scholarly journals Ponesimod oral therapy for the treatment of relapsing forms of multiple sclerosis in adults and its precautions in cardiovascular disease patients

2021 ◽  
pp. 248-252
Author(s):  
Mohammed Alrouji
Keyword(s):  
Multiple Sclerosis ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Oral Therapy ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Class Iii ◽  
United States Food ◽  
Sphingosine 1 Phosphate ◽  
Ischemic Attack

The ponesimod oral therapy was approved in March 2021 by the United States Food and Drug Administration for relapsing forms multiple sclerosis (MS). Ponesimod is a sphingosine 1-phosphate (S1P) receptor 1 modulator that acts selectively as an anti- inflammatory agent and provides a suitable microenvironment for the function of the other neuroprotective agents. Ponesimod is contraindicated in patients who in the last 6 months, have experienced myocardial infarction, unstable angina, stroke, transient ischemic attack (TIA), decompensated heart failure requiring hospitalization, or Class III or IV heart failure. Also contraindicated in patients who have the presence of Mobitz type II second-degree, third-degree atrioventricular (AV) block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemaker. This article briefs the information about dosage, precautions and warnings required in cardiovascular disease patients before initiation of ponesimod oral therapy.

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 15214: Food Insecurity and Cardiovascular Disease in NHANES (National Health and Nutrition Examination Survey) 2011-2016

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
MONICA M DELSON ◽  
Janice F Bell ◽  
Tequila S Porter ◽  
Julie T Bidwell
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Food Insecurity ◽  
National Health ◽  
The United States ◽  
Nutrition Examination Survey ◽  
Health And Nutrition ◽  
Artery Disease

Background: Adherence to a heart-healthy diet is foundational for the prevention, management, and treatment of cardiovascular disease (CVD). Despite the fact that adhering to dietary guidelines may be challenging in the context of food insecurity, little is known about the likelihood of food insecurity in persons with CVD. Hypothesis: We hypothesized that persons with CVD (hypertension, coronary artery disease, heart failure, or stroke) would have significantly higher odds of food insecurity. Methods: This was an analysis of data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional study of health in the United States. All adults aged 19 years or older with food insecurity data were included across 3 cycles of NHANES (2011-2016). Food insecurity was measured using the 10-item Food Security Scale. CVD diagnosis was measured by self-report. Risk for food insecurity by CVD diagnosis was examined using multivariable logistic regression models, incorporating NHANES sample and person weights, and controlling for common sociodemographic confounders (age, gender, race/ethnicity, education, marital status). Results: The sample consisted of 17,175 persons (weighted study N =229,247,659). Slightly more than half were male (51.9%), and most were non-Hispanic white (65.1%). Just under half (45.6%) were in early adulthood (19-44 years), 35.3% were in middle adulthood (45-64 years), and 18.6% were in late adulthood (≥65 years). One quarter (25.9%) were food insecure. Consistent with our hypothesis, diagnosis of any CVD (stroke, heart failure, coronary artery disease, or hypertension) was significantly associated with higher likelihood for food insecurity (stroke: OR=2.18; 95% CI 1.83-2.60; p<0.001; heart failure OR=1.94, 95% CI 1.46-2.57, p<0.001; coronary artery disease: OR=1.90, 95% CI 1.49-2.43, p<0.001; and hypertension: OR=1.25, 95% CI 1.10-1.42, p=0.001). Conclusions: Diagnoses of hypertension, stroke, coronary artery disease, and heart failure were all significantly associated with higher risk for food insecurity. Given the necessity of dietary modification in CVD, further efforts to study food insecurity in CVD alongside other social determinants of health are urgently needed.

scholarly journals Estimating the number of preventable cardiovascular disease events in the United States using the EMPA-REG OUTCOME trial results and National Health and Nutrition Examination Survey

2020 ◽  
Vol 17 (4) ◽  
pp. 147916412094567
Author(s):  
Nathan D Wong ◽  
Wenjun Fan ◽  
Jonathan Pak
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Confidence Interval ◽  
National Health ◽  
The United States ◽  
Eligibility Criteria ◽  
Health And Nutrition ◽  
The Difference ◽  
Event Rates

