scholarly journals Outbreak and impact of coronavirus disease 2019 (COVID-19) on dialysis patients; Al Khezam dialysis center experience, Kuwait

2021 ◽  
Vol 7 (1) ◽  
pp. e14-e14
Author(s):  
Emad Abdallah ◽  
Bassam Al Helal ◽  
Reem Asad ◽  
George Nessim ◽  
Shaikha Al-Bader ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chest Pain ◽  
Kidney Disease ◽  
World Health ◽  
Maintenance Hemodialysis ◽  
Chronic Obstructive ◽  
Dialysis Patients ◽  
Icu Admission ◽  
Dialysis Center ◽  
History Of

Introduction: Coronavirus disease 2019 (COVID-19) is an outbreak due to SARS-CoV-2, declared by the World Health Organization (WHO) as a global pandemic in March 2020. Patients with underlying diseases, such as those with end-stage kidney disease (ESKD) on dialysis, are at greater risk. Objectives: The aim of our study to assess the outbreak and impact of COVID-19 on dialysis patients. Patients and Methods: Our study prospectively assessed and followed 442 patients with ESKD undergoing dialysis [390 patients on maintenance hemodialysis (HD) and 52 patients on peritoneal dialysis (PD)] for outbreak and impact of COVID-19 on these patients during the period from April 22, 2020 until March 23, 2021 in Al Khezam dialysis center, Kuwait. Age, gender, nationality, original kidney disease, history of hypertension (HTN), diabetes mellitus (DM), ischemic heart disease (IHD), congestive heart failure (CHF), bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), history of pulmonary embolism (PE) and source of infection were analyzed. Symptoms as fever, fatigue, cough, loss of smell and taste and chest pain were recorded, the need for ICU admission, mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO), medications were recorded. The need to shift to continuous renal replacement therapy (CRRT) and outcomes (complications and mortality) were analyzed. Results: Our study reported that 102 out of 442 (23%) dialysis patients [97 out of 390 (24.8%) HD patients and 5 out of 52 (9.6%) PD patients] got infected with COVID-19 and reinfection reported in 4 out of 97 (4%) COVID-19 HD patients. Around 27% of COVID-19 HD patients had fever, 19% had fatigue, 8% had cough, 4% had loss of smell, 4% had loss of taste, 4% had chest pain and 40% of COVID-19 PD patients had fever. Fifteen out of 97 (15 %) COVID-19 HD patients needed ICU admission, 12 out of 97 (12 %) COVID-19 HD patients needed MV. A 33 out of 97 (34%) COVID-19 HD patients and 4 out of 5 (80%) COVID-19 PD patients needed to switch to CRRT. Mortality was 17 (15 HD and 2 PD) out of 102 (16.6 %) COVID-19 dialysis patients and common causes of death were sepsis, myocardial infarction (MI), heart failure and PE. Conclusion: Outbreak and mortality of COVID-19 infection is high in ESKD patients undergoing dialysis compared with general populations. Strict protocol for prevention of COVID-19 should be undertaken in dialysis centers and encourage of home dialysis and highly protective COVID-19 vaccination priority for dialysis patients.

scholarly journals Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽  
2010 ◽  
Vol 12 (02) ◽  
pp. 128-134 ◽  
Author(s):  
Erik P. Hess ◽  
Jeffrey J. Perry ◽  
Pam Ladouceur ◽  
George A. Wells ◽  
Ian G. Stiell
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Chest Radiography ◽  
Clinical Decision ◽  
Chest Radiographs ◽  
Clinical Decision Rule ◽  
Coronary Syndrome ◽  
History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

Abstract TP138: Chronic Kidney Disease in Heart Failure Patients is Associated with Increased Prevalence of Atrial Fibrillation or Atrial Flutter as well as CVA/TIA

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher Lu ◽  
Jack Chan ◽  
Zejia Yu ◽  
Paula Anzenberg ◽  
Mikhail Torosoff
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atrial Flutter ◽  
Stroke Risk ◽  
Multivariate Logistic Regression Analysis ◽  
History Of ◽  
Get With The Guidelines

