Safety Indicators in Patients Receiving High-intensity Care After Hospital Admission for Acute Heart Failure: The STRONG-HF Trial DOI Creative Commons
Daniela Tomasoni, Beth A. Davison, Marianna Adamo

et al.

Journal of Cardiac Failure, Journal Year: 2023, Volume and Issue: 30(4), P. 525 - 537

Published: Oct. 9, 2023

BackgroundSTRONG-HF demonstrated the safety and efficacy of rapid up-titration guideline-directed medical therapy (GDMT) with high intensity care (HIC) compared to usual in patients hospitalized for acute heart failure (HF). In HIC group, following indicators were used guide up-titration: estimated glomerular filtration rate [eGFR] <30ml/min/1.73m2, serum potassium >5.0 mmol/L, systolic blood pressure (SBP) <95mmHg, <55bpm, NT-proBNP concentration >10% higher than pre-discharge values.MethodsWe examined impact protocol-specified on achieved dose GDMT clinical outcomes.ResultsThree-hundred-thirteen 542 arm (57.7%) met at least one indicator any follow-up visit 1 6 weeks after discharge. As those without, meeting had more severe HF symptoms, lower SBP baseline a average percentage optimal doses (mean difference vs not reaching indicator, -11.0% [95% CI -13.6 -8.4%], P<0.001). The primary endpoint 180-day all-cause death or re-admission occurred 15.0% versus 14.2% without (adjusted hazard ratio [HR] 0.84, 95% 0.48 1.46, P=0.540). None each considered alone, was significantly associated endpoint, but < 95mmHg trend towards increased 180 days mortality HR = 2.68 [0.94 7.64]; P 0.065) eGFR drop 30ml/min/1.73m2 readmissions 3.60 [1.22 10.60]; p 0.0203). occurrence smaller 90-day improvement EQ-5D VAS mean -3.32 points, -5.97 -0.66, P=0.015).ConclusionsAmong enrolled STRONG-HF arm, administration slightly less quality life no significant increase outcome readmission when appropriately addressed according study protocol.

Language: Английский

2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure DOI Open Access
Theresa A. McDonagh, Marco Metra, Marianna Adamo

et al.

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(37), P. 3627 - 3639

Published: Aug. 25, 2023

Poland), and Katja Zeppenfeld (

Language: Английский

Citations

976
2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure DOI Open Access
Theresa A. McDonagh, Marco Metra, Marianna Adamo

et al.

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(1), P. 5 - 17

Published: Jan. 1, 2024

Language: Английский

Citations

174
Gliflozins in the Management of Cardiovascular Disease DOI
Eugene Braunwald

New England Journal of Medicine, Journal Year: 2022, Volume and Issue: 386(21), P. 2024 - 2034

Published: May 25, 2022

Gliflozins — sodium–glucose cotransporter 2 inhibitors lower blood glucose and glycated hemoglobin in patients with type diabetes without causing hypoglycemia. The agents also improve cardiac function who have heart failure or renal function, few adverse effects.

Language: Английский

Citations

172
Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology DOI Open Access
Marco Metra, Daniela Tomasoni, Marianna Adamo

et al.

European Journal of Heart Failure, Journal Year: 2023, Volume and Issue: 25(6), P. 776 - 791

Published: April 27, 2023

Language: Английский

Citations

101
Diabetic cardiomyopathy: Early diagnostic biomarkers, pathogenetic mechanisms, and therapeutic interventions DOI Creative Commons

Jin-Ling Huo,

Qi Feng, Shaokang Pan

et al.

Cell Death Discovery, Journal Year: 2023, Volume and Issue: 9(1)

Published: July 21, 2023

Abstract Diabetic cardiomyopathy (DCM) mainly refers to myocardial metabolic dysfunction caused by high glucose, and hyperglycemia is an independent risk factor for cardiac function in the absence of coronary atherosclerosis hypertension. DCM, which a severe complication diabetes, has become leading cause heart failure diabetic patients. The initial symptoms are inconspicuous, patients gradually exhibit left ventricular eventually develop total failure, brings great challenge early diagnosis DCM. To date, underlying pathological mechanisms DCM complicated have not been fully elucidated. Although there therapeutic strategies available treatment focused on controlling blood glucose lipids, lack effective drugs targeting injury. Thus, large percentage with inevitably failure. Given neglected symptoms, intricate cellular molecular mechanisms, drugs, it necessary explore diagnostic biomarkers, further understand signaling pathways involved pathogenesis summarize current strategies, new targeted interventions.

Language: Английский

Citations

61
SGLT2 Inhibitor Therapy in Patients With Transthyretin Amyloid Cardiomyopathy DOI Creative Commons
Aldostefano Porcari, Francesco Cappelli, Christian Nitsche

et al.

