29 (1) ◽  
pp. 46-57 ◽  
Author(s):  
Sarah Hanigan ◽  
Robert J. DiDomenico
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiovascular Death ◽  
Phase 3 ◽  
Reduced Ejection Fraction ◽  
Emerging Therapies ◽  
Treat Heart Failure ◽  
Novel Drugs ◽  
The Us ◽  
History Of

Although the period from 1953 to 2001 resulted in the approval of more than 30 medications currently used to treat heart failure (HF), few novel drugs have been approved in the last decade. However, the investigational pipeline for HF medications once again appears promising. In patients with chronic heart failure with reduced ejection fraction (HFrEF), ivabradine and valsartan/sucubitril (LCZ696) were recently approved by the US Food and Drug Administration. Both agents have been shown to reduce the risk of cardiovascular death and HF hospitalization. In the treatment of acute HF, serelaxin and ularitide are the farthest along in development. Both agents have demonstrated favorable effects on surrogate end points and preliminary data suggest a possible mortality benefit with serelaxin. Consequently, phase 3 trials are ongoing to evaluate the effect of serelaxin and ularitide on clinical outcomes. Given the poor history of recent investigational acute HF drugs that have advanced to phase 3/4 studies, enthusiasm for both serelaxin and ularitide must be tempered until these trials are completed.

Managing Heart Failure On the Go: Usability Issues with mHealth Apps for Older Adults

2017 ◽  
Vol 61 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Stephanie A. Morey ◽  
Laura H. Barg-Walkow ◽  
Wendy A. Rogers
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Congestive Heart Failure ◽  
Human Factors ◽  
Mobile Apps ◽  
Phase 1 ◽  
Data Entry ◽  
Health Conditions ◽  
Phase 3 ◽  
Mhealth Apps

Mobile apps for self-managing chronic health conditions are widely available for download from online app stores. Mobile health (mHealth) apps provide a convenient way of managing health conditions (e.g., congestive heart failure); however, little is known about their design specifications with respect to older adult users. We conducted a 3-phase assessment of human factors issues for common mHealth apps designed for managing congestive heart failure. In Phase 1, we identified two apps often used by older adults. In Phase 2, we evaluated these apps according to standard human factors principles. In Phase 3, we conducted usability testing of the apps with six older adults. We report design issues identified in the apps that limit usability by older adults. We encourage mHealth app designers to improve usability by: 1) providing easier navigation, 2) streamlining data entry processes, 3) providing clear recovery from errors, and 4) simplifying visualizations of data patterns.

scholarly journals Performance of a multisensory implantable cardioverter-defibrillator algorithm for remote heart failure management: the RE-HEART registry

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
J De Juan Baguda ◽  
M Pachon Iglesias ◽  
J J Gavira Gomez ◽  
V Martinez Mateo ◽  
M F Arcocha Torres ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Implantable Cardioverter Defibrillator ◽  
Phase 1 ◽  
Study Phase ◽  
Phase 2 ◽  
Office Visits ◽  
Phase 3 ◽  
Cardioverter Defibrillator ◽  
Clinical Events

Abstract Background The HeartLogic algorithm measures data from multiple implantable cardioverter-defibrillator-based (ICD) sensors and combines them into a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation. Objective To analyze the association between HeartLogic alerts and clinical events and to describe the implementation in clinical practice of the algorithm for remote management of HF patients. Methods The association between HeartLogic alerts and clinical events has been analyzed in the blinded study Phase 1 (from ICD implantation to HeartLogic alert activation) and in the following unblinded Phase 2 and 3 (after HeartLogic activation). During Phase 1, patients were managed according to the standard clinical practice and physicians were blinded to the alert status. During Phase 2 physicians reacted to alerts according to their clinical practice, while during Phase 3 they followed a standardized protocol in response to alerts. Results We enrolled 288 patients who received HeartLogic-enabled ICD or CRT-D at 15 centers. 101 patients contributed to Phase 1. During a median observation period of 10 [95% CI: 5 – 19] months, the HeartLogic index crossed the alert-threshold value 73 times (0.72 alerts/patient-year) in 39 patients. 8 HF hospitalizations and 2 emergency room admissions occurred in 9 patients (0.10 events/patient-year) during HeartLogic IN alert state. Other 10 minor events (HF in-office visits and non-HF hospitalization) were associated with HeartLogic alerts. During the active phases 267 patients were observed for a median follow-up of 16 [95% CI: 15 – 22] months. 277 HeartLogic alerts (0.89 alerts/patient-year) occurred in 136 patients. Thirty-three HeartLogic alerts were associated with hospitalizations for HF or with HF death (n=6), and 46 alerts were associated with unplanned in-office visits for HF. In 78 cases, HeartLogic alerts were associated with other clinically relevant events. The rate of unexplained alerts was low (0.39 alerts/patient-year). During the active phases, one HF hospitalization and one unplanned in-office visit for HF occurred when patients were in OUT of alert state. Patient phone contacts or in-person assessments were performed more frequently in Phase 3 (85%) than in Phase 2 (73%; p=0.047), while alert-triggered actions were similar in the two phases. Most alerts in both Phases (82% in 2 and 81% in 3; p=0.861) were managed remotely. The total number of patient phone contacts performed during Phase 2 was 35 (0.65 contacts/patient-year) and during Phase 3 was 287 (1.12 contacts/patient-year; p=0.002). Conclusions HeartLogic index was frequently associated with HF-related clinical events, with a low rate of unexplained events. The HeartLogic alert and a standardize protocol of actions allowed to remotely detect impending decompensation events and to implement clinical actions with a low workload for the centers. Funding Acknowledgement Type of funding sources: None.

