International journal of heart failure最新文献

Heart failure (HF) continues to pose a significant public health burden in Korea, marked by increasing prevalence, hospitalizations, and healthcare costs. Although advances in guideline-directed medical therapy (GDMT) have improved patient prognosis, a persistent gap between evidence-based guidelines and real-world practice hinders optimal patient outcomes. To address this challenge, the Korean Society of Heart Failure launched the Keep Standards for Heart Failure (KSHF) initiative to enhance the quality of care (QoC) for individuals with HF. This initiative combines registry-based and non-registry approaches, including the development of structured educational programs, a standardized discharge checklist, and the implementation of the KSHF-QoC registry. The registry is designed to systematically evaluate HF management across diverse healthcare settings by analyzing prescription trends, treatment adherence, and patient-centered outcomes. Unlike earlier registries that focused primarily on acute HF in tertiary care centers managed by HF specialists, the KSHF-QoC registry broadens its scope to include general cardiologists, thereby offering a more comprehensive and representative assessment of routine care. Through continuous monitoring of QoC indicators, benchmarking across institutions, and structured performance feedback, the KSHF initiative aims to improve GDMT adherence, optimize HF care delivery, and reduce readmission rates. These efforts represent a critical advancement toward standardizing HF management and improving long-term outcomes for patients in Korea.

Background and objectives: Heart failure (HF) in younger patients, who are typically active, can significantly affect their quality of life. We assessed the clinical features and prognosis of younger patients with acute HF according to changes in their left ventricular function.

Methods: This multi-center cohort study was conducted from March 2011 to February 2014 across 10 representative university hospitals. Adult aged <50 years at the time of admission for acute HF were included. Patients were classified into 2 groups according to changes in echocardiographic left ventricular ejection fraction (LVEF) at 1-year follow-up (improved LVEF group vs. non-improved LVEF group). The primary outcome was the incidence of all-cause mortality during the follow-up period.

Results: Among the 437 patients, 14.6% experienced worsening LVEF at the 1-year follow-up. Fifty-six (12.8%) patients died during the follow-up. The non-improved LVEF group had a higher incidence of all-cause mortality than the improved LVEF groups (32.8% vs. 9.4%, p<0.001). Clinical outcomes, including all-cause death, cardiac death, and HF readmission were significantly worse in the non-improved LVEF group. Multivariate logistic regression analysis identified angiotensin converting enzyme inhibitor use at discharge as an independent predictor of reduced risk of non-improved LVEF (odds ratio, 0.37; 95% confidence interval, 0.171-0.786).

Conclusions: Worsening LVEF was associated with poor clinical prognosis in younger patients hospitalized for acute HF. Clinicians should be aware of the characteristics of younger patients with acute HF and monitoring and treating changes in LVEF in younger patients with acute HF is crucial for improving clinical outcomes.

Background and objectives: Cardiac amyloidosis due to transthyretin (ATTR-CA) is often an unrecognized cause of heart failure. Recently validated, the T-Amylo model estimates the risk of ATTR-CA. Its utility in hospitalized patients with acute heart failure (AHF), however, remains unevaluated.

Methods: A unicentric prospective study was conducted, included consecutive patients over 60 years admitted with a primary diagnosis of AHF between 2022-2024. Final diagnosis of ATTR-CA was established based on clinical and complementary results. The T-Amylo model was calculated blindly.

Results: A total of 138 patients were included, 63% of whom were men, with a mean age of 80 (standard deviation, 6.9). The diagnosis of ATTR-CA was established in 15.9% of patients. The T-Amylo predictive model showed an area under the curve of 0.93 (95% confidence interval, 0.87-0.98). 26.8% of patients were classified as low risk, with a 0% diagnosis of ATTR-CA, showing a sensitivity of 100% and specificity of 32%; 10.2% were identified as high risk, with ATTR-CA diagnosed in 78.6%, showing a sensitivity of 50% and specificity of 97.4%.

Conclusions: In AHF patients, the T-Amylo score adequately identified low- and high-risk patients for ATTR-CA. Based on readily available parameters, this model is a useful tool for detecting ATTR-CA.

Background and objectives: Left ventricular reverse remodeling (LVRR) reflects a good prognosis in patients with idiopathic dilated cardiomyopathy (IDCM). This study aimed to evaluate the usefulness of contractile reserve on dobutamine stress echocardiography (CR-DSE) for predicting LVRR in patients with IDCM.

Methods: A total of 38 patients with IDCM were enrolled between March 2014 and May 2018. All patients underwent echocardiography and cardiac magnetic resonance imaging at baseline, and echocardiography at 6 months.

Results: Among 38 patients, 22 (57.9%) exhibited CR-DSE at baseline, and 14 (36.8%) experienced LVRR at 6 months. LVRR occurred in 12 of the 22 patients with CR-DSE (54.5%) and in 2 of 16 patients without CR-DSE (12.5%) (p<0.05). In multivariate logistic regression analysis, a CR-DSE was an independent predictor of LVRR (odds ratio, 1.24; 95% confidence interval, 1.01-1.51; p=0.043). Delta LV ejection fraction during DSE also predicted LVRR (area under the curve: 0.765; p=0.007).

Conclusions: Preserved CR-DSE was significantly associated with LVRR at 6 months, suggesting its potential utility as a functional predictor of myocardial recovery in patients with IDCM.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in cases of severe cardiac failure or cardiac arrest. While VA-ECMO improves hemodynamics, it markedly increases left ventricular (LV) afterload, contributing to pulmonary congestion and thrombus formation. This review highlights the hemodynamic and mechanical effects of VA-ECMO, employing the pressure-volume (PV) loop and the generalized circulatory equilibrium model. The PV loop framework clarifies how VA-ECMO elevates afterload, potentially reducing stroke volume and the cardiac output curve when LV contractility is severely impaired. Similarly, the generalized circulatory equilibrium concept illustrates how VA-ECMO shifts the circulatory equilibrium point in both ventricles. These models establish a mechanistic foundation for strategies combining VA-ECMO with other devices, such as an intra-aortic balloon pump, Impella, or central VA-ECMO equipped with LV venting. Based on these frameworks, appropriate patient selection, effective device management, and integration with LV unloading devices may enhance survival in patients requiring VA-ECMO.

Frailty in heart failure (HF) patients contributes to poor outcomes, emphasizing the need for effective management. In many previous studies, frailty interventions have mainly targeted physical frailty or focused community-dwelling patients, neglecting the multidimensional needs of hospitalized individuals. As a frailty for HF patients need to include clinical, functional, psycho-cognitive, and social domains, nurses must assess it holistically and provide personalized support, especially during care transitions. This study aims to evaluate the effectiveness of a nurse-led, personalized health coaching program for hospitalized HF patients with frailty through a randomized controlled trial. This 12-week intervention program targets hospitalized HF patients with frailty. After screening frailty HF patients using validated tools such as Fried's phenotype, Tilburg Frailty Indicator, participants will be randomly assigned to either an intervention or control group. The intervention group will receive personalized health services, including pre-discharge education and weekly telephone coaching, addressing clinical, functional, psycho-cognitive, and social frailty domains. Psychiatric support and community integration program will be provided as needed. The control group will receive standard care. Frailty, quality of life (QoL), and clinical outcomes will be measured at baseline, 12 weeks, and 24 weeks. The primary outcomes will be improvements in frailty and QoL. Frailty will be measured both multidimensional and each of the 4 domains of frailty for HF patients. This study will clarify the role of multidimensional personalized interventions in addressing adverse outcomes related to frailty in patients with HF, thereby providing evidence of their necessity in its management.