Journal of the American College of Cardiology, Journal Year: 2024, Volume and Issue: 83(24), P. 2411 - 2422

Published: June 1, 2024

Language: Английский

Citations

58
Early intervention and intensive management of patients with diabetes, cardiorenal, and metabolic diseases DOI Creative Commons
Yehuda Handelsman, Javed Butler, George L. Bakris

et al.

Journal of Diabetes and its Complications, Journal Year: 2023, Volume and Issue: 37(2), P. 108389 - 108389

Published: Jan. 3, 2023

Increasing rates of obesity and diabetes have driven corresponding increases in related cardiorenal metabolic diseases.In many patients, these conditions occur together, further increasing morbidity mortality risks to the individual.Yet all too often, risk factors for disorders are not addressed promptly clinical practice, leading irreversible pathologic progression.To address this gap, we convened a Task Force experts cardiology, nephrology, endocrinology, primary care develop recommendations early identification intervention obesity, diabetes, other diseases.The include screening diagnosis, interventions with lifestyle, when how implement medical therapies.These organized into secondary prevention along continuum from through syndrome, prediabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular (ASCVD) atrial fibrillation, chronic kidney (CKD), heart failure (HF).The goal intensive is comorbidities or decrease worsening reduce mortality.These efforts will inertia may improve patients' well-being adherence.

Language: Английский

Citations

45
Pre‐discharge and early post‐discharge management of patients hospitalized for acute heart failure: A scientific statement by the Heart Failure Association of the ESC DOI Open Access
Marco Metra, Marianna Adamo, Daniela Tomasoni

et al.

European Journal of Heart Failure, Journal Year: 2023, Volume and Issue: 25(7), P. 1115 - 1131

Published: May 18, 2023

Language: Английский

Citations

43
2024 update in heart failure DOI Creative Commons

Alberto Beghini,

Antonio Maria Sammartino, Z. Papp

et al.

ESC Heart Failure, Journal Year: 2024, Volume and Issue: unknown

Published: May 28, 2024

Abstract In the last years, major progress has occurred in heart failure (HF) management. The 2023 ESC focused update of 2021 HF guidelines introduced new key recommendations based on results years science. First, two drugs, sodium–glucose co‐transporter‐2 (SGLT2) inhibitors and finerenone, a novel nonsteroidal, selective mineralocorticoid receptor antagonist (MRA), are recommended for prevention patients with diabetic chronic kidney disease (CKD). Second, SGLT2 now treatment across entire left ventricular ejection fraction spectrum. benefits quadruple therapy reduced (HFrEF) well established. Its rapid early up‐titration along close follow‐up frequent clinical laboratory re‐assessment after an episode acute (the so‐called ‘high‐intensity care’ strategy) was associated better outcomes STRONG‐HF trial. Patients experiencing worsening might require fifth drug, vericiguat. STEP‐HFpEF‐DM STEP‐HFpEF trials, semaglutide 2.4 mg once weekly administered 1 year decreased body weight significantly improved quality life 6 min walk distance obese preserved (HFpEF) or without history diabetes. Further data safety efficacy, including also hard endpoints, needed to support addition acetazolamide hydrochlorothiazide standard diuretic regimen hospitalized due HF. meantime, PUSH‐AHF supported use natriuresis‐guided therapy. options most recent evidence HF, specific drugs cardiomyopathies (i.e., mavacamten hypertrophic cardiomyopathy tafamidis transthyretin cardiac amyloidosis), device therapies, contractility modulation percutaneous valvulopathies, finding from TRILUMINATE Pivotal trial, reviewed this article.

Language: Английский

Citations

31
Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care DOI Creative Commons
Daniela Tomasoni, Julie K.K. Vishram‐Nielsen, Matteo Pagnesi

et al.

ESC Heart Failure, Journal Year: 2022, Volume and Issue: 9(3), P. 1507 - 1523

Published: March 30, 2022

Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality life burden for the healthcare system. The number patients that progress to an advanced stage HF growing. Only limited proportion these can undergo heart transplantation or mechanical circulatory support. purpose this review summarize medical management with HF. First, evidence-based oral treatment must be implemented although it often not tolerated. New therapeutic options may soon become possible patients. second goal lessen symptomatic through both decongestion haemodynamic improvement. Some new treatments acting on cardiac function fulfil needs. Inotropic agents increase in intracellular calcium have increased risk death. However, recent Global Approach Lowering Adverse Cardiac Outcomes Through Improving Contractility Failure (GALACTIC-HF) trial, omecamtiv mecarbil was safe effective reduction primary outcome cardiovascular death event compared placebo (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = 0.03) its effects were larger those more severe left ventricular dysfunction. Patients who received experienced significant benefit, whereas without did (P 0.005 interaction). Lastly, clinicians should take care end appropriate multidisciplinary approach. Medical therefore remains challenge wide open area further research.

Language: Английский

Citations

51