Ivabradine

2015 ◽  
Vol 21 (4) ◽  
pp. 335-343 ◽  
Author(s):  
Rahul Chaudhary ◽  
Jalaj Garg ◽  
Parasuram Krishnamoorthy ◽  
Neeraj Shah ◽  
Gregg Lanier ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Rate ◽  
Systolic Heart Failure ◽  
Negative Inotropic Effect ◽  
Heart Association ◽  
The United States ◽  
High Rate ◽  
Inappropriate Sinus Tachycardia ◽  
Reduced Ejection Fraction

Heart failure affects over 5 million people in the United States and carries a high rate of mortality. Ivabradine, a new agent has been added to the current medical options for managing heart failure. It is a selective funny current ( If) inhibitor in sinoatrial node and slows its firing rate, prolonging diastolic depolarization without a negative inotropic effect. Ivabradine was only recently approved by Food and Drug administration after the results of Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) trial, for a reduction in rehospitalizations from chronic heart failure. This trial assessed patients with stable heart failure with reduced ejection fraction and a heart rate of at least 70 beats per minute at rest on maximally tolerated beta-blocker therapy and demonstrated statistically significant reduction in heart failure hospitalization and deaths. Additionally, ivabradine has been associated with reduced cardiac remodeling, reduced heart rate variability, improvement in exercise tolerance, improved heart failure class of New York Heart Association, and better quality of life. It has also been tried in other conditions, such as inappropriate sinus tachycardia and cardiogenic shock, and is currently in phase II trial for patients with newly diagnosed multiple organ dysfunction syndrome.

scholarly journals Does Platelet and Inflammatory Readings Differ Between Chronic Heart Failure Patients‘ Groups According to NYHA Functional Classes?

2019 ◽  
Vol 2 (4) ◽  
pp. e00111
Author(s):  
Aušra Mongirdienė ◽  
Jolanta Laukaitienė ◽  
Vilius Skipskis
Keyword(s):  
Heart Failure ◽  
New York ◽  
Platelet Aggregation ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
Fibrinogen Concentration ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients

It is stated in the literature that thrombosis in the chronic heart failure (CHF) patients may be caused by interaction of inflammation and platelets. The incidence of venous thromboembolism in heart failure patients is found to be the highest in the patients classified as NYHA IV. We aimed to test the hypothesis that prothrombotic state depends on inflammation. We have compared the C-reactive protein (CRP), fibrinogen concentration, platelet count (PLT), mean platelet volume (MPV) and platelet aggregation in CHF patients’ groups according to New York Heart Association (NYHA). 203 patients with CHF with reduced ejection fraction (systolic heart failure classes I‒IV according to NYHA) were included in the study. There were no statistically significant differences in fibrinogen concentration, CRP, PLT and platelet aggregation between the groups according to NYHA. The MPV was statistically significant higher in NYHA IV group than in NYHA III, NYHA II and NYHA I groups (10.86 ± 1.14 and 9.78 ± 1.21 and 9.65 ± 1.22 and 9.21 ± 0.59 respectively, p = 0.006). There was a weak correlation between CRP and PLT (r = 0.293, p = 0.010), and between MPV and fibrinogen concentration (r=0.205, p=0.012). There was a moderate correlation between MPV and NYHA (r = 0.361, p < 0.001) and between fibrinogen concentration and CRP (r = 0.381, p < 0.001). MPV rising in the patients’ groups and correlation between MPV and NYHA class, and plasma fibrinogen concentration, correlation between PLT and CRP, correlation between CRP and NT-proBNP concentration confirm, that low inflammation can take place in the MPV rising.

scholarly journals Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

2019 ◽  
Vol 28 (1) ◽  
pp. 3-13 ◽  
Author(s):  
J. F. Veenis ◽  
J. J. Brugts
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Heart Association ◽  
The United States ◽  
Pharmacological Therapy ◽  
Functional Class ◽  
Class Iii ◽  
Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

