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

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

Published: April 27, 2023

Language: Английский

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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

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

Published: May 18, 2023

Language: Английский

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Heart failure: an update from the last years and a look at the near future

ESC Heart Failure, Journal Year: 2022, Volume and Issue: 9(6), P. 3667 - 3693

Published: Dec. 1, 2022

Abstract In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all patients with HF reduced ejection fraction. Whilst verciguat becoming available across several countries, omecamtiv mecarbil waiting to be released clinical use. Concurrent use of potassium‐lowering agents may counteract hyperkalaemia and facilitate renin–angiotensin–aldosterone system inhibitor implementations. The results EMPagliflozin outcomE tRial Patients With chrOnic heaRt Failure Preserved Ejection Fraction (EMPEROR‐Preserved) trial were confirmed by Dapagliflozin Heart Mildly Reduced or (DELIVER) trial, we have, first time, evidence treatment also preserved a pre‐specified meta‐analysis randomized controlled trials, sodium–glucose co‐transporter‐2 inhibitors all‐cause mortality, cardiovascular (CV) hospitalization regardless left ventricular Other steps forward have decompensated HF. Acetazolamide Acute Decompensated Volume Overload (ADVOR) showed that addition intravenous acetazolamide loop diuretics leads greater decongestion vs. placebo. hydrochlorothiazide was evaluated CLOROTIC trial. Torasemide did not change outcomes, compared furosemide, TRANSFORM‐HF. Ferric derisomaltose had an effect on primary outcome CV mortality rehospitalizations IRONMAN (rate ratio 0.82; 95% confidence interval 0.66–1.02; P = 0.070). Further options HF, including device therapies, cardiac contractility modulation, percutaneous valvulopathies, are summarized this article.

Language: Английский

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Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence

Journal of Personalized Medicine, Journal Year: 2023, Volume and Issue: 13(2), P. 333 - 333

Published: Feb. 15, 2023

A biomarker is a molecule that can be measured in biological sample an objective, systematic, and precise way, whose levels indicate whether process normal or pathological. Knowing the most important biomarkers their characteristics key to precision medicine intensive perioperative care. Biomarkers used diagnose, assessment of disease severity, stratify risk, predict guide clinical decisions, treatments response them. In this review, we will analyze what should have how ensure its usefulness, review our opinion make knowledge more useful reader practice, with future perspective. These biomarkers, opinion, are lactate, C-Reactive Protein, Troponins T I, Brain Natriuretic Peptides, Procalcitonin, MR-ProAdrenomedullin BioAdrenomedullin, Neutrophil/lymphocyte ratio lymphopenia, Proenkephalin, NefroCheck, Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin 6, Urokinase-type soluble plasminogen activator receptor (suPAR), Presepsin, Pancreatic Stone Protein (PSP), Dipeptidyl peptidase 3 (DPP3). Finally, propose approach evaluation high-risk patients critically ill Intensive Care Unit (ICU) based on biomarkers.

Language: Английский

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NT-proBNP and high intensity care for acute heart failure: the STRONG-HF trial

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(31), P. 2947 - 2962

Published: May 22, 2023

Abstract Aims STRONG-HF showed that rapid up-titration of guideline-recommended medical therapy (GRMT), in a high intensity care (HIC) strategy, was associated with better outcomes compared usual care. The aim this study to assess the role N-terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline and its changes early during up-titration. Methods results A total 1077 patients hospitalized for acute heart failure (HF) >10% NT-proBNP decrease from screening (i.e. admission) randomization pre-discharge), were included. Patients HIC stratified by further changes, 1 week later, as decreased (≥30%), stable (<30% ≤10% increase), or increased (>10%). primary endpoint 180-day HF readmission death. effect vs. independent NT-proBNP. group older, more severe worse renal liver function. Per protocol, received diuretics up-titrated slowly first weeks after discharge. However, 6 months, they reached 70.4% optimal GRMT doses, 80.3% those decrease. As result, 60 90 days occurred 8.3% 11.1% 2.2% 4.0% (P = 0.039 P 0.045, respectively). no difference outcome found 180 (13.5% 13.2%; 0.93). Conclusion Among enrolled STRONG-HF, reduced death regardless post-discharge, utilizing guidance increase diuretic reduce rate, resulted same post-discharge change.

Language: Английский

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New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(6), P. 5089 - 5089

Published: March 7, 2023

Cardiorenal syndrome consists in the coexistence of acute or chronic dysfunction heart and kidneys resulting a cascade feedback mechanisms causing damage to both organs associated with high morbidity mortality. In last few years, different biomarkers have been investigated aim achieve an early accurate diagnosis cardiorenal syndrome, provide prognostic role guide development targeted pharmacological non-pharmacological therapies. such context, sodium-glucose cotransporter 2 (SGLT2) inhibitors, recommended as first-line choice management failure, might represent promising strategy due their efficacy reducing cardiac renal outcomes. this review, we will discuss current knowledge on pathophysiology adults, well utility kidney potential insights into novel therapeutics.

