Chinese guidelines for the diagnosis and management of atrial fibrillation DOI
Changsheng Ma, Shulin Wu, Shaowen Liu

et al.

Pacing and Clinical Electrophysiology, Journal Year: 2024, Volume and Issue: 47(6), P. 714 - 770

Published: April 30, 2024

Abstract Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing risk death, stroke, heart failure, dementia. Over past two decades, there have been significant breakthroughs in AF prediction screening, stroke prevention, rhythm control, catheter ablation, integrated management. During this period, scale, quality, experience management China greatly improved, providing a solid foundation for development guidelines diagnosis AF. To further promote standardized management, apply new technologies concepts to clinical practice timely fully, Chinese Society Cardiology Medical Association Heart Rhythm Committee Biomedical Engineering jointly developed Guidelines Diagnosis Management Fibrillation . The comprehensively elaborated on various aspects proposed CHA 2 DS ‑VASc‑60 score based characteristics Asian population. also reevaluated application emphasized significance early highlighted central role ablation control.

Language: Английский

Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity DOI Open Access
Mikhail Kosiborod,

Steen Z. Abildstrøm,

Barry A. Borlaug

et al.

New England Journal of Medicine, Journal Year: 2023, Volume and Issue: 389(12), P. 1069 - 1084

Published: Aug. 25, 2023

BackgroundHeart failure with preserved ejection fraction is increasing in prevalence and associated a high symptom burden functional impairment, especially persons obesity. No therapies have been approved to target obesity-related heart fraction.MethodsWe randomly assigned 529 patients who had body-mass index (the weight kilograms divided by the square of height meters) 30 or higher receive once-weekly semaglutide (2.4 mg) placebo for 52 weeks. The dual primary end points were change from baseline Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range 0 100, indicating fewer symptoms physical limitations) body weight. Confirmatory secondary included 6-minute walk distance; hierarchical composite point that death, events, differences KCCQ-CSS C-reactive protein (CRP) level.Download PDF Research Summary.ResultsThe mean was 16.6 8.7 (estimated difference, 7.8 points; 95% confidence interval [CI], 4.8 10.9; P<0.001), percentage −13.3% −2.6% −10.7 CI, −11.9 −9.4; P<0.001). distance 21.5 m 1.2 20.3 m; 8.6 32.1; In analysis point, produced more wins than (win ratio, 1.72; 1.37 2.15; CRP level –43.5% –7.3% treatment 0.61; 0.51 0.72; Serious adverse events reported 35 participants (13.3%) group 71 (26.7%) group.ConclusionsIn obesity, led larger reductions limitations, greater improvements exercise function, loss placebo. (Funded Novo Nordisk; STEP-HFpEF ClinicalTrials.gov number, NCT04788511.) Quick Take Semaglutide Heart Failure Obesity 2m 5s

Language: Английский

Citations

647
Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes DOI
Mikhail Kosiborod, Mark C. Petrie, Barry A. Borlaug

et al.

New England Journal of Medicine, Journal Year: 2024, Volume and Issue: 390(15), P. 1394 - 1407

Published: March 28, 2024

Obesity and type 2 diabetes are prevalent in patients with heart failure preserved ejection fraction characterized by a high symptom burden. No approved therapies specifically target obesity-related persons diabetes.

Language: Английский

Citations

201
Semaglutide in HFpEF across obesity class and by body weight reduction: a prespecified analysis of the STEP-HFpEF trial DOI Creative Commons
Barry A. Borlaug, Dalane W. Kitzman, Melanie J. Davies

et al.

Nature Medicine, Journal Year: 2023, Volume and Issue: 29(9), P. 2358 - 2365

Published: Aug. 27, 2023

In the STEP-HFpEF trial, semaglutide improved symptoms, physical limitations and exercise function reduced body weight in patients with obesity phenotype of heart failure preserved ejection fraction (HFpEF). This prespecified analysis examined effects on dual primary endpoints (change Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS) weight) confirmatory secondary 6-minute walk distance (6MWD), hierarchical composite (death, HF events, change KCCQ-CSS 6MWD) C-reactive protein (CRP)) across classes I-III (body mass index (BMI) 30.0-34.9 kg m

Language: Английский

Citations

114
Design and Baseline Characteristics of STEP-HFpEF Program Evaluating Semaglutide in Patients With Obesity HFpEF Phenotype DOI Creative Commons
Mikhail Kosiborod,

Steen Z. Abildstrøm,

Barry A. Borlaug

et al.