Abstract 17470: Racial Disparities in Goal Directed Medical Therapy in Patients With Systolic Heart Failure- A Single Center Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ayesha Azmeen ◽  
Naga Vaishnavi Gadela ◽  
Vergara Cunegundo
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Racial Disparities ◽  
Beta Blockers ◽  
Systolic Heart Failure ◽  
The United States ◽  
Clinical Syndrome ◽  
Single Center ◽  
Geographic Variations ◽  
Reduced Ejection Fraction

Introduction: Heart failure(HF) is a clinical syndrome that is widely prevalent affecting approximately 6.5 million people in the United States. It accounts for the ever-rising health care costs in the US due to recurrent hospitalizations. Despite advancements in medical management, the mortality and the rate of hospitalizations continues to be high with geographic variations and racial disparities. Through this descriptive study, we sought to analyze the health disparities among Hispanic, African American (AA) and Caucasian population in a single-center. Methods: We identified a total of 178 patients with HF with reduced ejection fraction from our outpatient clinic by utilizing the ICD-10 codes. Patients with ejection fraction >50% have been excluded. A retrospective chart review of their ethnic background, medications, and number of heart failure exacerbations per year has been performed. Results: 178 patients (mean age 62 years, 35.56% of females) including Hispanics (n=102), AA(n=44), and Caucasians (n=32) were included in the study. Although all patients were started on Beta-blockers, only 76.4% and 37.2% of Hispanics were started on ACEi/ARBs and spironolactone respectively. Similarly, 72.7% and 45.4% of AA were started on ACEi/ARBs and spironolactone respectively. This is in contrast to Caucasians population, where a majority of patients were on started on GDMT; 90% and 75% were started on ACEi/ARBs and spironolactone respectively. This was also reflected by the number of admissions due to HF exacerbations which ranged from 2-4/year for Hispanics and AA populations and 0-1/year for Caucasians. Conclusions: GDMT for HF is known to reduce heart failure exacerbations, mortality and the ever rising cost of the healthcare system. We have observed that despite recommendations to initiate GDMT in all patients with HF with reduced ejection fraction, racial disparities exist. Physicians should be mindful of initiating GDMT in all patients.

Abstract 216: Left Ventricular Enlargement and Heart Failure Events: Is Bigger Better?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Farbod Raiszadeh ◽  
Neeraja Yedlapati ◽  
Ileana L Piña ◽  
Daniel M Spevack
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cox Regression ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Volumes ◽  
End Diastolic Volume ◽  
New York Heart Association ◽  
The Individual

Background: Since stroke volume (SV) is a function of ejection fraction (EF) and end-diastolic volume (EDV) (SV = EF x EDV), we hypothesized that increased EDV may be advantageous in systolic heart failure (HF), allowing the left ventricle to supply increased cardiac output. Methods: Echocardiograms from 968 consecutive patients seen in our hospital’s HF clinic were reviewed. Left ventricular volumes were measured both at end systole and end diastole using the bi-plane Simpson’s method and were indexed to body surface area. EF was calculated using (EDV-ESV)/EDV. Dates of subsequent HF events (death or admission for HF exacerbation) were obtained from our database. Results: Systolic HF (EF < 50%) was found in 649 of the study subjects. Increased SV index was associated with increased EDV index. The strength of this association varied with EF, Figure. In a bivariate Cox regression model, lower SV index and higher EDV index were each independent predictors of HF events. Increase in EDV by 50 cc was associated with a 20% increase in HF events, p<0.001. Decrease in SVI by 5 cc was associated with 5% increase in HF events, p<0.001. These associations were limited to those with systolic HF. The associations between both EDVI and SVI and HF events were not confounded by patient age, sex and New York Heart Association Class. Conclusion: Increased EDV index was independently associated with increased HF events, indicating that LV enlargement in HF is not favorable. These findings underscore the individual contributions of the components of EF (SV and EDV) in predicting HF outcomes.

