Congestive Heart Failure

Publisher: Heart Failure Society of America, Wiley

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Other titles Congestive heart failure (Greenwich, Conn.: Online), CHF
ISSN 1527-5299
OCLC 85449786
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

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Publications in this journal

  • No preview · Article · Aug 2013 · Congestive Heart Failure
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    [Show abstract] [Hide abstract] ABSTRACT: Objectives. We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). Background. Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel is associated with absolute mortality reduction in AMI patients. Methods. All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan–Meier method and Cox regression analyses. Results. We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n=5050) and a mean follow-up of 1.50 years (SD=1.2), 709 (28.1%) and 812 (32.2%) deaths occurred in patients receiving and not receiving clopidogrel treatment, respectively (P=.002). The corresponding numbers for patients without HF (n=6092), with a mean follow-up of 2.05 years (SD=1.3), were 285 (9.4%) and 294 (9.7%), respectively (P=.83). Patients with HF receiving clopidogrel demonstrated reduced mortality (hazard ratio, 0.86; 95% confidence interval, 0.78–0.95) compared with patients with HF not receiving clopidogrel. No difference was observed among patients without HF (hazard ratio, 0.98; 95% confidence interval, 0.83–1.16). Conclusions. Clopidogrel was associated with reduced mortality in patients with HF who do not undergo PCI after their first-time AMI, whereas this association was not apparent in patients without HF. Further studies of the benefit of clopidogrel in patients with HF and AMI are warranted.—Bonde L, Sorensen R, Fosbol EL, et al. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study. J Am Coll Cardiol. 2010;55:1300–1307.
    Preview · Article · Sep 2010 · Congestive Heart Failure
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    [Show abstract] [Hide abstract] ABSTRACT: Primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counterpulsation (IABP) are established treatment modalities in acute myocardial infarction complicated by cardiogenic shock. We hypothesized that the insertion of the IABP before primary PCI might result in better survival of patients with cardiogenic shock compared with postponing the insertion until after primary PCI. We, therefore, retrospectively studied 48 patients who had undergone primary PCI with IABP because of cardiogenic shock complicating acute myocardial infarction (26 patients received the IABP before and 22 patients after primary PCI). No significant differences were present in the baseline clinical characteristics between the 2 groups. The mean number of diseased vessels was greater in the group of patients treated with the IABP before primary PCI (2.8±0.5 vs 2.3±0.7, P=.012), but the difference in the number of treated vessels was not significant. The peak creatine kinase and creatine kinase-MB levels were lower in patients treated with the IABP before primary PCI (median, 1077; interquartile range, 438–2067 vs median, 3299; interquartile range, 695–6834; P=.047 and median, 95; interquartile range, 34–196 vs median, 192; interquartile range, 82–467; P=.048, respectively). In-hospital mortality and the overall incidence of major adverse cardiac and cerebrovascular events were significantly lower in the group of patients receiving the IABP before primary PCI (19% vs 59% and 23% vs 77%, P=.007 and P=.0004, respectively). Multivariate analysis identified renal failure (odds ratio, 15.2; 95% confidence interval, 3.13–73.66) and insertion of the IABP after PCI (odds ratio, 5.2; 95% confidence interval, 1.09–24.76) as the only independent predictors of in-hospital mortality. In conclusion, the results of the present study suggest that patients with cardiogenic shock complicating acute myocardial infarction who undergo primary PCI assisted by IABP have a more favorable in-hospital outcome and lower in-hospital mortality than patients who receive IABP after PCI. Abdel-Wahab M, Saad M, Kynast J, et al. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol. 2010;105:967–971.
    Preview · Article · Sep 2010 · Congestive Heart Failure
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    [Show abstract] [Hide abstract] ABSTRACT: Objectives. This study ascertains the relationship between continuation or withdrawal of β-blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF). Background. Whether β-blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients. Methods. The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) enrolled 5791 patients admitted with HF in a registry with prespecified 60- to 90-day follow-up at 91 academic and community hospitals throughout the United States. Outcomes data were prospectively collected and analyzed according to whether β-blocker therapy was continued, withdrawn, or not started. Results. Among 2373 patients eligible for β-blockers at discharge, there were 1350 (56.9%) who were receiving β-blockers before admission and continued on therapy, 632 (26.6%) were newly started, 79 (3.3%) in whom therapy was withdrawn, and 303 (12.8%) were eligible but not treated. Continuation of β-blockers was associated with a significantly lower risk and propensity-adjusted postdischarge death (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.37–0.99; P=.044) and death/rehospitalization (odds ratio, 0.69; 95% CI, 0.52–0.92; P=.012) compared with no β-blocker. In contrast, withdrawal of β-blocker use in patients was associated with a substantially higher adjusted risk for mortality compared with those continued on β-blockers (HR, 2.3; 95% CI, 1.2–4.6; P=.013) but with similar risk as HF patients eligible but not treated with β-blockers. Conclusions. The continuation of β-blocker therapy in patients hospitalized with decompensated HF is associated with lower postdischarge mortality risk and improved treatment rates. In contrast, withdrawal of β-blocker therapy is associated with worse risk and propensity-adjusted mortality.—Fonarow GC, Abraham WT, Albert NM, et al; for the OPTIMIZE-HF investigators. Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program. J Am Coll Cardiol. 2008;52(3):190–199.