JACC Heart Failure, Journal Year: 2023, Volume and Issue: 11(8), P. 1000 - 1010

Published: May 21, 2023

The majority of patients with heart failure preserved ejection fraction (HFpEF) have the obesity phenotype, but no therapies specifically targeting in HFpEF exist.The aim this study was to describe design and baseline characteristics 2 trials semaglutide, a glucagon-like peptide-1 receptor agonist, phenotype: STEP-HFpEF (Semaglutide Treatment Effect People HFpEF; NCT04788511) DM type diabetes; NCT04916470).Both are international multicenter, double-blind, placebo-controlled that randomized adults body mass index ≥30 kg/m2 once-weekly semaglutide at dose 2.4 mg or placebo. Participants were eligible if they had left ventricular (LVEF) ≥45%; NYHA functional class II IV; Kansas City Cardiomyopathy Questionnaire (KCCQ)-Clinical Summary Score (CSS) <90 points; ≥1 following: elevated filling pressures, natriuretic peptides plus structural echocardiographic abnormalities, recent hospitalization ongoing diuretic use, and/or abnormalities. dual primary endpoints 52-week change KCCQ-CSS weight.In (N = 529 N 617, respectively), nearly half women, most severe (median 37 kg/m2) typical features LVEF 57%, frequent comorbidities, peptides). Most participants received agents renin-angiotensin blockers baseline, approximately one-third on mineralocorticoid antagonists. Sodium-glucose cotransporter-2 inhibitor use rare not STEP (32%). Patients both marked symptomatic impairments (KCCQ-CSS ∼59 points, 6-minute walking distance ∼300 m).In total, program 1,146 phenotype will determine whether improves symptoms, physical limitations, exercise function addition weight loss vulnerable group.

Language: Английский

Citations

52
Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial DOI Creative Commons
John Deanfield, Subodh Verma, Benjamin M. Scirica

et al.

The Lancet, Journal Year: 2024, Volume and Issue: 404(10454), P. 773 - 786

Published: Aug. 1, 2024

Semaglutide, a GLP-1 receptor agonist, reduces the risk of major adverse cardiovascular events (MACE) in people with overweight or obesity, but effects this drug on outcomes patients atherosclerotic disease and heart failure are unknown. We report prespecified analysis effect once-weekly subcutaneous semaglutide 2·4 mg ischaemic outcomes. aimed to investigate if was beneficial history compared placebo; there difference outcome designated as having preserved ejection fraction reduced fraction; efficacy safety related baseline characteristics subtype failure.

Language: Английский

Citations

51
Effects of Semaglutide on Symptoms, Function, and Quality of Life in Patients With Heart Failure With Preserved Ejection Fraction and Obesity: A Prespecified Analysis of the STEP-HFpEF Trial DOI Creative Commons
Mikhail Kosiborod, Subodh Verma, Barry A. Borlaug

et al.

Circulation, Journal Year: 2023, Volume and Issue: 149(3), P. 204 - 216

Published: Nov. 12, 2023

Patients with heart failure (HF) preserved ejection fraction (HFpEF) and obesity experience a high burden of symptoms functional impairment, poor quality life. In the STEP-HFpEF trial (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure Obesity), once-weekly semaglutide 2.4 mg improved symptoms, physical limitations, exercise function, reduced inflammation body weight. This prespecified analysis investigated effects on primary confirmatory secondary end points across range Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at baseline all key summary individual KCCQ domains.

Language: Английский

Citations

43
Heart failure with preserved ejection fraction DOI
Carine E. Hamo, Colette DeJong, Nick Hartshorne‐Evans

et al.