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

Abstract 15407: Comorbidities and the Associated Long-term Utilization of Transthoracic Echocardiography Among Medicare Beneficiaries at a Large Academic Center

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Patrick M Hyland ◽  
Jiaman Xu ◽  
Changyu Shen ◽  
Lawrence Markson ◽  
Warren J Manning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Transthoracic Echocardiography ◽  
Medicare Beneficiaries ◽  
Female Sex ◽  
History Of

Introduction: The association between baseline patient characteristics and the long-term utilization of transthoracic echocardiography (TTE) is unknown and may help focus value-based care initiatives. Methods: TTE reports from patients with ≥ 2 TTEs at our institution were linked to 100% Medicare Fee-for-service inpatient claims, 1/1/2000 – 12/31/2017. To avoid inclusion of individuals with short-interval follow-up, TTEs with < 1 year between studies were excluded. Validated claims algorithms were used to create 12 baseline cardiovascular comorbidities. Multivariable Poisson regression was used to estimate adjusted rates of TTE intensity according to baseline comorbidities. Results: Over a median (IQR) follow-up of 5.8 (3.1 – 9.5) years, 18,579 individuals (69.3 ± 12.8 years; 50.5% female) underwent a total of 59,759 TTEs (range 2 – 59). The median TTE intensity was 0.64 TTEs/patient/year (IQR 0.35 – 1.24; range 0.11 – 22.02). The top five contributors to TTE intensity were heart failure, chronic kidney disease, history of myocardial infarction, smoking, and hyperlipidemia ( Figure ). Female sex was associated with decreased TTE utilization (adjusted RR 0.95, 95% CI 0.94-0.96, p < 0.0001). Atrial fibrillation, hypertension, and history of ischemic stroke or transient ischemic attack were not significantly related to TTE intensity after multivariable adjustment (all p > 0.05). Conclusions: Among Medicare beneficiaries with ≥ 2 TTEs at our institution, the median TTE intensity was 0.64 TTEs/patient/year but varied widely. Heart failure, chronic kidney disease, and history of myocardial infarction were the strongest predictors of increased utilization. Female sex was associated with decreased utilization, reflecting broader disparities in utilization of cardiovascular procedures. Further research is needed to clarify reasons for this sex disparity and associations with cardiovascular outcomes.

scholarly journals Finerenone and Cardiovascular Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes

Circulation ◽  
2020 ◽  
Author(s):  
Gerasimos Filippatos ◽  
Stefan D. Anker ◽  
Rajiv Agarwal ◽  
Bertram Pitt ◽  
Luis M. Ruilope ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renin Angiotensin System ◽  
Mineralocorticoid Receptor Antagonist ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
History Of

Background: The FIDELIO-DKD trial evaluated the effect of the nonsteroidal, selective mineralocorticoid receptor antagonist finerenone on kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) with optimized renin-angiotensin system blockade. Compared with placebo, finerenone reduced the composite kidney and CV outcomes. We report the effect of finerenone on individual CV outcomes and in patients with and without history of atherosclerotic CV disease (CVD). Methods: This randomized, double-blind, placebo-controlled trial included patients with T2D and urine albumin-to-creatinine ratio 30-5000 mg/g and an estimated glomerular filtration rate (eGFR) ≥25-<75 mL/min/1.73 m 2 , treated with optimized renin-angiotensin system blockade. Patients with a history of heart failure with reduced ejection fraction were excluded. Patients were randomized 1:1 to receive finerenone or placebo. The composite CV outcome included time to CV death, myocardial infarction, stroke, or hospitalization for heart failure. Prespecified CV analyses included analyses of the components of this composite and outcomes according to CVD history at baseline. Results: Between September 2015 and June 2018, 13,911 patients were screened and 5674 were randomized; 45.9% of patients had CVD at baseline. Over a median follow-up of 2.6 years (interquartile range, 2.0-3.4 years), finerenone reduced the risk of the composite CV outcome compared with placebo (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.75-0.99; P=0.034), with no significant interaction between patients with and without CVD (HR, 0.85; 95% CI, 0.71-1.01 in patients with a history of CVD; HR, 0.86; 95% CI, 0.68-1.08 in patients without a history of CVD; P-value for interaction, 0.85). The incidence of treatment-emergent adverse events was similar between treatment arms, with a low incidence of hyperkalemia-related permanent treatment discontinuation (2.3% with finerenone vs 0.8% with placebo in patients with CVD and 2.2% with finerenone vs 1.0% with placebo in patients without CVD). Conclusions: Among patients with CKD and T2D, finerenone reduced incidence of the composite CV outcome, with no evidence of differences in treatment effect based on pre-existing CVD status. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02540993 (Funded by Bayer AG)

