scholarly journals Levosimendan Plus Dobutamine in Acute Decompensated Heart Failure Refractory to Dobutamine

2020 ◽  
Vol 9 (11) ◽  
pp. 3605
Author(s):  
William Juguet ◽  
Damien Fard ◽  
Laureline Faivre ◽  
Athanasios Koutsoukis ◽  
Camille Deguillard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Superior Vena ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Circulatory Support ◽  
Low Cardiac Output ◽  
Major Cardiovascular Events ◽  
Single Center Study

Randomized studies showed that Dobutamine and Levosimendan have similar impact on outcome but their combination has never been assessed in acute decompensated heart failure (ADHF) with low cardiac output. This is a retrospective, single-center study that included 89 patients (61 ± 15 years) admitted for ADHF requiring inotropic support. The first group consisted of patients treated with dobutamine alone (n = 42). In the second group, levosimendan was administered on top of dobutamine, when the superior vena cava oxygen saturation (ScVO2) remained <60% after 3 days of dobutamine treatment (n = 47). The primary outcome was the occurrence of major cardiovascular events (MACE) at 6 months, defined as all cause death, heart transplantation or need for mechanical circulatory support. Baseline clinical characteristics were similar in both groups. At day-3, the ScVO2 target (>60%) was reached in 36% and 32% of patients in the dobutamine and dobutamine-levosimendan group, respectively. After adding levosimendan, 72% of the dobutamine-levosimendan-group reached the ScVO2 target value at dobutamine weaning. At six months, 42 (47%) patients experienced MACE (n = 29 for death). MACE was less frequent in the dobutamine-levosimendan (32%) than in the dobutamine-group (64%, p = 0.003). Independent variables associated with outcome were admission systolic blood pressure and dobutamine-levosimendan strategy (OR = 0.44 (0.23–0.84), p = 0.01). In conclusion, levosimendan added to dobutamine may improve the outcome of ADHF refractory to dobutamine alone.

scholarly journals Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): Observational and Retrospective Study (Preprint)

2018 ◽  
Author(s):  
Behnam Tehrani ◽  
Alexander Truesdell ◽  
Ramesh Singh ◽  
Charles Murphy ◽  
Patricia Saulino
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Survival Rates ◽  
Decompensated Heart Failure ◽  
Circulatory Support

BACKGROUND The development and implementation of a Cardiogenic Shock initiative focused on increased disease awareness, early multidisciplinary team activation, rapid initiation of mechanical circulatory support, and hemodynamic-guided management and improvement of outcomes in cardiogenic shock. OBJECTIVE The objectives of this study are (1) to collect retrospective clinical outcomes for acute decompensated heart failure cardiogenic shock and acute myocardial infarction cardiogenic shock, and compare current versus historical survival rates and clinical outcomes; (2) to evaluate Inova Heart and Vascular Institute site specific outcomes before and after initiation of the Cardiogenic Shock team on January 1, 2017; (3) to compare outcomes related to early implementation of mechanical circulatory support and hemodynamic-guided management versus historical controls; (4) to assess survival to discharge rate in patients receiving intervention from the designated shock team and (5) create a clinical archive of Cardiogenic Shock patient characteristics for future analysis and the support of translational research studies. METHODS This is an observational, retrospective, single center study. Retrospective and prospective data will be collected in patients treated at the Inova Heart and Vascular Institute with documented cardiogenic shock as a result of acute decompensated heart failure or acute myocardial infarction. This registry will include data from patients prior to and after the initiation of the multidisciplinary Cardiogenic Shock team on January 1, 2017. Clinical outcomes associated with early multidisciplinary team intervention will be analyzed. In the study group, all patients evaluated for documented cardiogenic shock (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) treated at the Inova Heart and Vascular Institute by the Cardiogenic Shock team will be included. An additional historical Inova Heart and Vascular Institute control group will be analyzed as a comparator. Means with standard deviations will be reported for outcomes. For categorical variables, frequencies and percentages will be presented. For continuous variables, the number of subjects, mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum will be reported. Reported differences will include standard errors and 95% CI. RESULTS Preliminary data analysis for the year 2017 has been completed. Compared to a baseline 2016 survival rate of 47.0%, from 2017 to 2018, CS survival rates were increased to 57.9% (58/110) and 81.3% (81/140), respectively (P=.01 for both). Study data will continue to be collected until December 31, 2018. CONCLUSIONS The preliminary results of this study demonstrate that the INOVA SHOCK team approach to the treatment of Cardiogenic Shock with early team activation, rapid initiation of mechanical circulatory support, hemodynamic-guided management, and strict protocol adherence is associated with superior clinical outcomes: survival to discharge and overall survival when compared to 2015 and 2016 outcomes prior to Shock team initiation. What may limit the generalization of these results of this study to other populations are site specific; expertise of the team, strict algorithm adherence based on the INOVA SHOCK protocol, and staff commitment to timely team activation. Retrospective clinical outcomes (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) demonstrated an increase in current survival rates when compared to pre-Cardiogenic Shock team initiation, rapid team activation and diagnosis and timely utilization of mechanical circulatory support. CLINICALTRIAL ClinicalTrials.gov NCT03378739; https://clinicaltrials.gov/ct2/show/NCT03378739 (Archived by WebCite at http://www.webcitation.org/701vstDGd)

scholarly journals Inotropes Are Linked to Increased Mortality in Heart Failure

2015 ◽  
Author(s):  
M Chadi Alraies ◽  
Bill Tran ◽  
Sirtaz Adatya
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Supplemental Oxygen ◽  
Circulatory Support ◽  
Organ Perfusion ◽  
The Usa ◽  
End Stage