Language: Английский

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Comprehensive characterization of non-cardiac comorbidities in acute heart failure: an analysis of ESC-HFA EURObservational Research Programme Heart Failure Long-Term Registry

European Journal of Preventive Cardiology, Journal Year: 2023, Volume and Issue: 30(13), P. 1346 - 1358

Published: May 12, 2023

Abstract Aims To evaluate the prevalence and associations of non-cardiac comorbidities (NCCs) with in-hospital post-discharge outcomes in acute heart failure (AHF) across ejection fraction (EF) spectrum. Methods results The 9326 AHF patients from European Society Cardiology (ESC)-Heart Failure Association (HFA)-EURObservational Research Programme Heart Long-Term Registry had complete information for following 12 NCCs: anaemia, chronic obstructive pulmonary disease (COPD), diabetes, depression, hepatic dysfunction, renal malignancy, Parkinson’s disease, peripheral vascular (PVD), rheumatoid arthritis, sleep apnoea, stroke/transient ischaemic attack (TIA). Patients were classified by number NCCs (0, 1, 2, 3, ≥4). Of patients, 20.5% no NCC, 28.5% 1 23.1% 2 15.4% 3 12.5% ≥4 NCC. In-hospital mortality increased 3.0% 18.5% NCC to 36% NCCs. Anaemia, COPD, PVD, stroke/TIA, Parkinson, depression more prevalent HF preserved EF (HFpEF). hazard ratio (95% confidence interval) death each was anaemia 1.6 (1.4–1.8), diabetes 1.2 (1.1–1.4), kidney dysfunction 1.7 (1.5–1.9), COPD 1.4 (1.2–1.5), PVD stroke/TIA 1.3 (1.1–1.5), (1.0–1.5), 2.1 (1.8–2.5), malignancy 1.5 (1.2–1.8), apnoea (0.9–1.7), arthritis (1.1–2.1), Parkinson (0.9–2.1). associated all categories, only reduced EF, HFpEF. Conclusion Multiple conferred poor outcomes. Ejection categories different risk profile individual

Language: Английский

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Sodium–glucose cotransporter‐2 inhibitors in heart failure: Potential decongestive mechanisms and current clinical studies

European Journal of Heart Failure, Journal Year: 2023, Volume and Issue: 25(9), P. 1526 - 1536

Published: July 21, 2023

Congestion is a key pathophysiological feature of heart failure (HF) syndrome that drives most the clinical manifestations acute HF and related with poor quality life outcomes. Therefore, safe effective decongestion an important therapeutic target in management despite use guideline-recommended loop diuretics, adequate not always achieved patients HF. Recently, sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been shown to provide benefits across broad spectrum HF, including consistent reduction risk episodes. While exact mechanisms underlying these remain matter debate, growing body evidence suggests may be partly responsible, especially setting In this review, we discuss potential decongestive SGLT-2 inhibitors, such as osmotic diuresis, natriuresis, preservation glomerular filtration facilitation interstitial drainage, which can collectively translate into decongestion. Furthermore, comprehensive review up-to-date data inhibitor population.

Language: Английский

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Enhanced Decongestive Therapy in Patients With Acute Heart Failure

Journal of the American College of Cardiology, Journal Year: 2024, Volume and Issue: 83(13), P. 1243 - 1252

Published: March 25, 2024

Language: Английский

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Biologically active adrenomedullin as a marker for residual congestion and early rehospitalization in patients hospitalized for acute heart failure: Data from STRONG‐HF

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(7), P. 1480 - 1492

Published: June 14, 2024

Aims Biologically active adrenomedullin (bio‐ADM) is a promising marker of residual congestion. The STRONG‐HF trial showed that high‐intensity care (HIC) guideline‐directed medical therapy (GDMT) improved congestion and clinical outcomes in heart failure (HF) patients. association between bio‐ADM, decongestion, the effect size HIC GDMT remains to be elucidated. Methods results We measured plasma bio‐ADM concentrations 1005 patients within 2 days prior anticipated discharge (baseline) 90 later. Bio‐ADM correlated with most signs congestion, exception rales. Changes were strongly change status from baseline day (gamma −0.24; p = 0.0001). Patients highest tertile at greater risk than lowest for primary outcome 180‐day all‐cause mortality or HF rehospitalization (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.42–3.22) (HR 2.33, CI 1.38–3.94). Areas under receiver‐operating characteristic curves 0.5977 (95% 0.5561–0.6393), 0.5800 0.5356–0.6243), 0.6159 0.5711–0.6607) N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) their combination, respectively, suggesting both NT‐proBNP provided similarly modest discrimination this outcome. A trend towards better by combined alone was found ( 0.059). outcome, irrespective concentration (interaction 0.37). In contrast NT‐proBNP, 90‐day did not differ significantly usual care. Conclusions predicts 3 months after hospitalization. Higher modestly associated higher death early hospital readmission may have added value when NT‐proBNP.

Language: Английский

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