scholarly journals One-year rehospitalisations for congestive heart failure in Portuguese NHS hospitals: a multilevel approach on patterns of use and contributing factors

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031346 ◽  
Author(s):  
Bruno Moita ◽  
Ana Patricia Marques ◽  
Ana Maria Camacho ◽  
Pedro Leão Neves ◽  
Rui Santana
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pulmonary Disease ◽  
Material Deprivation ◽  
Chronic Obstructive ◽  
Principal Diagnosis ◽  
Contributing Factors ◽  
Obstructive Pulmonary Disease

ObjectivesIdentification of rehospitalisations for heart failure and contributing factors flags health policy intervention opportunities designed to deliver care at a most effective and efficient level. Recognising that heart failure is a condition for which timely and appropriate outpatient care can potentially prevent the use of inpatient services, we aimed to determine to what extent comorbidities and material deprivation were predictive of 1 year heart failure specific rehospitalisation.SettingAll Portuguese mainland National Health Service (NHS) hospitals.ParticipantsA total of 68 565 hospitalisations for heart failure principal cause of admission, from 2011 to 2015, associated to 45 882 distinct patients aged 18 years old or over.Outcome measuresWe defined 1 year specific heart failure rehospitalisation and time to rehospitalisation as outcome measures.ResultsHeart failure principal diagnosis admissions accounted for 1.6% of total hospital NHS budget, and over 40% of this burden is associated to patients rehospitalised at least once in the 365-day follow-up period. 22.1% of the patients hospitalised for a principal diagnosis of heart failure were rehospitalised for the same cause at least once within 365 days after previous discharge. Nearly 55% of rehospitalised patients were readmitted within 3 months. Results suggest a mediation effect between material deprivation and the chance of 1 year rehospitalisation through the effect that material deprivation has on the prevalence of comorbidities. Heart failure combined with chronic kidney disease or chronic obstructive pulmonary disease increases by 2.8 and 2.2 times, respectively, the chance of the patient becoming a frequent user of inpatient services for heart failure principal cause of admission.ConclusionsOne-fifth of patients admitted for heart failure are rehospitalised due to heart failure exacerbation. While the role of material deprivation remained unclear, comorbidities considered increased the chance of 1 year heart failure specific rehospitalisation, in particular, chronic kidney disease and chronic obstructive pulmonary disease.

scholarly journals Effect of Dapagliflozin on Clinical Outcomes in Patients with Chronic Kidney Disease, With and Without Cardiovascular Disease

Circulation ◽  
2020 ◽  
Author(s):  
John J.V. McMurray ◽  
David C. Wheeler ◽  
Bergur V. Stefánsson ◽  
Niels Jongs ◽  
Douwe Postmus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Prevention ◽  
Cardiovascular Death ◽  
Composite Outcome ◽  
Primary And Secondary Prevention ◽  
History Of ◽  
End Stage