scholarly journals Clinical course and related costs of patients with diabetes and heart failure and/or chronic kidney disease, drawn from a sample of more than 7 million people

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A.P Maggioni ◽  
C Piccinni ◽  
S Calabria ◽  
L Dondi ◽  
G Ronconi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Metabolic Diseases ◽  
Clinical Epidemiology ◽  
Community Setting ◽  
Private Company ◽  
Funding Sources ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Background Diabetes (T2DM), heart failure (HF) and chronic kidney disease (CKD) are among the leading causes of mortality and hospitalization worldwide. This analysis of the Ricerca e Salute (ReS) database is aimed to describe clinical epidemiology, 2-year outcomes and direct costs of T2DM patients with HF, CKD or both in a community setting. Methods Analyses were performed on the ReS database including 7,365,716 subjects. During 2015, subjects with T2DM were selected and subsequently split in the following mutually exclusive cohorts (Figure): – “healthy” T2DM patients, subjects with T2DM but without coronary artery disease (CAD), HF, stroke, TIAs, peripheral artery disease (PAD) and CKD. – Patients affected by T2DM and HF. – Patients affected by T2DM and CKD. – Patients affected by T2DM and both HF and CKD. Results Table shows the baseline characteristics, hospitalization reasons, and related costs of the 4 cohorts. In the 2-year follow-up, T2DM patients with comorbidities are older, more frequently males, and more often admitted for CV and renal reasons. T2DM patients with both HF and CKD have the worst outcome profile. The cost per patient per year is 5 times more for T2DM patients with both HF and CKD than for those with T2DM without these comorbidities. Conclusions Coexistence of HF and/or CKD in patients with T2DM ia associated with a very high clinical and economical burden. Instead of treating each condition individually, the most appropriate approach should be to adopt a collaborative approach that embraces CV, renal and metabolic diseases. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): This research was partially supported by an unrestricted grant from Astra Zeneca. Astra Zeneca was not involved in data collection, analysis and interpretation, in writing the report, nor in deciding to submit the article for publication.

scholarly journals Narrowing of the neonatal region in the FBN1 gene

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M N Brogger ◽  
G Fernandez Ferro ◽  
I Cardenas Reyes ◽  
J P Ochoa ◽  
S Garcia Hernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Genetic Variants ◽  
Severe Form ◽  
Private Company ◽  
Missense Variants ◽  
Funding Sources ◽  
Fbn1 Gene ◽  
Pathogenic Variants ◽  
Kaplan Meier ◽  
Worse Prognosis

Abstract Background Neonatal Marfan syndrome (MFS) is considered the most severe form of MFS and is characterized by early childhood death due to congestive heart failure. It has been suggested that genetic variants associated with this clinical presentation, cluster in a specific region between exons 24 and 32. It has been reported that patients carrying genetic variants in these exons have worse prognosis. Purpose Our purpose was to analyze cardiovascular outcome by location of the genetic variants in the “neonatal region” of the FBN1 gene. Materials and methods We analyzed clinical data on 1353 carriers and affected relatives with 683 missense pathogenic or likely pathogenic genetic variants of FBN1 gene (including cases identified in our laboratory and cases described in the literature) in whom age at last follow-up was available. Kaplan-Meier survival curves were generated to examine location of the genetic variant in the FBN1 gene in relation to survival free of surgical intervention or cardiovascular (CV) death (composite of deaths related to aortic dissection, heart failure/transplant, sudden, stroke or CV surgery). Missense genetic variants were classified as located in the “neonatal region” (residues 952–1363, corresponding to exons 24–32) and in the “non-neonatal region” (residues 45–951 and 1364–2731). In the “neonatal region”, we have also analyzed a sub-region of “over-representation” of heart failure deaths in the first year of life, which we called “critical neonatal region” (amino acids 1028–1088, corresponding to exon 25 and few residues from exon 26) in comparison to the “non-critical neonatal region”. Results Data were examined on 1060 patients with missense variants located in the “non neonatal region” and on 293 patients with missense variants located in the “neonatal region”. Of these, 96 patients were carriers of missense variants in the “critical neonatal region”, the rest of patients carried variants in the neonatal region, outside this particular domain (“non-critical neonatal region”). Patients carrying missense variants in the neonatal region had worse prognosis than those carrying variants outside this region. This poorer outcome was due to events occurring in patients carrying variants in the “critical neonatal region” (see Figure). These patients had the worse prognosis (p=0.000108, vs. the other groups). Furthermore, events in the non-critical neonatal region were similar to other missense variants located outside the neonatal region. There were no differences in the “neonatal region” when analyzing by gender. Conclusion In our cohort, the worse prognosis seen in patients carrying missense pathogenic or likely pathogenic variants in the “neonatal region” compared to the “non-neonatal region”, was due to events in patients carrying missense variants in a small subregion which we called the “critical-neonatal region” (exons 25 and 26). These patients had the worse prognosis, irrespective of gender. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Health in Code Figure 1. Neonatal region FBN1

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