Aim: We examined eligibility and preventable cardiovascular disease events in US adults with diabetes mellitus from the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME). Methods: We identified adults with diabetes mellitus eligible for EMPA-REG OUTCOME based on trial eligibility criteria available from the National Health and Nutrition Examination Surveys, 2007–2016. We estimated composite cardiovascular disease endpoints, as well as all-cause deaths, death from cardiovascular disease and hospitalizations for heart failure from trial treatment and placebo event rates, the difference indicating the preventable events. Results: Among 29,629 US adults aged ⩾18 years (representing 231.9 million), 4672 (27.3 million) had diabetes mellitus, with 342 (1.86 million) meeting eligibility criteria of EMPA-REG OUTCOME. We estimated from trial primary endpoint event rates of 10.5% and 12.1% in the empagliflozin and placebo groups, respectively, that based on the ‘treatment’ of our 1.86 million estimated EMPA-REG OUTCOME eligible subjects, 12,066 (95% confidence interval: 10,352–13,780) cardiovascular disease events could be prevented annually. Estimated annual preventable deaths from any cause, cardiovascular causes and hospitalizations from heart failure were 17,078 (95% confidence interval: 14,652–19,504), 14,479 (95% confidence interval: 12,422–16,536) and 9467 (95% confidence interval: 8122–10,812), respectively. Conclusion: Empagliflozin, if provided to EMPA-REG OUTCOME eligible US adults, may prevent many cardiovascular disease events, cardiovascular and total deaths, as well as heart failure hospitalizations.

Defining the nutritional status and dietary intake of older heart failure patients

2007 ◽  
Vol 6 (3) ◽  
pp. 178-183 ◽  
Author(s):  
Rosemary J.G. Price ◽  
Miles D. Witham ◽  
Marion E.T. Mcmurdo
Keyword(s):  
Heart Failure ◽  
New York ◽  
Dietary Intake ◽  
Dietary Intervention ◽  
Handgrip Strength ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Class Iii ◽  
Heart Failure Patients ◽  
Meal Preparation

Background Little information exists about diet in the management of heart failure. Aims To describe the nutritional and biochemical status, and the dietary intake of older heart failure patients. Methods Stable outpatients and patients with recent hospitalisation for decompensated heart failure were recruited. Anthropometric measurements, handgrip strength, biochemical values and echocardiography were recorded. Patients kept 7-day food diaries and completed questionnaires concerning food provision. Results Forty-five patients with a mean (S.D.) age of 80.8 (6.8) years were studied and classed according to the New York Heart Association (NYHA) (11% Class I, 27% Class II and 62% Class III). Mean (S.D.) body mass index (BMI) was 27.1 (5.4) kg/m2 with 7% of patients having a BMI<20 kg/m2 and 56% with a BMI above 25 kg/m2. 64% of participants failed to achieve the estimated average requirements for energy intake; 82% took more than 2 mg of sodium daily; and 18% had a potassium intake above 3500 mg/day. Only 29% of individuals did not need assistance with food shopping, whilst 58% required assistance with meal preparation. Conclusion Possible targets for dietary intervention in older heart failure patients have been identified but whether such changes would be beneficial to patients is unknown.

scholarly journals Isoflavones Protective Mechanisms Against Cardiovascular Diseases

2020 ◽  
Vol 11 (3) ◽  
pp. 4670-4675
Author(s):  
Vadivelan Ramachandran ◽  
Raju Bairi ◽  
Kalirajan Rajagopal ◽  
Manogaran Elumalai
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Estrogen Receptors ◽  
The United States ◽  
Epidemiological Studies ◽  
Protective Mechanisms ◽  
Cellular Targets ◽  
Functional Changes ◽  
United States Food ◽  
Estrogenic Action

Isoflavones are polyphenolic compounds and a class of phytoestrogens naturally present in plants belongs to legume family and also quantified in fruits, vegetables and beverages.Soybean is rich source of isoflavones. Their chemical structure is similar to endogenously available female reproductive hormonal substance estradiol,and cellular targets are estrogen receptors. After bind to the estrogen receptors isoflavones exert estrogenic and anti-estrogenic action based upon circulatory levels of estradiol. Cardiovascular diseases are leading cause of death in most of the developing countries and they may occur due to the structural and functional changes in either cardiac muscle or smooth muscle of the vasculature and both. Common cardiac diseases are heart attack, coronary heart disease, hyperlipidaemia, angina pectoris, hypertension. Many epidemiological studies data revealing that consumption of soy protein and soy enriched diet correlate with preventive chances of cardiovascular disease. The United States Food and Drug Administration (USFDA) and other countries declared that everyday consumption of food enriched soy along with low fat may decrease the risk of cardiovascular disease. In this review we attempt the mechanism based cardioprotection of isoflavones in different cardiovascular diseases.