Background: Dapagliflozin reduces the risk of end-stage renal disease in patients with chronic kidney disease. We examined the relative risk of cardiovascular and kidney events in these patients and the effect of dapagliflozin on either type of event, taking account of history of cardiovascular disease. Methods: In the DAPA-CKD trial (Dapagliflozin And Prevention of Adverse Outcomes in Chronic Kidney Disease), 4304 participants with chronic kidney disease were randomized to dapagliflozin 10 mg once daily or placebo. The primary endpoint was a composite of sustained decline in estimated GFR ≥50%, end-stage kidney disease, or kidney or cardiovascular death. The secondary endpoints were a kidney composite outcome (primary endpoint, minus cardiovascular death), the composite of hospitalization for heart failure or cardiovascular death and all-cause death. In a prespecified subgroup analysis, we divided patients into primary and secondary prevention subgroups according to history of cardiovascular disease. Results: Secondary prevention patients (n=1610; 37.4%) were older, more often male, had a higher blood pressure and body-mass index, and were more likely to have diabetes. Mean estimated glomerular filtration rate and median urinary albumin-to-creatinine ratio was similar in the primary and secondary prevention groups. The rates of adverse cardiovascular outcomes were higher in the secondary prevention group, but kidney failure occurred at the same rate in the primary and secondary prevention groups. Dapagliflozin reduced the risk of the primary composite outcome to a similar extent in both the primary (HR, 0.61 [95% CI, 0.48-0.78]) and secondary (0.61, 0.47-0.79) prevention groups (P-interaction=0.90). This was also true for the composite of heart failure hospitalization or cardiovascular death (0.67, 0.40-1.13 versus 0.70, 0.52-0.94, respectively, P-interaction=0.88), and all-cause (0.63, 0.41-0.98 versus 0.70, 0.51-0.95, respectively, P-interaction=0.71). Rates of adverse events were low overall and did not differ between patients with and without cardiovascular disease. Conclusions: Dapagliflozin reduced the risk of kidney failure, death from cardiovascular causes or hospitalization for heart failure, and prolonged survival, in people with chronic kidney disease, with or without type 2 diabetes, independently of the presence of concomitant cardiovascular disease Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03036150

scholarly journals 30 YEARS OF THE MINERALOCORTICOID RECEPTOR: Mineralocorticoid receptor antagonists: 60 years of research and development

2017 ◽  
Vol 234 (1) ◽  
pp. T125-T140 ◽  
Author(s):  
Peter Kolkhof ◽  
Lars Bärfacker
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Clinical Trials ◽  
Kidney Disease ◽  
Research And Development ◽  
Mineralocorticoid Receptor ◽  
Clinical Use ◽  
Patients With Heart Failure ◽  
History Of

The cDNA of the mineralocorticoid receptor (MR) was cloned 30 years ago, in 1987. At that time, spirolactone, the first generation of synthetic steroid-based MR antagonists (MRAs), which was identified in preclinical in vivo models, had already been in clinical use for 30 years. Subsequent decades of research and development by Searle & Co., Ciba-Geigy, Roussel Uclaf and Schering AG toward identifying a second generation of much more specific steroidal MRAs were all based on the initial 17-spirolactone construct. The salient example is eplerenone, first described in 1987, coincidentally with the cloning of MR cDNA. Its launch on the market in 2003 paralleled intensive drug discovery programs for a new generation of non-steroidal MRAs. Now, 30 years after the cDNA cloning of MR and 60 years of clinical use of steroidal MRAs, novel non-steroidal MRAs such as apararenone, esaxerenone and finerenone are in late-stage clinical trials in patients with heart failure, chronic kidney disease (CKD), hypertension and liver disease. Finerenone has already been studied in over 2000 patients with heart failure plus chronic kidney disease and/or diabetes, and in patients with diabetic kidney disease, in five phase II clinical trials. Here, we reflect on the history of the various generations of MRAs and review characteristics of the most important steroidal and non-steroidal MRAs.

scholarly journals Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Case Newsom ◽  
Rebecca Jeanmonod ◽  
Karl Weller ◽  
Nabil Boutros ◽  
Mark Reiter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Alcohol Abuse ◽  
Decision Rule ◽  
Predictive Value ◽  
Breath Sounds ◽  
History Of ◽  
Sensitivity Specificity

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.