    Preview · Article · Nov 2008 · Congestive Heart Failure
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    [Show abstract] [Hide abstract] ABSTRACT: Background. Thiazolidinediones are associated with fluid retention, often interpreted as worsening cardiac function, limiting their use in patients with heart failure (HF). We compared the effects of pioglitazone and glyburide on cardiac function in patients with type 2 diabetes, systolic dysfunction, and New York Heart Association functional class II or III HF. Methods and Results. Participants received pioglitazone or glyburide (±insulin) for 6 months in this double-blind, randomized, multicenter study. The primary end point was time to HF, a composite of cardiovascular mortality, and hospitalization or emergency department visit for HF. Secondary end points included echocardiographic and functional classification assessments. An earlier time to onset and higher incidence of the primary end point was noted with pioglitazone (13%) vs glyburide (8%) (P=.024). Hospitalization or emergency department visit occurred in 30 pioglitazone and 15 glyburide participants, 19 and 12 of whom, respectively, continued treatment. Cardiac mortality (5 vs 6 participants, respectively) and cardiac function, as measured by change in ventricular mass index (P=.959), ejection fraction (P=.413), or fractional shortening (P=.280), were similar between treatments. Conclusions. Pioglitazone was associated with a higher incidence of hospitalization for HF without an increase in cardiovascular mortality or worsening cardiac function (by echocardiography).—Giles TD, Miller AB, Elkayam U, et al. Pioglitazone and heart failure: results from a controlled study in patients with type 2 diabetes mellitus and systolic dysfunction. J Card Fail. 2008;14(6):445–452.
    Preview · Article · Nov 2008 · Congestive Heart Failure
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    Preview · Article · Sep 2008 · Congestive Heart Failure
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    [Show abstract] [Hide abstract] ABSTRACT: Although adherence to evidence-based therapy has been shown to improve clinical outcomes post-myocardial infarction (MI) and in patients with heart failure, adherence remains suboptimal. One method that has demonstrated success in improving adherence is the reduction in the frequency of drug administration (eg, switching from a twice-daily to a once-daily regimen). A once-daily controlled-release (CR) formulation of carvedilol--a beta-blocker used in the treatment of post-MI left ventricular dysfunction (LVD), heart failure, and hypertension--has recently received US approval. This review provides a switching protocol for transitioning stable patients from twice-daily carvedilol to once-daily carvedilol CR. Based on the findings from a head-to-head comparison study of carvedilol and metoprolol tartrate suggesting that carvedilol is associated with superior reductions in mortality and morbidity, physicians may consider switching patients with heart failure receiving beta-blockers who have not shown benefits in this setting. Algorithms are provided for switching patients with heart failure or post-MI LVD from another beta-blocker to carvedilol CR.
    Preview · Article · Sep 2008 · Congestive Heart Failure
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    [Show abstract] [Hide abstract] ABSTRACT: Objectives. The objective of this study was to assess the usefulness of each type of strain for left ventricular (LV) dyssynchrony assessment and its predictive value for a positive response after cardiac resynchronization therapy (CRT). Furthermore, changes in extent of LV dyssynchrony for each type of strain were evaluated during follow-up. Background. Different echocardiographic techniques have been proposed for assessment of LV dyssynchrony. The novel 2-dimensional (2D) speckle tracking strain analysis technique can provide information on radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). Methods. In 161 patients, 2D echocardiography was performed at baseline and after 6 months of CRT. Extent of LV dyssynchrony was calculated for each type of strain. Response to CRT was defined as a decrease in LV end-systolic volume ≥15% at follow-up. Results. At follow-up, 88 patients (55%) were classified as responders. Differences in baseline LV dyssynchrony between responders and nonresponders were noted only for RS (251±138 ms vs 94±65 ms; P<.001), whereas no differences were noted for CS and LS. A cutoff value of radial dyssynchrony ≥130 ms was able to predict response to CRT with a sensitivity of 83% and a specificity of 80%. In addition, a significant decrease in extent of LV dyssynchrony measured with RS (from 251±138 ms to 98±92 ms; P<.001) was demonstrated only in responders. Conclusions. Speckle tracking RS analysis constitutes the best method to identify potential responders to CRT. Reduction in LV dyssynchrony after CRT was noted only in responders.—Delgado V, Ypenburg C, van Bommel RJ, et al. Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy. J Am Coll Cardiol. 2008;51;1944–1952.
    Preview · Article · Sep 2008 · Congestive Heart Failure
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    [Show abstract] [Hide abstract] ABSTRACT: Congestive heart failure is a widespread cardiac disease in western countries. At present, the main measure for monitoring the level of pulmonary edema in telemedicine systems is weight, which is not a reliable indicator. The authors propose a novel bioimpedance telemedical system to monitor these patients. The system measures the resistivity of each lung using optimization methods and transmits the measurements via a modem to a call center. Preliminary results show that the measured resistivity values among healthy young patients are consistent and reproducible within 48 hours. The mean resistivity values in patients with pulmonary congestion were lower than those of the healthy patients: 887 [Omega*cm]+/-117 vs 1244 [Omega*cm]+/-87 (P<.01). The system is noninvasive, safe, and portable. It retrieves unique information correlated with the amount of fluid in the lungs and transmits the data to a medical call center in order to improve the diagnostics and treatment of congestive heart failure.
    Preview · Article · Aug 2008 · Congestive Heart Failure