Nature Reviews Disease Primers, Journal Year: 2024, Volume and Issue: 10(1)

Published: Aug. 14, 2024

Language: Английский

Citations

37
Artificial intelligence-enabled ECG for left ventricular diastolic function and filling pressure DOI Creative Commons
Eunjung Lee, Saki Ito, William R. Miranda

et al.

npj Digital Medicine, Journal Year: 2024, Volume and Issue: 7(1)

Published: Jan. 6, 2024

Abstract Assessment of left ventricular diastolic function plays a major role in the diagnosis and prognosis cardiac diseases, including heart failure with preserved ejection fraction. We aimed to develop an artificial intelligence (AI)-enabled electrocardiogram (ECG) model identify echocardiographically determined dysfunction increased filling pressure. trained, validated, tested AI-enabled ECG 98,736, 21,963, 98,763 patients, respectively, who had echocardiographic assessment within 14 days no exclusion criteria. It was also 55,248 patients indeterminate by echocardiography. The evaluated using area under curve (AUC) receiver operating characteristic curve, its prognostic performance compared AUC for detecting pressure 0.911. AUCs grades ≥1, ≥2, 3 were 0.847, 0.911, 0.943, respectively. During median follow-up 5.9 years, 20,223 (20.5%) died. Patients predicted AI-ECG higher mortality than those normal pressure, after adjusting age, sex, comorbidities test group (hazard ratio (HR) 1.7, 95% CI 1.645–1.757) similar echocardiography (HR 1.34, 1.298–1.383). An identifies good value is simple promising tool enhance detection diseases associated

Language: Английский

Citations

32
Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis DOI Creative Commons
Pardeep S. Jhund, Atefeh Talebi, Alasdair Henderson

et al.

The Lancet, Journal Year: 2024, Volume and Issue: 404(10458), P. 1119 - 1131

Published: Sept. 1, 2024

SummaryBackgroundMineralocorticoid receptor antagonists (MRAs) reduce hospitalisations and death in patients with heart failure reduced ejection fraction (HFrEF), but the benefit mildly (HFmrEF) or preserved (HFpEF) is unclear. We evaluated effect of MRAs four trials that enrolled across range fraction.MethodsThis a prespecified, individual patient level meta-analysis RALES (spironolactone) EMPHASIS-HF (eplerenone) trials, which HFrEF, TOPCAT FINEARTS-HF (finerenone) HFmrEF HFpEF. The primary outcome this was composite time to first hospitalisation for cardiovascular death. also estimated on components composite, total (first repeat) (with without deaths), all-cause Safety outcomes were assessed, including serum creatinine, glomerular filtration rate, potassium, systolic blood pressure. An interaction between treatment tested examine heterogeneity these populations. This study registered PROSPERO, CRD42024541487.Findings13 846 included trials. risk (hazard ratio 0·77 [95% CI 0·72–0·83]). There statistically significant by (p interaction=0·0012) due greater efficacy HFrEF (0·66 [0·59–0·73]) compared HFpEF (0·87 [0·79–0·95]). observed reductions (0·63 [0·55–0·72]) (0·82 [0·74–0·91]). same pattern Cardiovascular (0·72 [0·63–0·82]) not (0·92 [0·80–1·05]). All-cause (0·73 [0·65–0·83]) (0·94 [0·85–1·03]). With an MRA, hyperkalaemia doubled placebo (odds 2·27 2·02–2·56]), incidence serious (serum potassium >6·0 mmol/L) low (2·9% vs 1·4%); hypokalaemia (potassium <3·5 halved (0·51 [0·45–0·57]; 7% 14%).InterpretationSteroidal non-steroidal HFpEF.FundingNone.

Language: Английский

Citations

30
10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 DOI

Nuha A. ElSayed,

Rozalina G. McCoy, Grazia Aleppo

et al.

Diabetes Care, Journal Year: 2024, Volume and Issue: 48(Supplement_1), P. S207 - S238

Published: Dec. 9, 2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide components diabetes care, general treatment goals guidelines, tools evaluate quality care. Members ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating Standards annually, or more frequently as warranted. For a detailed description standards, statements, reports, well evidence-grading system full list Committee members, please refer Introduction Methodology. Readers who wish comment on invited do so at professional.diabetes.org/SOC.

Language: Английский

Citations

28