Abstract 16124: Implantable Cardioverter Defibrillators in Patients With Hereditary Transthyretin Cardiac Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sreeram Yalamanchili ◽  
Matthew T Brown ◽  
Evan A Blank ◽  
Melissa A Lyle ◽  
Kunal N Bhatt
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Cardiac Amyloidosis ◽  
Clinical Decision Making ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
High Rate ◽  
Implantable Cardioverter Defibrillators ◽  
Antitachycardia Pacing ◽  
Icd Implantation

Introduction: Implantable cardioverter defibrillator (ICD) implantation in patients with cardiac amyloidosis is controversial, with no clear guidelines for clinical decision-making.. The role of ICD implantation in hereditary Transthyretin Amyloid Cardiomyopathy (hATTR-CM) is unclear. We sought to establish the burden of ventricular arrhythmias and the outcomes of ICD implantation in a single center cohort of hATTR-CM patients. Methods: A total of 69 patients with a confirmed diagnosis of hATTR-CM from genetic testing, and technetium pyrophosphate (PYP) scanning, or endomyocardial biopsy underwent retrospective chart review for demographic, clinical, and arrhythmia data. Results: Seventy-four percent of the cohort was male, with a mean age at diagnosis of 68 (SD=18 years). Sixty-five patients (94.2%) patients were African-American; all of whom carried the Valine 122 Isoleucine mutation. Most had systolic heart failure (New York Heart Association Staging II [18, 26%] and III [40, 58.8%]); 37 (54%) patients had an LVEF ≤ 35%. Thirty-six (52.2%) patients had documented episodes of non-sustained ventricular tachycardia (NSVT), three (4.3%) with ventricular tachycardia (VT), and one (1.5%) with ventricular fibrillation (VF). A total of 15 (21.7%) patients had ICDs placed for prevention of sudden cardiac death in the setting of low LVEF (EF <35%). All recorded VT/VF episodes occurred in three patients with ICDs. Of these patients, one experienced two episodes of VT each successfully abated by antitachycardia pacing (ATP), another experienced a single episode of VT abated by ATP, while the final experienced VF with successful 36J shock as well as two episodes of VT each successfully treated with 36J shocks. No inappropriate ICD shocks were delivered, however, there were two instances of ATP for inappropriately detected atrial arrhythmias. Conclusions: In a cohort of patients with hATTR-CM, we observed a high incidence of NSVT, yet only 41% of patients with severe systolic heart failure had ICDs implanted. A high rate of successful defibrillation and no inappropriate ICD shocks were noted, suggesting that ICDs should be strongly considered, and may be underutilized, in patients with systolic heart failure and/or arrhythmias in the setting of hATTR-CM.

Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model

2017 ◽  
Vol 17 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Thomas Müller-Tasch ◽  
Bernd Löwe ◽  
Nicole Lossnitzer ◽  
Lutz Frankenstein ◽  
Tobias Täger ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Anxiety Disorder ◽  
Sex Education ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Self Care ◽  
Heart Association ◽  
Depression Score ◽  
Negatively Associated

Background: While comprehensive evidence exists regarding negative effects of depression on self-care behaviours in patients with chronic heart failure (CHF), the relation between anxiety and self-care behaviours in patients with CHF is not clear. The aim of this study was to analyse the interactions between anxiety, depression and self-care behaviours in patients with CHF. Methods: The self-care behaviour of CHF outpatients was measured using the European Heart Failure Self-care Behaviour Scale (EHFScBS). The Patient Health Questionnaire (PHQ) was used to assess anxiety, the PHQ-9 was used to measure depression severity. Differences between patients with and without anxiety were assessed with the respective tests. Associations between anxiety, self-care and other predictors were analysed using linear regressions. Results: Of the 308 participating patients, 35 (11.4%) fulfilled the PHQ criteria for an anxiety disorder. These patients took antidepressants more frequently (11.8% versus 2.3%, p = .02), had had more contacts with their general practitioner within the last year (11.8 ± 16.1 versus 6.7 ± 8.6, p = .02), and had a higher PHQ-9 depression score (12.9 ± 5.7 versus 6.5 ± 4.7, p < .01) than patients without anxiety disorder. Anxiety and self-care were negatively associated (ß = −0.144, r2 = 0.021, p = 0.015). The explanation of variance was augmented in a multivariate regression with the predictors age, sex, education, living with a partner, and New York Heart Association (NYHA) class ( r2 = 0.098) when anxiety was added ( r2 = 0.112). Depression further increased the explanation of variance (ß = −0.161, r2 = 0.131, p = 0.019). Conclusions: Anxiety is negatively associated with self-care behaviour in patients with CHF. However, this effect disappears behind the stronger influence of depression on self-care. The consideration of mental comorbidities in patients with CHF is important.