Remote TELEmonitoring and Health Coaching for patients with acute heart failure: results of the TELE-HC randomized trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Schulte ◽  
L Olson ◽  
C Bruce
Keyword(s):  
Heart Failure ◽  
Randomized Trial ◽  
Standard Care ◽  
Primary Outcome ◽  
Acute Decompensated Heart Failure ◽  
Treatment Strategies ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Health Coaching ◽  
Funding Source

Abstract Introduction Patients discharged after acute decompensated heart failure (ADHF) have elevated risk for readmission due to multiple factors including suboptimal behavioral and social support. Telemonitoring interventions have shown inconsistent effectiveness in reducing HF readmissions. Patient-centered health coaching, when combined with telemonitoring, may be a viable model to engage patients in self-care behaviors and enhance patient experiences following acute hospitalization. Purpose This multicenter randomized trial evaluates whether remote telemonitoring combined with health coaching decreases 60 day readmission rates for patients with ADHF when compared to standard of care. Methods Patients with primary or secondary diagnosis of ADHF were consented and randomized prior to hospital discharge to either standard care or intervention of remote telemonitoring and health coaching. Within 2 days of hospital dismissal, intervention patients were onboarded to the remote monitoring platform, which links personal health sensors which collect on-body physiologic measures (ECG, heart rate, respiration rate, and activity via 3-axis accelerometer) with providers through secure mobile communication. A registered nurse was designated as the primary health coach focusing on disease management - including symptom recognition, adherence to treatment strategies, care coordination, medication matters, and problem solving. A social worker and nutritionist were also assigned. The primary outcome was all-cause mortality or readmission within 60 days of hospital dismissal. Statistical analysis included stratified log-rank tests and stratified Cochran-Mantel-Haenszel Chi-square test to account for site-stratified randomization. Results The study was halted due to low rate of subject accrual. Of planned 304 subjects, 143 were randomized between 2015 and 2019 at 6 sites in the United States. Dropout and withdrawal after randomization of 32 subjects (22%) left 112 analyzable for the primary endpoint. Many subject withdrawals after unblinded disclosure of arm allocation were related to treatment assignment. Immediate withdrawal without follow up in these subjects precluded an intention-to-treat analysis. Mean age was 69 years and subjects were more often male (56%) and non-Hispanic white (70%). In per-protocol analysis, using subjects adherent to protocol specified visits (n=112), we observe no difference in the primary outcome (26% among intervention vs 28% among standard care, Figure, p=0.77). There were also no differences among secondary outcomes of overall mortality (2% vs 7%, p=0.20) or composite emergency department visit, hospital admission, or death (35% vs 34%, p=0.85). Conclusions Among patients with heart failure, an intervention of remote telemonitoring and health coaching did not reduce all-cause readmission or mortality. Significant withdrawal rates suggest future studies may need to improve screening and study retention. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health, National Institute on Aging

scholarly journals Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
David Kinas ◽  
Michael Dalley ◽  
Kayla Guidry ◽  
Mark A. Newberry ◽  
David A. Farcy
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Severe Sepsis ◽  
Point Of Care ◽  
Disease Process ◽  
Young Male ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Point Of Care Ultrasound ◽  
Methamphetamine Abuse

We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management. Emergency physicians can utilize point-of-care ultrasound (POCUS) to help identify these high-risk patients in the emergency department and guide appropriate resuscitation. Methamphetamine-Associated Cardiomyopathy (MAC) is an infrequently described complication of methamphetamine abuse, most commonly presented as a nonischemic dilated cardiomyopathy. With the rise in methamphetamine abuse in the United States, complications from methamphetamine use are more commonly presenting to the emergency department. Proper education and rehabilitation, with a goal of abstinence from amphetamine use, may allow patients to potentially regain normal cardiac function. Since the majority of patients present late with severe cardiac dysfunction, early detection is essential amongst critically ill patients since recognition may significantly influence ED management.

scholarly journals Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States’ settings

CJEM ◽  
2015 ◽  
Vol 18 (2) ◽  
pp. 81-89 ◽  
Author(s):  
Anita Lai ◽  
Elliott Tenpenny ◽  
David Nestler ◽  
Erik Hess ◽  
Ian G. Stiell
Keyword(s):  
United States ◽  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Admission Rate ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Health Records ◽  
Male Sex ◽  
Relapse Rates ◽  
The U.S

AbstractIntroductionThe objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients.MethodsThis was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses.ResultsIn total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0).ConclusionsThe U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

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