Heart Failure

Results from a substudy of the PLATO trial show that patients with extensive CAD and high rates of recurrent cardiovascular events, death, and bleeding may benefit from treatment with ticagrelor.

Results from a sub-study of the Trial to Assess Chelation Therapy (TACT) that focused on quality of life issues in patients who had previously suffered a heart attack and were treated with chelation therapy reveal no improvements in these patients' quality of life.

Experts at Kidney Week 2012 discuss several treatment options for hyponatremia, including fluid restriction, loop diuretics, and the use of selective vasopressin V2-receptor antagonists.

Tolvaptan appears to have both clinical and economic benefits for heart failure patients with hyponatremia, reports a new study.

Dr. Marrick Kukin discusses heart failure recommendations, the role of the PCP in the diagnosis, and major myths related to heart failure.

Senators reintroduce legislation to ensure that heart disease, stroke, and other cardiovascular diseases are better treated in women.

The American Heart Association recently released the 2011 update to its cardiovascular disease prevention guidelines for women.

The American Heart Association recently revealed its annual list of the most important cardiovascular and stroke research findings from the past year.

As more angiotensin receptor blockers come off patent, it will be interesting to see how manufacturers, payers, and physicians react.

PSVT ablation is effective in about 90% of cases where an aberrant connection is located, and is as invasive as a routine cardiac catheterization.

Combining cardiac-resynchronization therapy with medication and an ICD reduces deaths and hospitalizations due to heart failure.

Genetic diversity in great apes compares to our own genetic make-up, and contributes to similarities and differences in disease risk, including CVD.

Dyspnea, or difficulty breathing, is a key symptom in acute heart failure. Lack of relief can result in longer hospital stays and poorer outcomes.

We evaluated how well patients taking spironolactone were monitored for hyperkalemia, as well as the association between spironolactone and hyperkalemia. Only two thirds of patients received testing for serum potassium and creatinine levels, and higher baseline serum creatinine levels predicted a high risk of hyperkalemia. These results indicate that appropriate patient selection and close monitoring are essential, especially for patients with renal impairment.

In 1999 Pitt and colleagues published the results of the RALES trial, an important study showing that the addition of a relatively small dose of the aldosterone antagonist spironolactone to a regimen that included angiotensin-converting enzyme (ACE) in­hibitors for patients with severe congestive heart failure (NYHA Class III-IV) had a striking benefit on mortality

Studies have shown that elderly patients with heart failure are undertreated with evidence-based therapy, such as angiotensin-converting enzyme inhibitors and beta-blockers, although these therapeutic options appear to be effective in this age group. The risk of some side effects may be increased in elderly patients, and physicians should be aware of those when prescribing therapy. Cardiac resynchronization therapy is predicted to play a major role in future heart failure treatment, including in the elderly population.

Over a period of 14 years, we followed 282 patients aged 70 years or older who were hospitalized with heart failure. Median survival was 2.5 years, but 25% of patients died within 1 year, and 25% survived for at least 5 years following hospital discharge. A simple 7-item risk score based on data readily available at the time of hospitalization effectively stratified patients into low-, intermediate-, and high-risk categories for subsequent mortality.

Congestive heart failure does not necessarily "go away" in the elderly.

We conducted a multi-hospital population-based study of 2445 residents of a large New England metropolitan area hospitalized with acute heart failure and found that the long-term prognosis for these patients remains poor. More than one third of patients died in the first year after hospital discharge,and nearly 4 of 5 patients died over the 5-year follow-up period. Several demographic and clinical factors were associated with an adverse prognosis. It is important to know the factors that negatively affect long-term survival after hospital discharge for decompensated heart failure so that treatment can be directed toward specific high-risk groups.

The effects of recurrent tachycardia after resolution of cardiomyopathy have not been thoroughly assessed. We evaluated and followed 24 patients with tachycardia-induced cardiomyopathy for more than 12 years. Our observations showed that patients with tachycardia-induced cardiomyopathy may be at long-term risk for sudden death. Surreptitious cardiomyopathy due to occult ultrastructural changes may persist. It has yet to be determined whether rapid and aggressive rate control would prevent structural damage to risk of sudden cardiac death.

Diuretic use has long been a mainstay in the management of symptomatic heart failure with pulmonary or systemic congestion, or both.

We assessed preoperative cardiac physiology using echocardiography in patients undergoing cardiac surgery to identify predictors of postoperative atrial fibrillation. Subjects with enlarged left atrial volume had a 5-fold greater risk of postoperative atrial fibrillation, independent of age and other risk factors, than those without enlarged left atrial volume. Left atrial volume appears to be a powerful tool to stratify patients according to risk before surgery and to effectively target preventive therapy.

The epidemiologic finding that women with heart failure have better overall survival than men may be because of the higher prevalence of diastolic heart failure or heart failure with preserved ejection fraction (HF-PEF) among women.