scholarly journals Effects of Exercise Training on Autonomic Function in Chronic Heart Failure: Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Chung-Yin Hsu ◽  
Ping-Lun Hsieh ◽  
Shu-Fang Hsiao ◽  
Meng-Yueh Chien
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Rate ◽  
Chronic Heart Failure ◽  
Exercise Training ◽  
Heart Rate Recovery ◽  
Low Frequency ◽  
Heart Association ◽  
Functional Class ◽  
Positive Effects

Objectives. Cardiac autonomic imbalance accompanies the progression of chronic heart failure (CHF). It is unclear whether exercise training could modulate autonomic control in CHF. This study aimed to review systematically the effects of exercise training on heart rate recovery (HRR) and heart rate variability (HRV) in patients with CHF.Methods. Literatures were systematically searched in electronic databases and relevant references. Only published randomized controlled trials (RCTs) focusing on exercise training for CHF were eligible for inclusion. Outcome measurements included HRR and HRV parameters.Results. Eight RCTs were eligible for inclusion and provided data on 280 participants (186 men). The participants were 52–70 years of age with New York Heart Association functional class II-III of CHF. Each study examined either aerobic or resistance exercise. Two trials addressed outcome of HRR and six HRV among these studies. Two RCTs showed that moderate aerobic exercise could improve HRR at 2 minutes after exercise training in CHF. Five of six RCTs demonstrated positive effects of exercise training on HRV which revealed the increments in high frequency (HF) and decrements in LF (low frequency)/HF ratio after training.Conclusion. Participation in an exercise training program has positive effects on cardiac autonomic balance in patients with CHF.

Plasma urocortin in human systolic heart failure

2004 ◽  
Vol 106 (4) ◽  
pp. 383-388 ◽  
Author(s):  
Leong L. NG ◽  
Ian W. LOKE ◽  
Russell J. O'BRIEN ◽  
Iain B. SQUIRE ◽  
Joan E. DAVIES
Keyword(s):  
Heart Failure ◽  
New York ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Area Under The Curve ◽  
Logistic Models ◽  
Heart Association ◽  
Roc Curves ◽  
Relative Increase ◽  
And Gender

Urocortin (UCN), a member of the corticotrophin-releasing factor family, is expressed in heart, brain and gut. UCN has potent cardiostimulatory, cardioprotective, vasodilator and diuretic/natriuretic effects, and cardiac UCN expression is increased in heart failure (HF). In the present study, we investigated plasma levels of UCN in 119 patients with HF and 212 age- and gender-matched controls to clarify its relationship with gender and disease severity. UCN was elevated in HF [normal males, 19.5 (3.9–68.8) pmol/l and HF males, 50.2 (6.9–108.2) pmol/l, P<0.0005; normal females, 14.2 (3.9–53.5) pmol/l and HF females, 21.8 (3.9–112.5) pmol/l, P<0.001; values are medians (range)]. The relative increase was greater in males than females (P<0.03). UCN fell with increasing age, especially in HF patients (rs=-0.56, P<0.0005) and with increasing New York Heart Association (NYHA) class (rs=-0.55, P<0.0005). The fall in UCN levels with increasing NYHA class was reinforced by a significant correlation between UCN and ejection fraction (rs=0.45, P<0.0005) in HF patients. Although receiver operating characteristic (ROC) curves for diagnosis of all HF cases yielded an area under the curve (AUC) of 0.76, ROC AUCs for patients with early HF (NYHA class I and II) were better (0.91). ROC AUCs for logistic models incorporating N-terminal probrain natriuretic peptide (N-BNP) and UCN were better than either peptide alone. In conclusion, plasma UCN is elevated in HF, especially in its early stages. Its decline with increasing HF severity may expedite disease progression due to diminished cardioprotective/anti-inflammatory effects. UCN measurement may also complement N-BNP in the diagnosis of early HF.

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