With the advancement of technology and availability of mechanical circulatory support (MCS) devices for the treatment of acute decompensated systolic HF in the 21st century, the role of inotropes is becoming obsolete. Medical therapy for acute decompensated heart failure (HF) has not changed since 1960’s, we still use supplemental oxygen, diuretics, vasodilators and inotropes to improve congestion, cardiac output, end organ perfusion and symptoms related to elevate filling pressures1 . Despite demonstrated improvements in hemodynamics, the uses of inotropes have not demonstrated any improvements in mortality. Mechanical circulatory support (MCS) use is growing rapidly in the USA, in patients with stage D HF both as destination therapy and as a bridge to cardiac transplantation. In both, transplant-eligible and non-transplant-eligible patients, improvement in end-organ perfusion, functional capacity, quality of life and most importantly mortality have been demonstrated. In this perspective paper we are going to discuss the current lack of evidence for inotropic therapy and the evolving benefit of MCS in end-stage systolic HF patients.

scholarly journals The Effect of a Personalized Approach to Patient Education on Heart Failure Self-Management

2018 ◽  
Vol 8 (4) ◽  
pp. 39 ◽  
Author(s):  
Muhammad W. Athar ◽  
Janet D. Record ◽  
Carol Martire ◽  
David B. Hellmann ◽  
Roy C. Ziegelstein
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Vena Cava ◽  
Ultrasound Image ◽  
Decompensated Heart Failure ◽  
Low Sodium Diet ◽  
Adherence Scale ◽  
Personalized Approach ◽  
Personalized Health Care ◽  
To Receive

: Personalized tools relevant to an individual patient’s unique characteristics may be an important component of personalized health care. We randomized 97 patients hospitalized with acute decompensated heart failure to receive a printout of an ultrasound image of their inferior vena cava (IVC) with an explanation of how the image is related to their fluid status (n = 50) or to receive no image and only generic heart failure information (n = 47). Adherence to medications, low-sodium diet, and daily weight measurement at baseline and 30 days after discharge were assessed using the Medical Outcomes Study Specific Adherence Scale, modified to a three-item version for heart failure (HF), (MOSSAS-3HF, maximum score = 15, indicating adherence all of the time). The baseline MOSSAS-3HF scores (mean ± standard deviation (SD)) were similar for intervention and control groups (7.4 ± 3.4 vs. 6.4 ± 3.7, p = 0.91). The MOSSAS-3HF scores improved for both groups but were not different at 30 days (11.8 ± 2.8 vs. 11.7 ± 3.0, p = 0.90). Survival without readmission or emergency department (ED) visit at 30 days was similar (82.6% vs. 84.1%, p = 0.85). A personalized HF tool did not affect rates of self-reported HF treatment adherence or survival without readmission or ED visit.

Percutaneous (short-term) mechanical circulatory support

2021 ◽  
pp. 351-359
Author(s):  
Holger Thiele ◽  
Pascal Vranckx
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Mechanical Circulatory Support ◽  
Decompensated Heart Failure ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Acute Heart Failure Syndromes ◽  
Artery Disease ◽  
Invasive Management

Coronary artery disease (CAD) has emerged as the dominant aetiologic factor in acute heart failure syndromes (AHFS) and cardiogenic shock (CS). The invasive management of the complex cardiac patient with advanced (decompensated) heart failure, CS, and/or potential haemodynamic compromise during and/after percutaneous coronary intervention (PCI) has become the remit of specialty myocardial intervention centres. Such centres provide state-of the art facilities for PCI, including experienced senior operators and critical care physicians who are available 24 hours per day, 7 days per week, with immediate access to cardiac surgery and mechanical circulatory support (MCS) systems.

Inferior vena cava diameter change after intravenous furosemide in patients diagnosed with acute decompensated heart failure

2014 ◽  
Vol 43 (3) ◽  
pp. 187-193 ◽  
Author(s):  
Stefan Tchernodrinski ◽  
Brian P. Lucas ◽  
Ambarish Athavale ◽  
Carolina Candotti ◽  
Bosko Margeta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Acute Decompensated Heart Failure ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Inferior Vena Cava Diameter ◽  
Diameter Change

A role for the Reitan catheter pump for percutaneous cardiac circulatory support of patients presenting acute congestive heart failure with low output and renal dysfunction?

2020 ◽  
Vol 16 (3) ◽  
pp. 159-164
Author(s):  
Julien Regamey ◽  
Nicolas Barras ◽  
Marco Rusca ◽  
Roger Hullin
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Impaired Renal Function ◽  
Acute Decompensated Heart Failure ◽  
Vascular Complications ◽  
Decompensated Heart Failure ◽  
Circulatory Support ◽  
Heart Failure Patients

Outcomes in acute decompensated heart failure remain poor, in particular when patients present with impaired renal function. Recent results indicate that treatment of acute decompensated heart failure patients with the Reitan catheter pump not only increases cardiac index, but also improves renal function resulting in maintained increase of diuresis. These favorable effects were achieved without significant hemolysis, bleeding or vascular complications suggesting that Reitan catheter pump treatment has the potential to facilitate recovery from acute decompensated heart failure with low output and complicated by renal dysfunction.

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