scholarly journals Finerenone Reduces Risk of Incident Heart Failure in Patients With Chronic Kidney Disease and Type 2 Diabetes: Analyses from the FIGARO-DKD Trial

Circulation ◽  
2021 ◽  
Author(s):  
Gerasimos Filippatos ◽  
Stefan D. Anker ◽  
Rajiv Agarwal ◽  
Luis M. Ruilope ◽  
Peter Rossing ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Risk ◽  
Cardiovascular Death ◽  
History Of ◽  
The Impact ◽  
New Onset

Background: Chronic kidney disease (CKD) and type 2 diabetes (T2D) are independently associated with heart failure (HF), a leading cause of morbidity and mortality. In the FIDELIO-DKD and FIGARO DKD trials, finerenone (a selective, nonsteroidal mineralocorticoid receptor antagonist) improved cardiovascular outcomes in patients with albuminuric CKD and T2D. These prespecified analyses from FIGARO-DKD assessed the impact of finerenone on clinically important HF outcomes. Methods: Patients with T2D and albuminuric CKD (urine albumin-to-creatinine ratio [UACR] ≥30 to <300 mg/g and estimated glomerular filtration rate [eGFR] ≥25 to ≤90 ml/min/1.73 m 2 , or UACR ≥300 to ≤5000 mg/g and eGFR ≥60 ml/min/1.73 m 2 ,), without symptomatic HF with reduced ejection fraction, were randomized to finerenone or placebo. Time-to-first event outcomes included: new-onset HF (first hospitalization for HF [HHF] in patients without a history of HF at baseline); cardiovascular death or first HHF; HF-related death or first HHF; first HHF; cardiovascular death or total (first or recurrent) HHF; HF-related death or total HHF; and total HHF. Outcomes were evaluated in the overall population and in prespecified subgroups categorized by baseline HF history (as reported by the investigators). Results: Overall, 7352 patients were included in these analyses; 571 (7.8%) had a history of HF at baseline. New-onset HF was significantly reduced with finerenone versus placebo (1.9% versus 2.8%; hazard ratio [HR], 0.68 [95% CI 0.50-0.93]; P =0.0162). In the overall population, the incidences of all HF outcomes analyzed were significantly lower with finerenone than placebo, including a 18% lower risk of cardiovascular death or first HHF (HR, 0.82 [95% CI 0.70-0.95]; P =0.011), a 29% lower risk of first HHF (HR, 0.71 [95% CI 0.56-0.90]; P =0.0043) and a 30% lower rate of total HHF (rate ratio, 0.70 [95% CI, 0.52- 0.94]). The effects of finerenone on improving HF outcomes were not modified by a history of HF. The incidence of treatment-emergent adverse events was balanced between treatment groups. Conclusions: The results from these FIGARO-DKD analyses demonstrate that finerenone reduces new-onset HF and improves other HF outcomes in patients with CKD and T2D, irrespective of a history of HF.

scholarly journals Isolated Interrupted Aortic Arch: Unexpected Diagnosis in a 63-Year-Old Male

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Hassan Javadzadegan ◽  
Jahan Porhomayon ◽  
Alireza Sadighi ◽  
Mehrdad Yavarikia ◽  
Nader Nader
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Chest Pain ◽  
Aortic Arch ◽  
Aortic Root ◽  
Interrupted Aortic Arch ◽  
Advanced Heart Failure ◽  
Arterial Blood ◽  
Brachiocephalic Trunk ◽  
History Of

A 63-year-old male with history of hypertension, dyspnea on exertion, and chronic chest pain was admitted for elective cardiac angiography. Arterial blood pressure was 160/90 mmHg in both arms. Femoral and popliteal pulses were extremely weak, and third (S3) and fourth (S4) heart sounds were audible. Aortography showed a mildly dilated aortic root with double brachiocephalic trunk and interruption of aortic arch at isthmus. Profuse and well-developed collaterals appeared at neck and thorax. The patient was recommended to take medical treatment for his hypertension and advanced heart failure. The aim of this paper, is to review the diagnostic and therapeutic options for treatment of the interrupted aortic arch.

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